Home Phototherapy Proves Effective and Preferred in LITE Study for Psoriasis Treatment

"We asked both our colleagues in dermatology and patients what comparative effectiveness studies they want done; a lot of them want to see comparative studies of biologics. Interestingly, when we talked to patients, they wanted comparative studies of home phototherapy. Despite all the advances we’ve had in dermatology with biologics, many patients still prefer phototherapy as an effective treatment for psoriasis,” Joel M. Gelfand, MD, MSCE, FAAD, said in a recent interview with Dermatology Times.

Image Credit: © Nataliia - stock.adobe.com

Gelfand, a board-certified dermatologist, professor of dermatology and epidemiology at the Perelman School of Medicine at the University of Pennsylvania, and director of the Penn Dermatology Phototherapy Treatment Center in Philadelphia, served as the principal investigator of the LITE study (NCT03726489). LITE aimed to compare the effectiveness of home- vs office-based narrowband UV-B phototherapy for patients aged 12 and older with plaque or guttate psoriasis.¹

Launched in 2019 and concluding in December 2023, the LITE study enrolled 783 patients across 42 dermatology practices in the United States. The study was an investigator-initiated, pragmatic, open-label, parallel-group, multicenter, noninferiority randomized clinical study, with special emphasis on patient feedback. Additionally, the study is the “result of a long-standing collaboration” between Gelfand, Kristina Callis Duffin, MD, MS, and the National Psoriasis Foundation.²

Unlike traditional clinical trials with strict inclusion criteria, the LITE study included patients with ongoing systemic, topical, or biologic treatments, reflecting real-world practice, according to Gelfand.

“When we surveyed thousands of patients across the country, this was the type of research they wanted. There’s an agency called the Patient-Centered Outcomes Research Institute, or PCORI, and they fund exactly this kind of work: work that’s designed to help health care be more patient centered. This is a very patient-centered question: Can you improve psoriasis in the home setting as opposed to the office setting?” Gelfand noted.

Methods

Patients were randomly assigned to receive a home narrowband UV-B device with guided mode dosimetry or routine care with office-based narrowband UV-B for 12 weeks, followed by an additional 12-week observation period. Patients in the home-based phototherapy arm received narrowband phototherapy via Daavlin 7 Series 8-bulb narrowband phototherapy home units.¹

The Daavlin 7 is a class II device with an FDA 510(k) indication for psoriasis, vitiligo, atopic dermatitis/eczema, various cutaneous T-cell lymphomas, and pruritus. The LITE study units used a dosimetry-based controller called Guided Mode, which delivered the initial and subsequent doses based on the patient’s Fitzpatrick skin type, dermatologist-determined protocol, and treatment tolerance. Before each session, patients reported any redness or burning from the previous dose via the device, including duration. If redness lasted under 24 hours, the dose increased per protocol; if it lasted 24 to 48 hours, the dose remained unchanged; and if burning persisted beyond 48 hours, the dose was reduced or treatment was paused until recovery.³

The co-primary effectiveness outcomes of the study were a physician global assessment (PGA) score of clear/almost clear skin (score, ≤ 1) at the end of the intervention period and a Dermatology Life Quality Index (DLQI) score of 5 or lower (no to small effect on quality of life) at week 12.³

Of the 783 enrolled patients, 393 received home-based phototherapy and 390 received office-based phototherapy, with 350 (44.7%) having skin phototype (SPT) I/II, 350 (44.7%) with SPT III/IV, and 83 (10.6%) with SPT V/VI. In total, 93 patients (11.9%) were receiving systemic treatment. Additionally, approximately 40% of patients had prior systemic therapy experience.³

“This is a reminder that ultraviolet light therapy is very relevant in 2025. We’ve made all this progress with new biologics, new oral medications, and new topicals, but there are so many patients out there who don’t do great on these modalities or don’t prefer these modalities and prefer ultraviolet light phototherapy,” Gelfand said.

Key Findings

At baseline, the mean PGA score was 2.7 and DLQI was 12.2. At week 12, 129 patients (32.8%) receiving home-based phototherapy and 100 patients (25.6%) receiving office-based phototherapy achieved clear/almost clear skin, and 206 (52.4%) and 131 (33.6%) achieved a DLQI score of 5 or lower, respectively.³

According to Gelfand et al, home-based phototherapy was “noninferior to office-based phototherapy for PGA and DLQI in the overall population and across all SPTs.” Home-based phototherapy compared with office-based phototherapy was associated with better treatment adherence (51.4% vs 15.9%) and a lower burden of indirect costs to patients; however, home-based vs office-based phototherapy showed more episodes of persistent erythema (5.9% vs 1.2%).¹ Both treatments were well tolerated with no discontinuations due to adverse events. Gelfand noted that phototherapy was especially effective in patients who were adherent to the treatment schedule (receiving at least 2 treatments a week) in whom the rate of being clear or almost clear was approximately 60%.

Regarding the higher rates of erythema in the home-based phototherapy arm, Gelfand explained that newer at-home phototherapy devices, such as the Daavlin 7 Series, personalize treatment doses based on the patient’s prescription and skin type.

Gelfand emphasized that transient erythema lasting 6 to 24 hours is expected and aligns with optimal UV dosing for psoriasis. If clinicians or patients are concerned about frequent redness, treatment protocols can be adjusted to reduce erythema. The protocol used follows the 2019 American Academy of Dermatology guidelines.⁴

“The important point is that the machine limits the ability to get a significant burn that would cause symptoms, and no patient stopped home phototherapy due to problems with treatment-related erythema,” Gelfand said.

Duffin, a board-certified dermatologist, professor and chair of the Department of Dermatology at the University of Utah, and co-principal investigator, connected the high adherence rates of the home-based phototherapy group to travel times and ease of use.

“Traveling to obtain home phototherapy creates a significant barrier to getting treatment, even if they live a short distance away—people simply cannot leave home, work, or school for 2 hours 3 times per week. It’s not surprising that study participants assigned to the home phototherapy arm, who could use the device in their own home without driving or paying a co-pay each time, were less likely to miss treatments,” Duffin told Dermatology Times.

Overall, the study findings demonstrated that more patients randomly assigned to home phototherapy vs office-based treatment achieved clear or almost clear skin (32.8% vs 25.6%) with no significant impact on health-related quality of life (52.4% vs 33.6%).¹

Barriers

Despite the proven efficacy and preference of home-based phototherapy among patients, some barriers to access still exist. According to Gelfand and Duffin, location and insurance stand as 2 of the top barriers.

“It can be difficult for patients to access phototherapy because it’s hard to come into the office 2 or 3 times a week, or they may not even be close to a dermatologist who offers phototherapy. Home phototherapy, which has been around for quite some time, is available to people, but there hasn’t been a lot of data on it, especially in the US population. As a result, clinicians are often uncomfortable prescribing it, and payers are often uncomfortable in covering it for patients, even though it is covered by Medicare, for example,” Gelfand noted.

Given the outcome of the LITE study results, the availability of the Guided Mode controller, and educational resources that are available to providers, home phototherapy should be given strong consideration by both clinicians and patients.

“The LITE study data provided a great deal of reassurance that home phototherapy is safe and effective. Use of the Guided Mode controller also is a game-changer—it allows the physician and the patient to easily follow the same dose-based protocol that they would use in the office,” Duffin added.

Gelfand highlighted the challenges clinicians face in securing insurance coverage for home phototherapy, despite many health plans offering it. He emphasized that although insurers have policies in place, the administrative burden—such as prior authorizations—creates obstacles to prescribing. This can lead clinicians to potentially favor systemic treatments, which are often more expensive for the health care system. Gelfand advocates for reducing these barriers, arguing that if a clinician and patient determine home phototherapy is medically necessary, the process should not be so cumbersome. He encourages dermatologists to engage in shared decision-making with patients and navigate insurer requirements strategically.

“We’re working with payers to improve this situation,” Gelfand noted.

Clinical Implications

Looking ahead, Gelfand highlighted the surprising efficacy of phototherapy compared with biologics in psoriasis treatment. In a clinical trial (NCT01553058) comparing UV phototherapy with adalimumab, phototherapy demonstrated a notable reduction in IL-6, a key inflammatory cytokine linked to cardiovascular disease. Additionally, phototherapy achieved similar skin clearance rates to adalimumab, but resulted in better patient-reported outcomes, including pain reduction and overall well-being.⁵

Researchers in a separate study (NCT03020199) comparing secukinumab (an IL-17 inhibitor) with office-based phototherapy found that although secukinumab had higher clearance rates, phototherapy still provided substantial skin improvement with a significantly lower risk of infections. Gelfand emphasized that phototherapy remains a valuable option for patients concerned about infections, particularly those with recurrent infections on biologics.6

Another way to keep the momentum going on home-based phototherapy discussions is to involve insurance companies.

“Our next steps are to partner with our insurers and health system leaders to lower the barriers to accessing home phototherapy. Some payers have policies that say you must complete a successful course of in-office phototherapy prior to approving a home phototherapy unit to demonstrate that it was effective or that the patient was compliant. The LITE study shows that this is not a necessary step,” Duffin said.

Gelfand further underscored the importance of pragmatic clinical trials in advancing dermatologic research, particularly in determining the most effective treatments in real-world settings. He emphasized that whereas findings from registry and observational studies provide valuable insights, pragmatic trials eliminate selection bias by embedding randomization into routine clinical care.

“These pragmatic or simple clinical trials can be very important for our specialty going forward. They’re increasingly being done in a larger house of medicine to decide what’s the best course of treatment for chronic diseases,” Gelfand noted.

Gelfand encouraged dermatologists, regardless of prior research experience, to engage in pragmatic trials, noting their low burden in terms of data collection and regulatory requirements. He specifically highlighted the LITE study as an example of how such research can guide real-world treatment strategies across various dermatologic conditions, from psoriasis and atopic dermatitis to hidradenitis suppurativa and alopecia areata.

References

1. Gelfand JM, Armstrong AW, Lim HW, et al. Home- vs office-based narrowband UV-B phototherapy for patients with psoriasis: the LITE randomized clinical trial. JAMA Dermatol. 2024;160(12):1320-1328. doi:10.1001/jamadermatol.2024.3897
2. Who we are. The LITE Study. Accessed February 13, 2025. https://www.thelitestudy.com/study-team.html
3. Light treatment effectiveness (LITE) study (LITE). ClinicalTrials.gov. Updated September 19, 2024. Accessed February 13, 2025. https://clinicaltrials.gov/study/NCT03726489
4. Elmets CA, Lim HW, Stoff B, et al. Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis with phototherapy. J Am Acad Dermatol. 2019;81(3):775-804. doi:10.1016/j.jaad.2019.04.042
5. Mehta NN, Shin DB, Joshi AA, et al. Effect of 2 psoriasis treatments on vascular inflammation and novel inflammatory cardiovascular biomarkers: a randomized placebo-controlled trial. Circ Cardiovasc Imaging. 2018;11(6):e007394. doi:10.1161/CIRCIMAGING.117.007394
6. Iversen L, Conrad C, Eidsmo L, et al. Secukinumab demonstrates superiority over narrow-band ultraviolet B phototherapy in new-onset moderate to severe plaque psoriasis patients: week 52 results from the STEPIn study. J Eur Acad Dermatol Venereol. 2023;37(5):1004-1016. doi:10.1111/jdv.18846