Could At-Home UVB Therapy Help Your Psoriasis?
Phototherapy has many benefits for the skin disease, but traditionally, convenience has not been one of them. Newer, better DIY units you can use at home could change that.
Editor's Note: This story is part of a new series on HealthCentral called "Get Your Ph.D.!", which is geared toward people who've got the basics of their condition down and want to up their expertise. Who's ready to go pro?!
If you still think of UVB as a type of light used in tanning salons, you probably don’t have psoriasis. But if you’ve been dealing with the skin condition for a while, you likely know that UVB phototherapy is a promising complement to traditional treatments when it comes to easing the scaly, itchy redness caused by the disease.
In 2019, the American Academy of Dermatology and National Psoriasis Foundation broke new ground when they announced joint recommendations for both narrowband (NB-UVB) and broadband UV-B (BB-UVB) phototherapies. Published in the Journal of the American Academy of Dermatology, the report outlined the benefits of these and other types of light therapy, concluding that at-home UVB therapy is an effective tool for managing plaque psoriasis and decreasing inflammation when used in doctor-recommended doses.
That’s big news, since in-office sessions can require scheduling three to five doc visits a week (fun times!), not to mention the hassle of travel. With at-home UVB therapy, you can DIY your treatment whenever the heck it’s convenient for you. Of course, there’s the not-inconsequential cost of purchasing a therapy unit, but if you can stomach it as a one-and-done deal, you’re on your way to an amount of freedom you probably haven’t had since you were diagnosed with the disease.
“Some studies have demonstrated that people who do at-home UVB therapy experience improvements in their overall quality of life,” says Jeffrey M. Cohen, M.D., a dermatologist at Yale School of Medicine in New Haven, CT, who specializes in psoriasis. Effective on its own, UVB treatment also works well in tandem with systemic medication.
As you work closely with your dermatologist to zero in on an at-home unit that’s right for you, there are a few things to consider. For instance, how much body surface are you treating? Also, how much space do you have in your home? And, of course, how much is your insurance willing to cover (and what can you afford to spend if they don’t)? We took these and other questions to our experts. Here’s what they told us about the ins and outs of at-home UVB therapy:
Am I a Good Candidate for At-Home UVB Therapy?
Your doctor will look at several factors to determine if this treatment approach is right for you. For instance, if you have widespread psoriasis and topical therapy has been ineffective, at-home UVB therapy may be worth trying. But if your skin is sensitive to light due to other meds you’re taking, it’s better to try another approach. If you have a history of melanoma or recurrent non-melanoma skin cancer, you’re also a skip.
If your psoriasis has been going on for a while and you’re good at listening to and following instructions, at-home UVB is right up your alley. But because misuse of the device can (rarely) lead to skin burns or blistering, doctors suggest at-home treatment only to those patients they believe can use the machine correctly and reliably. In-office treatments have a slight edge in that regard, since your doctor can monitor everything that’s going on.
What Size Should I Get?
In general, there are two types of UVB therapy units. First up: Hand-held devices. These units are best if you only have a small surface area affected by the disease. “If only 2% of your body needs to be treated or it’s in isolated spots such as your neck, legs, or hands, a hand-held one is great,” says Jessica Kaffenberger, M.D., an associate professor of dermatology at Ohio State University in Columbus. “However, if you’re treating a larger area—say, your back, butt, trunk, arms, and legs, you will need a much larger unit.”
Full-body machines are much more practical if the disease covers a lot of your body surface, says Carolyn Baker, P.A., a dermatology physician assistant at Newburgh Dermatology in Newburgh, NY. But these units might require a little rearranging of the furniture. Some are shaped like a booth with three vertical panels that you step inside; others are more horizontal and open at the top. Not all of them are quite so unwieldy: A few fold up flat when you’re done. Ask your doctor about options.
How Much Does It Cost?
Hand-held devices average $300, but the larger units can be a small fortune, so it’s important that you work with your dermatologist to assess what you need and what insurance will cover. “The large units can cost around $4,000,” Dr. Kaffenberger says. “We can usually get insurance to help cover them if you’ve been doing in-office therapy and it’s working for you, but even if your insurance covers 80%, that’s still a lot of money!”
How Do I Choose a UVB-Therapy Machine?
Go ahead and do your Google homework: There are a wide variety of units available on the market. But picking the right one is something best left to your dermatologist, who will be able to vet the companies and make sure the treatment quality is up to par. “Your dermatologist will help you select a unit that does a good job treating your specific symptoms,” Dr. Cohen says. Some of the major manufacturers include Daavlin and National Biological Corporation.
How Does It Work?
If you end up purchasing an at-home unit, your doctor will prescribe you a set amount of usages per week, and time per use. It’s easy: You lightly place the hand-held device over the affected area of exposed skin for the prescribed time or disrobe and step into the full-body unit, standing equidistant from all sides.
Some machines require you to set a countdown clock and monitor your time, while others can be pre-programmed by your dermatologist for time, UVB dose, and number of sessions. “You’ll be able to access a certain number of sessions in accordance with a regimen prescribed by your healthcare provider,” Baker says. After that, you’ll check in with your doctor to review your results and make any necessary adjustments to the program you’re following.
How Long Is One UVB-Therapy Session?
Just like the treatments you would receive at your doctor’s office, you will likely need to use these machines in small increments, say, two 5-minute sessions, three times a week, Dr. Kaffenberger says. “This isn’t usually a big time commitment and is definitely less of a time commitment than applying topical therapies,” she says. “I’ve found that patients are likelier to do UVB therapy when the unit is in their home than if they have to travel to my office for it.”
Is It Safe?
Yes. Despite its mistaken tanning-salon rep, narrowband UVB therapy has not been found to raise the risk of skin cancer. And even in instances of machine misuse, it’s pretty hard to give yourself a burn—although, just in case, many devices come preprogrammed to either shut off after a set amount of time (i.e., before a burn can happen) and/or come with a pin login you need to enter before using, to prevent kids in the house from accidentally turning the device on. No device is fail-proof, but “the manufacturers make it so that your machine won’t give you more phototherapy than you need,” says Dr. Cohen.
So should you get one? That depends on how the UVB treatment is currently working for you at your doctor’s office, how inconvenient those doc trips really are, and whether you are ready to assume responsibility for staying on top of the therapy sessions yourself. If your answers go something like: Good, very, and yes—go for it!
New UVB Therapy Recommendations: Journal of the American Academy of Dermatology. (2019). “Joint American Academy of Dermatology-National Psoriasis Foundation Guidelines of Care for Management and Treatment of Psoriasis with Phototherapy.” jaad.org/article/S0190-9622(19)30637-1/fulltext
Phototherapy and Systemic Meds: Journal of the American Academy of Dermatology. (2010). “Guidelines for Care for the Management of Psoriasis and Psoriatic Arthritis.” jaad.org/article/S0190-9622(09)01058-5/fulltext
Candidates for At-Home UVB Therapy: Practical Dermatology. (2010). “A Practical Approach to Home UVB Phototherapy for the Treatment of Generalized Psoriasis.” ncbi.nlm.nih.gov/pmc/articles/PMC4151182/
UVB and Skin Cancer Risk: Acto Dermota-Venereologica. (2004). “No Evidence for Increased Skin Cancer Risk in Psoriasis Patients Treated with Broadband or Narrowband UVB Phototherapy: A First Retrospective Study.” ncbi.nlm.nih.gov/pubmed/15370703