UV Phototherapy: Utilization in Patients with Dermatologic Disease, Co-Medications

Narrow-band ultraviolet B (NB-UVB) phototherapy is safe overall for dermatologic disease treatment and may be utilized with concomitant medication, according to recent findings, though careful dosing and medication history should be considered prior to initiation of therapy.¹

These findings and others represented the conclusion of new research conducted to evaluate UVB phototherapy tolerability with focus placed on distinctions given the underlying disease and long-term concomitant treatments. The study was led by Anna M. Halupczok, from the department of dermatology at the University Hospital of Schleswig-Holstein in Kiel, Germany.

“The simultaneous intake of medication can potentially lead to a drug-induced increase in photosensitivity,” Halupczok and colleagues wrote. “A large number of medications are reported to have photosen-sitising potential. The aim of this study was to investigate the tolerability of NB-UVB phototherapy in relation to the underlying dermatological disease and concomitant medications.”^2,3,4

Background and Methods

The investigators carried out a retrospective review of various archived NB-UVB phototherapy patient files, plans, discharge letters, and records of patients in day care units, outpatients, and inpatients at the Kiel University department of dermatology.¹ The demographic data of these subjects was assessed and the indication for UV therapy documented.

The research team looked specifically at classifications such as atopic dermatitis, other eczema types, psoriasis, parapsoriasis, lichen planus, mycosis fungoides, vitiligo, and others.

The number of subjects’ sessions of phototherapy, dosages, subjects’ beginning and ending dates, cumulative doses of UVB radiation, and rationale for patient discontinuation of therapy were all recorded by the team. They would also only include those with a minimum of 6 sessions of NB-UVB and a maintenance dose achievement or experience of treatment intolerance.

The investigators defined the maintenance dose as 6 sessions minimum, adding that the last 3 consecutive ones would be at a stable dose or would reach a dose of 1.0 J/cm2 at least. They categorized treatments by their ATC codes into 15 groups, the full list being antiepileptic drugs, anticoagulants, cardiovascular drugs, lipid-lowering drugs, diuretics, antibiotics, antidiabetics, analgesics, psychopharmaceuticals, hormone preparations, antacids, supplements, antianemics, uric acid reducers, and antihistamines.

The research team also placed the drugs’ photosensitizing potential into classifications that were based upon product characteristic summaries, with these categories being within a range between "not known" and "very frequently." Intolerance reaction criteria at the time of phototherapy were reported by the team, with attention focused on erythema severity grading as mild, moderate, or severe, and recordings of all erythema or adverse reactions (AEs), as opposed to only significant events.

Findings

The research team concluded the study having assessed a total of 534 courses of narrowband UVB therapy, with 303 male and 231 female patients having been evaluated in total. There were 89 of these courses in which there had been reported AEs connected to UVB exposure, the majority of which were erythematous reactions.

Subjects noted as female were shown by the team to have slightly more frequent AEs compared to the rates of males (20.3% versus 13.9%; P = .05). They added that most conditions had a higher AE incidence compared to the rates of psoriasis; specifically, the investigators found AEs to be more common for eczema (22.6%) and for atopic dermatitis (21.7%) as opposed to psoriasis (11.8%, P = .01 and P < .1, respectively).

The research team also reported that around two-thirds of the treatment courses had been done with subjects utilizing at least a single photosensitizing treatment, as per the products’ summaries. Prevalence of AEs at the time of phototherapy was noted more frequently when subjects had been concurrently using medication.

The investigators noted that the frequent coadministration of drugs with and without known photosensitizing potential in routine practice indicated a weak link, at best, as far as the relationship between AE incidence and the use of these types of drugs.

“It appears that the photosensitising potential of many drugs is partly overestimated in light of the frequency of their use,” they wrote. “However, if potentially photosensitising drugs are taken, clinicians should still aim for careful dose finding to be able to guarantee safe therapy even in the presence of light-sensitising medication.”

References

1. ^{Halupczok AM, Bohne AS, Gerdes S, Weidinger S, Weichenthal M. Tolerability of Narrow-band Ultraviolet-B Phototherapy for Different Dermatological Diseases in Relation to Co-medications. Acta Derm Venereol. 2024;104:adv35215. Published 2024 Apr 3. doi:10.2340/actadv.v104.35215.}
2. ^{Hofmann GA, Weber B. Medikamenten-induzierte Photosen-sibilität: auslösende Medikamente, mögliche Mechanismen und klinische Folgen. J Dtsch Dermatol Ges 2021; 19: 19–30.}
3. ^{Selvaag E. Clinical drug photosensitivity: a retrospective analysis of reports to the Norwegian Adverse Drug Reactions Committee from the years 1970–1994. Photodermatol Pho-toimmunol Photomed 1997; 13: 21–23.12.}
4. ^{Stein KR, Scheinfeld NS. Drug-induced photoallergic and pho-totoxic reactions. Expert Opin Drug Saf 2007; 6: 431–443.}