American Journal of Clinical Dermatology

, Volume 17, Issue 2, pp 125–133 | Cite as

Ultraviolet B Phototherapy for Psoriasis: Review of Practical Guidelines

Therapy in Practice


Psoriasis is an inflammatory skin condition that affects approximately 2 % of people worldwide. Topical treatments, systemic treatments, biologic agents, and phototherapy are all treatment options for psoriasis. Ultraviolet (UV) B phototherapy is most appropriate for patients with >10 % affected body surface area who have not responded to topical treatments. This review outlines the use, dosage, safety, and efficacy of narrowband UVB (NB-UVB) and targeted phototherapy. NB-UVB and excimer laser are effective treatment options for psoriasis; they are administered two to three times weekly until clearance followed by maintenance treatment before discontinuation. Long-term data on NB-UVB indicate that it has a good safety profile. NB-UVB is commonly used with adjunctive topical treatments such as emollients, calcipotriene, cortico-steroids, retinoids, and tar. NB-UVB can be used in selected patients with traditional systemic agents such as methotrexate, mycophenolate mofetil, and cyclosporine, although the duration of the combined treatment should be kept to a minimum and patients need to be closely monitored. Acitretin can be safely used with phototherapy, but robust data on the combination use of biologic agents or phosphodiesterase inhibitors with phototherapy are lacking.


  1. 1.
    Langley RG, Krueger GG, Griffiths CE. Psoriasis: epidemiology, clinical features, and quality of life. Ann Rheum Dis. 2005;64(Suppl 2):ii18–23 (discussion ii24–5).Google Scholar
  2. 2.
    Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 2008;58(5):826–50.CrossRefPubMedGoogle Scholar
  3. 3.
    Di Cesare A, Di Meglio P, Nestle FO. The IL-23/Th17 axis in the immunopathogenesis of psoriasis. J Invest Dermatol. 2009;129(6):1339–50.CrossRefPubMedGoogle Scholar
  4. 4.
    Lebwohl M. Psoriasis. Lancet. 2003;361(9364):1197–204.CrossRefPubMedGoogle Scholar
  5. 5.
    Goeckerman W. The treatment of psoriasis. Northwest Med. 1925;24:229–31.Google Scholar
  6. 6.
    Alderson H. Heliotherapy in psoriasis. Arch Derm Syphilol. 1923;8(1):79–80.CrossRefGoogle Scholar
  7. 7.
    Hönigsmann H. Phototherapy for psoriasis. Clin Exp Dermatol. 2001;26(4):343–50.CrossRefPubMedGoogle Scholar
  8. 8.
    Wu Q, Christensen LA, Legerski RJ, Vasquez KM. Mismatch repair participates in error-free processing of DNA interstrand crosslinks in human cells. EMBO Rep. 2005;6(6):551–7.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Chen X, Yang M, Cheng Y, Liu GJ, Zhang M. Narrow-band ultraviolet B phototherapy versus broad-band ultraviolet B or psoralen-ultraviolet A photochemotherapy for psoriasis. Cochrane Database Syst Rev. 2013;10:CD009481.Google Scholar
  10. 10.
    Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy. J Am Acad Dermatol. 2010;62(1):114–35.CrossRefPubMedGoogle Scholar
  11. 11.
    Pathirana D, Ormerod AD, Saiag P, Smith C, Spuls PI, Nast A, et al. European S3-guidelines on the systemic treatment of psoriasis vulgaris. J Eur Acad Dermatol Venereol. 2009;23(Suppl 2):1–70.CrossRefPubMedGoogle Scholar
  12. 12.
    Ibbotson SH, Bilsland D, Cox NH, Dawe RS, Diffey B, Edwards C, et al. British Association of Dermatologists. An update and guidance on narrowband ultraviolet B phototherapy: a British Photodermatology Group Workshop Report. Br J Dermatol. 2004;151(2):283–97.CrossRefPubMedGoogle Scholar
  13. 13.
    Heckman CJ, Chandler R, Kloss JD, Benson A, Rooney D, Munshi T, et al. Minimal erythema dose (MED) testing. J Vis Exp. 2013;75:e50175.PubMedGoogle Scholar
  14. 14.
    Menon K, Van Voorhees AS, Bebo BF Jr, Gladman DD, Hsu S, Kalb RE, et al. National Psoriasis Foundation. Psoriasis in patients with HIV infection: from the medical board of the National Psoriasis Foundation. J Am Acad Dermatol. 2010;62(2):291–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Gelfand JM, Rudikoff D, Lebwohl M, Klotman ME. Effect of UV-B phototherapy on plasma HIV type 1 RNA viral level: a self-controlled prospective study. Arch Dermatol. 1998;134(8):940–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Almutawa F, Thalib L, Hekman D, Sun Q, Hamzavi I, Lim HW. Efficacy of localized phototherapy and photodynamic therapy for psoriasis: a systematic review and meta-analysis. Photodermatol Photoimmunol Photomed. 2015;31(1):5–14.CrossRefPubMedGoogle Scholar
  17. 17.
    Lapolla W, Yentzer BA, Bagel J, Halvorson CR, Feldman SR. A review of phototherapy protocols for psoriasis treatment. J Am Acad Dermatol. 2011;64(5):936–49.CrossRefPubMedGoogle Scholar
  18. 18.
    Feldman SR. Remissions of psoriasis with excimer laser treatment. Dermatol Online J. 2002;8(2):23.PubMedGoogle Scholar
  19. 19.
    Boztepe G, Karaduman A, Sahin S, Hayran M, Kölemen F. The effect of maintenance narrow-band ultraviolet B therapy on the duration of remission for psoriasis: a prospective randomized clinical trial. Int J Dermatol. 2006;45(3):245–50.CrossRefPubMedGoogle Scholar
  20. 20.
    Mudigonda T, Dabade TS, Feldman SR. A review of protocols for 308 nm excimer laser phototherapy in psoriasis. J Drugs Dermatol. 2012;11(1):92–7.PubMedGoogle Scholar
  21. 21.
    Hearn RM, Kerr AC, Rahim KF, Ferguson J, Dawe RS. Incidence of skin cancers in 3867 patients treated with narrow-band ultraviolet B phototherapy. Br J Dermatol. 2008;159:931–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Asawanonda P, Anderson RR, Chang Y, Taylor CR. 308-nm excimer laser for the treatment of psoriasis: a dose-response study. Arch Dermatol. 2000;136(5):619–24.CrossRefPubMedGoogle Scholar
  23. 23.
    Gerber W, Arheilger B, Ha TA, Hermann J, Ockenfels HM. Ultraviolet B 308-nm excimer laser treatment of psoriasis: a new phototherapeutic approach. Br J Dermatol. 2003;149(6):1250–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Almutawa F, Alnomair N, Wang Y, Hamzavi I, Lim HW. Systematic review of UV-based therapy for psoriasis. Am J Clin Dermatol. 2013;14(2):87–109.CrossRefPubMedGoogle Scholar
  25. 25.
    Naldi L, Griffiths CE. Traditional therapies in the management of moderate to severe chronic plaque psoriasis: an assessment of the benefits and risks. Br J Dermatol. 2005;152(4):597–615.CrossRefPubMedGoogle Scholar
  26. 26.
    Asztalos ML, Heller MM, Lee ES, Koo J. The impact of emollients on phototherapy: a review. J Am Acad Dermatol. 2013;68(5):817–24.CrossRefPubMedGoogle Scholar
  27. 27.
    Lebwohl M, Martinez J, Weber P, DeLuca R. Effects of topical preparations on the erythemogenicity of UVB: implications for psoriasis phototherapy. J Am Acad Dermatol. 1995;32(3):469–71.CrossRefPubMedGoogle Scholar
  28. 28.
    Brands S, Brakman M, Bos JD, de Rie MA. No additional effect of calcipotriol ointment on low-dose narrow-band UVB phototherapy in psoriasis. J Am Acad Dermatol. 1999;41(6):991–5.CrossRefPubMedGoogle Scholar
  29. 29.
    Ashcroft DM, Li Wan Po A, Williams HC, Griffiths CE. Combination regimens of topical calcipotriene in chronic plaque psoriasis: systematic review of efficacy and tolerability. Arch Dermatol. 2000;136(12):1536–43.CrossRefPubMedGoogle Scholar
  30. 30.
    Tang YJ, Xu WW, Liu XM, Zhang RZ, Xu CX, Xu B, et al. Self-control study of combination treatment of 308 nm excimer laser and calcipotriene ointment on stable psoriasis vulgaris. Int J Clin Exp Med. 2014;7(9):2844–50.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Lebwohl M, Hecker D, Martinez J, Sapadin A, Patel B. Interactions between calcipotriene and ultraviolet light. J Am Acad Dermatol. 1997;37(1):93–5.Google Scholar
  32. 32.
    Meola T Jr, Soter NA, Lim HW. Are topical corticosteroids useful adjunctive therapy for the treatment of psoriasis with ultraviolet radiation? A review of the literature. Arch Dermatol. 1991;127(11):1708–13.CrossRefPubMedGoogle Scholar
  33. 33.
    Lebwohl M, Menter A, Koo J, Feldman SR. Combination therapy to treat moderate to severe psoriasis. J Am Acad Dermatol. 2004;50(3):416–30.CrossRefPubMedGoogle Scholar
  34. 34.
    Koo JY, Lowe NJ, Lew-Kaya DA, Vasilopoulos AI, Lue JC, Sefton J, et al. Tazarotene plus UVB phototherapy in the treatment of psoriasis. J Am Acad Dermatol. 2000;43(5 Pt 1):821–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Guenther L. Tazarotene combination treatments in psoriasis. J Am Acad Dermatol. 2000;43(2 Pt 3):S36–42.CrossRefPubMedGoogle Scholar
  36. 36.
    Paul BS, Momtaz K, Stern RS, Arndt KA, Parrish JA. Combined methotrexate–ultraviolet B therapy in the treatment of psoriasis. J Am Acad Dermatol. 1982;7(6):758–62.CrossRefPubMedGoogle Scholar
  37. 37.
    Asawanonda P, Nateetongrungsak Y. Methotrexate plus narrowband UVB phototherapy versus narrowband UVB phototherapy alone in the treatment of plaque-type psoriasis: a randomized, placebo-controlled study. J Am Acad Dermatol. 2006;54(6):1013–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Mahajan R, Kaur I, Kanwar AJ. Methotrexate/narrowband UVB phototherapy combination vs. narrowband UVB phototherapy in the treatment of chronic plaque-type psoriasis–a randomized single-blinded placebo-controlled study. J Eur Acad Dermatol Venereol. 2010;24(5):595–600.CrossRefPubMedGoogle Scholar
  39. 39.
    Lebwohl M, Drake L, Menter A, Koo J, Gottlieb AB, Zanolli M, et al. Consensus conference: acitretin in combination with UVB or PUVA in the treatment of psoriasis. J Am Acad Dermatol. 2001;45(4):544–53.CrossRefPubMedGoogle Scholar
  40. 40.
    Sevrain M, Richard MA, Barnetche T, Rouzaud M, Villani AP, Paul C, et al. Treatment for palmoplantar pustular psoriasis: systematic literature review, evidence-based recommendations and expert opinion. J Eur Acad Dermatol Venereol. 2014;28(Suppl 5):13–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Calzavara-Pinton PG, Sala R, Arisi M, Rossi MT, Venturini M, Ortel B. Synergism between narrowband ultraviolet B phototherapy and etanercept for the treatment of plaque-type psoriasis. Br J Dermatol. 2013;169(1):130–6.CrossRefPubMedGoogle Scholar
  42. 42.
    Gambichler T, Tigges C, Scola N, Weber J, Skrygan M, Bechara FG, et al. Etanercept plus narrowband ultraviolet B phototherapy of psoriasis is more effective than etanercept monotherapy at 6 weeks. Br J Dermatol. 2011;164(6):1383–6.CrossRefPubMedGoogle Scholar
  43. 43.
    Kircik L, Bagel J, Korman N, Menter A, Elmets CA, Koo J, et al. Unite Study Group. Utilization of narrow-band ultraviolet light B therapy and etanercept for the treatment of psoriasis (UNITE): efficacy, safety, and patient-reported outcomes. J Drugs Dermatol. 2008;7(3):245–53.PubMedGoogle Scholar
  44. 44.
    Wolf P, Hofer A, Legat FJ, Bretterklieber A, Weger W, Salmhofer W, et al. Treatment with 311-nm ultraviolet B accelerates and improves the clearance of psoriatic lesions in patients treated with etanercept. Br J Dermatol. 2009;160(1):186–9.CrossRefPubMedGoogle Scholar
  45. 45.
    Wolf P, Hofer A, Weger W, Posch-Fabian T, Gruber-Wackernagel A, Legat FJ. 311 nm ultraviolet B-accelerated response of psoriatic lesions in adalimumab-treated patients. Photodermatol Photoimmunol Photomed. 2011;27(4):186–9.CrossRefPubMedGoogle Scholar
  46. 46.
    Wolf P, Weger W, Legat FJ, Posch-Fabian T, Gruber-Wackernagel A, Inzinger M, et al. Treatment with 311-nm ultraviolet B enhanced response of psoriatic lesions in ustekinumab-treated patients: a randomized intraindividual trial. Br J Dermatol. 2012;166(1):147–53.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of DermatologyHenry Ford Hospital, Henry Ford Medical Center-New Center OneDetroitUSA

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