Old, but still good

San Francisco

- Phototherapy still plays a very useful role in the dermatologist’s treatment armamentarium, despite therapeutic advances and the advent of biologic drugs for treating many skin diseases, said Michael D. Zanolli, M.D., of Nashville, Tenn., who spoke Friday at the 67th Annual Meeting of the American Academy of Dermatology here.

While narrow-band ultraviolet therapy is used much of the time in the treatment of psoriasis, it can be useful in many other indications, says Dr. Zanolli, who is president of the Photomedicine Society.

Dr. Zanolli gave a snapshot presentation of the use of phototherapy in his solo practice. During the month of February, he noted, he had 53 active phototherapy patients undergoing treatment for a variety of conditions.Most of the patients received two to three treatments per week, said Dr. Zanolli, who discussed both full body and localized delivery.

"I love to say I’m just a simple dermatologist," he said. "But I treat a lot of diseases."

UVB therapy is considered first-line treatment for vitiligo, which is the second-most-common condition treated, he says.

"I am more aggressive than I used to be," he said. "If you produce a slight degree of pinkness or minimal erythema, you’ll have better results."

With localized UVB therapy, children "don't have to get scared and go into a light box and close the door," he said. "You can get very good response" for localized areas.

Discussing various conditions he treats, Dr. Zanolli said low-dose therapy is "all you need" in treating atopic dermatitis. Patients with pityriasis lichenoides respond very well, he says, and UVA monotherapy for CTCL in early stages is adequate.

"You're not going to be without some backup," he said.

Dr. Zanolli recommends treating Grover’s disease in the same way as atopic dermatitis.

For morphea, he said, UVA-1 treatment is better than narrow-band UVB therapy. For pruritus, he said, "narrow-band is as good as broad-band."

Lichen planus, he said, is difficult to treat when it becomes generalized. "You can try it if (patients) don't want to use systemic therapies."

Erythematous granuloma annulare has responded dramatically to narrow-band therapy, he says. "I certainly have cleared people who have widespread granuloma annulare, and it certainly can be considered," although "I think UVA-1 is probably better," he said.

Dr. Zanolli noted that one patient with central centrifugal cicatricial alopecia "is very happy" with treatment results. "Localized delivery of narrow-band certainly has helped."

In the future, Dr. Zanolli said, "red light and probably some infrared devices are going to be sold in Wal-Mart."

Among barriers to office-based phototherapy, he said, are the time off work and the travel required for patients, as well as the lack of after-hours scheduling. But one of the biggest barriers is the co-payments mandated by insurance carriers, some of which require $30 to $40 per visit.

"In my opinion, this is an artificial barrier to access for my patients," he said. DT