Phototherapy Offers Relief for Psoriasis in Patients With Skin of Color

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For many people living with psoriasis, finding the right treatment can feel like trial and error. While creams and ointments (called topical treatments) are often the first step, not everyone sees the results they need. And some patients may not want or be able to use stronger medicines, such as biologics or systemic drugs, due to other health conditions or personal preference.

A recent scientific review highlights an important alternative: narrowband ultraviolet B (NB-UVB) phototherapy. This treatment uses a special type of light to calm the immune system in the skin, reduce inflammation and slow the rapid growth of skin cells that causes psoriasis plaques.

Psoriasis affects people of all skin tones, but patients with skin of color (defined in dermatology research as Fitzpatrick skin types III to VI) are often underrepresented in clinical studies. This means doctors sometimes have fewer data on how treatments work specifically in Black, Hispanic, Asian and other non-White patient populations.

That’s why this review, led by Mio Nakamura, M.D., from the Department of Dermatology at the University of Michigan, Ann Arbor, and colleagues from the University of Michigan, is so important. Prior data suggest that approximately 62% of those treated with UVB attained at least 75% improvement in their Psoriasis Area and Severity Index scores (PASI75).The team looked at all published studies of NB-UVB phototherapy in patients with skin of color to better understand how effective this option is for psoriasis management.

The team carefully analyzed 54 studies, representing more than 1,300 patients with psoriasis who received NB-UVB phototherapy. Most of the patients studied had Fitzpatrick skin types III to IV.

Here’s what they found:

• Effectiveness: About 70% of patients achieved at least a 75% improvement in their psoriasis symptoms after undergoing NB-UVB phototherapy. This is a very strong response rate, showing that phototherapy can be highly effective.
• Comparison with other light therapies: NB-UVB was found to work better than broadband UVB (an older type of light therapy) for clearing psoriasis. Results were similar to that of PUVA (or photochemotherapy), another form of light therapy, though PUVA requires taking a pill and has more side effects.
• Consistency of results: Across multiple studies, patients consistently showed significant improvement in their psoriasis after NB-UVB treatment.

NB-UVB therapy is typically given in a dermatology clinic or hospital setting. Patients stand in a booth that looks a little like a tanning bed, where their skin is exposed to a controlled amount of ultraviolet light. Because it works directly on the skin and doesn’t involve oral or injected medications, NB-UVB is often a good choice for some patients:

• People with multiple health conditions who may not tolerate systemic or biologic drugs
• Patients who prefer to avoid strong medications
• Those whose psoriasis hasn’t improved enough with topical creams

Like any treatment, NB-UVB has potential downsides. The most common side effects are mild and may include redness or sunburn-like reactions on the skin, temporary tanning or darkening of the skin, and itching or dryness.

Long-term risks, such as increased skin cancer risk, appear to be much lower with NB-UVB compared with older light therapies, but patients should still be monitored regularly by their dermatologist.

One of the key points highlighted by Nakamura and her team is the need for more research in patients with darker skin tones. Although this review shows NB-UVB is effective, most of the studies included only people with Fitzpatrick types III to IV, leaving gaps in knowledge about patients with types V to VI (including many Black patients).

Greater diversity in clinical research ensures that treatment recommendations reflect the experiences and outcomes of all patients living with psoriasis.

NB-UVB phototherapy is a safe, effective and well-established treatment for psoriasis, including for patients with skin of color. About seven in 10 patients in the reviewed studies experienced major improvement, and many achieved clear or nearly clear skin.

“Phototherapy is effective for the treatment of psoriasis in (skin of color) patients and remains a valuable treatment option despite the advent of various topical, systemic and biologic treatments for psoriasis, especially in those who have a desire to avoid or do not have access to such treatments,” concluded investigators.