Home Narrow-Band UVB Therapy Instructions for Psoriasis
Home narrow-band UVB (NB-UVB) phototherapy should be considered for patients with psoriasis who are unable to receive phototherapy in an office setting but require this treatment modality for disease control. 1
Patient Selection
- Appropriate for patients with:
- Moderate to severe plaque or guttate psoriasis
- Psoriasis not adequately controlled with topical treatments
- Need for treatment that avoids systemic immunosuppression
- Logistical barriers to in-office phototherapy
Equipment Setup and Safety
- Ensure proper installation of the home NB-UVB unit in a well-ventilated area
- Verify the unit has been calibrated and is functioning properly
- Patient must have appropriate eye protection (UV-blocking goggles) during all treatments
- Treatment area should be free of reflective surfaces that could increase UV exposure
Treatment Protocol
Initial Dosing
- Starting dose should be based on skin type:
Dose Increments
- Fixed increments based on skin type are recommended to minimize risk of erythema:
- Skin type I-II: 15-30 mJ/cm² per treatment
- Skin type III-IV: 40-65 mJ/cm²
- Skin type V-VI: up to 150 mJ/cm² 3
Treatment Schedule
- Optimal frequency: 3 times per week (not on consecutive days)
- Duration: Typically requires 20-30 sessions for significant improvement
- Maintenance: Once clearing is achieved, reduce to 1-2 times weekly 2, 4
Monitoring and Side Effect Management
Patient Self-Monitoring
- Keep a treatment diary recording:
- Date and time of treatment
- Duration/dose of exposure
- Any side effects experienced
Common Side Effects
- Mild erythema (slight pinkness) is expected and acceptable
- Instruct patients to:
- Skip next treatment if moderate-severe erythema develops
- Reduce dose by 25% when resuming treatment after erythema
- Apply moisturizer after treatment to reduce dryness
When to Contact Provider
- Severe burning/blistering
- Persistent erythema lasting >24 hours
- Significant skin pain or discomfort
- Development of new lesions or worsening of psoriasis
Follow-up Schedule
- Initial provider follow-up: After first 2-4 weeks of home therapy
- Regular monitoring: Monthly during active treatment phase
- Long-term follow-up: Every 3-6 months during maintenance phase
Special Considerations
- Combination with topicals: Patients can use emollients after treatment; other topicals (corticosteroids, vitamin D analogs) should be applied at least 2 hours before or after phototherapy
- Sun protection: Advise use of SPF 30-50+ sunscreen on areas not requiring treatment on treatment days 2
- Maintenance therapy: May prolong remission periods 1
Efficacy and Expectations
- Home NB-UVB is as effective as outpatient NB-UVB treatment with similar cumulative doses and side effect profiles 5
- Patients should expect initial improvement within 8-10 treatments
- A complete course typically involves 15-20 treatments 1
- Patients should understand that consistent adherence to the treatment schedule is essential for optimal results
Home phototherapy under physician direction provides patients with greater convenience while maintaining treatment efficacy comparable to in-office therapy, leading to improved treatment satisfaction and reduced treatment burden 1, 5.