What are the side effects of phototherapy?

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What are the side effects of phototherapy?

Phototherapy, particularly ultraviolet (UV) light therapy, is a widely used treatment for psoriasis and other skin conditions. While it is generally considered safe and effective, phototherapy does come with potential side effects and risks. Here’s a detailed overview of the side effects of phototherapy:

1. Short-Term Side Effects

a. Erythema (Redness)

Mild Sunburn Reaction: Exposure to UV light can cause redness similar to a mild sunburn. This is usually temporary and resolves within a few hours to a few days.
Dose Adjustment: Adjusting the UV dose can help minimize this reaction in future sessions.

b. Itching and Dryness

Common Symptoms: Many patients experience itching and dryness of the skin following phototherapy sessions.
Management: Using moisturizers and emollients can help alleviate these symptoms.

c. Irritation and Discomfort

Localized Reactions: Some patients may experience localized irritation or discomfort at the treatment site.
Soothing Products: Applying soothing creams or lotions can help reduce discomfort.

d. Tanning and Hyperpigmentation

Skin Darkening: Phototherapy can cause tanning and darkening of the skin, particularly in areas exposed to UV light.
Reversibility: These changes are usually reversible over time after the cessation of treatment.

2. Medium-Term Side Effects

a. Photodamage

Skin Aging: Repeated exposure to UV light can accelerate skin aging, leading to wrinkles, loss of elasticity, and pigmentation changes.
Preventive Measures: Using broad-spectrum sunscreens and protective clothing when outdoors can help mitigate this effect.

b. Freckling and Lentigines

Sun Spots: Phototherapy can cause the development of freckles and lentigines (sun spots) due to increased melanin production.
Cosmetic Concerns: While generally harmless, these can be of cosmetic concern to some patients.

3. Long-Term Risks

a. Increased Risk of Skin Cancer

Cumulative Exposure: Long-term and repeated exposure to UV light can increase the risk of skin cancers, including basal cell carcinoma, squamous cell carcinoma, and, to a lesser extent, melanoma.
Monitoring: Regular skin examinations and monitoring by a dermatologist are essential to detect any early signs of skin cancer.

b. Actinic Keratosis

Pre-Cancerous Lesions: Phototherapy can lead to the development of actinic keratosis, which are rough, scaly patches that can potentially progress to squamous cell carcinoma.
Treatment: Actinic keratoses can be treated effectively if detected early.

4. Specific Side Effects Based on Phototherapy Type

a. Narrowband UVB (NB-UVB) Therapy

Generally Well-Tolerated: NB-UVB is considered to have a favorable safety profile, with fewer and less severe side effects compared to other forms of phototherapy.
Side Effects: Similar to those mentioned above, including redness, itching, and dryness.

b. Broadband UVB (BB-UVB) Therapy

Higher Risk of Erythema: BB-UVB therapy has a higher risk of causing erythema and sunburn-like reactions compared to NB-UVB.
Side Effects: Includes skin aging, hyperpigmentation, and an increased risk of skin cancer with long-term use.

c. Psoralen + UVA (PUVA) Therapy

Psoralen Side Effects: Psoralen, a photosensitizing agent used in PUVA therapy, can cause nausea, vomiting, and, in some cases, liver toxicity.
UVA Side Effects: UVA exposure increases the risk of skin aging and skin cancers more than UVB exposure. PUVA therapy carries a higher long-term risk of skin cancer compared to UVB therapy.
Cataracts: There is a risk of developing cataracts if the eyes are not adequately protected during PUVA therapy. Patients are advised to wear UVA-blocking sunglasses during and after treatment sessions.

5. Rare and Severe Side Effects

a. Blistering and Burns

Overexposure: Excessive UV exposure can cause severe burns and blistering, especially in patients with fair skin or those who are overly sensitive to UV light.
Immediate Medical Attention: Severe burns require immediate medical attention and may necessitate discontinuation of phototherapy.

b. Allergic Reactions

Photosensitivity: Some patients may develop an allergic reaction to UV light or the photosensitizing agents used in PUVA therapy.
Symptoms: Include rash, itching, and swelling, and may require cessation of therapy and medical intervention.

6. Patient Considerations and Compliance

a. Patient Education

Informing Patients: Educating patients about the potential side effects and risks of phototherapy is crucial for informed consent and compliance.
Expectations: Setting realistic expectations regarding the outcomes and side effects of treatment can help patients adhere to their therapy regimen.

b. Regular Monitoring

Follow-Up Visits: Regular follow-up visits with healthcare providers ensure that side effects are detected early and managed appropriately.
Adjustments: Treatment plans may need adjustments based on the patient’s response and any side effects experienced.

Conclusion

Phototherapy is an effective treatment for psoriasis, but it comes with potential side effects and risks. Short-term side effects include redness, itching, dryness, and tanning, while medium-term effects can involve skin aging and pigmentation changes. Long-term risks primarily revolve around an increased risk of skin cancer and actinic keratosis. Specific types of phototherapy, such as NB-UVB, BB-UVB, and PUVA, have their unique side effect profiles, with PUVA carrying higher risks due to the use of psoralen. Understanding these side effects and implementing regular monitoring and patient education can help manage risks and ensure the safe and effective use of phototherapy in treating psoriasis.

Julissa Clay