Light Therapies (Terapias con luz)

Número de política: MA 2.046

Fecha de entrada en vigencia: 10/1/2025

Política

Ultraviolet Light B (UVB) Phototherapy may be considered medically necessary for individuals who have one of the following diagnoses that are resistant or have not responded to conservative treatment (i.e., topical corticosteroids, coal/tar preparations, topical retinoids, etc.):

• Aquagenic pruritus (AP) associated with polycythemia vera (PV)
• Atopic Dermatitis/Severe Eczema
• Dermographism (Dermatographic Urticaria)
• Dyshidrotic Eczema
• Lichen Planus
• Morphea/Scleroderma
• Mycosis Fungoides (T-Cell Lymphoma)
• Parapsoriasis
• Photodermatoses
• Pityriasis Lichenoides
• Pityriasis Rosea
• Polymorphic Light Eruptions
• Prurigo nodularis
• Pruritus
• Psoriasis
• Sezary's Disease
• Vitiligo

Psoralen and Ultraviolet Light A (PUVA) Therapy may be considered medically necessary for individuals who have one of the following diagnoses that are resistant or has not adequately responded to conservative treatment (i.e., topical corticosteroids, coal/tar preparations, topical retinoids, etc.):

• Alopecia Areata
• Atopic Dermatitis/Severe Eczema
• Chronic Palmoplantar Pustulosis
• Cutaneous graft-versus-host-disease occurring as a result of allogeneic bone marrow transplant
• Dyshidrotic Eczema
• Eosinophilic Folliculitis
• Granuloma Annulare
• Lichen Planus
• Morphea and Localized Skin Lesions Associated with Scleroderma
• Mycosis fungoides (T-Cell Lymphoma)
• Necrobiosis Lipoidica
• Other Pruritic Eruptions of HIV Infection
• Parapsoriasis
• Pityriasis Lichenoides
• Polymorphic Light Eruptions
• Pruritus of Renal Disease
• Pruritus of Malignancy
• Psoriasis
• Severe Refractory Pruritus of Polycythemia Vera
• Severe urticaria pigmentosa (cutaneous mastocytosis)
• Sezary's Disease
• Vitiligo

PUVA is considered investigational for all other conditions. There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

308nm Excimer Laser and/or Lamp may be considered medically necessary in the treatment of:

• Localized vitiligo (i.e., comprising less than 20% body area)
• Localized psoriasis (i.e., comprising less than 20% body area) that has failed to adequately respond to 3 or more months of topical treatments, including at least 3 of the following:
• Anthralin
• Corticosteroids (e.g., betamethasone dipropionate ointment and fluocinonide cream)
• Keratolytic agents (e.g., lactic acid, salicylic acid, and urea)
• Retinoids (e.g., tazarotene)
• Tar preparations
• Vitamin D derivatives (e.g., calcipotriene)

No more than 13 laser treatments per course and 3 courses per year may be considered medically necessary. If the individual fails to respond to an initial course of laser therapy, as documented by a reduction in Psoriasis Area and Severity Index (PASI) score or other objective response measurement, additional courses are considered investigational. There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

Laser treatment for acne scarring is considered cosmetic and therefore investigational. There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

Goeckerman Therapy may be considered medically necessary in the treatment of:

• Atopic dermatitis/severe eczema
• Dyshidrotic eczema
• Lichen Planus
• Mycosis Fungoides (Cutaneous T-cell Lymphoma)
• Psoriasis (moderate to severe)

Targeted Phototherapy may be considered medically necessary for the treatment of the following:

• Moderate to severe localized psoriasis (i.e., comprising less than 20% body area) for which NB-UVB or PUVA are indicated
• Mild to moderate localized psoriasis that is unresponsive to conservative treatment

Targeted phototherapy is considered investigational for all other conditions as there is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure for these indications.

Home Phototherapy

Broad Band (BB) or Narrow Band (NB) UVB home phototherapy may be considered medically necessary when ALL of the following criteria are met:

• The individuals has a documented positive response to UVB light; and
• The individuals’s condition must be chronic in nature requiring long term maintenance exceeding (4) months; and
• The individuals’s condition must comply with one of the eligible diagnoses listed below:
• Psoriasis;
• Vitiligo;
• Cutaneous T-cell lymphoma/mycosis fungoides;
• Polymorphous light eruption;
• Atopic dermatitis;
• Pruritus; and
• The device must be ordered by the physician; and
• The device must be approved by the Food and Drug Administration; and
• The device must be appropriate for the body surface/area being treated.

All other uses of the lasers and lights not listed above are considered investigational as there is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with the procedure.

Policy Guidelines

Disease severity is minimally defined by body surface area (mild psoriasis affects less than 5% of body surface area, moderate psoriasis affects 5%-10%, and severe disease affects greater than 10% body surface area). However, lesion characteristics (e.g., location and severity of erythema, scaling, induration, pruritus) and impact on quality of life are also taken into account. For example, while a handprint is equal to approximately 1% body surface area, lesions on the hands, feet, or genitalia that cause disability may be classified as moderate-to-severe. The Psoriasis Area and Severity Index may be used as an outcome measure in clinical research. Clinical assessment of disease severity is typically qualitative.

Established treatments for psoriasis include the use of topical ointments and ultraviolet light ("light lamp") treatments. Lasers and targeted ultraviolet B lamps are considered equivalent devices; targeted ultraviolet devices are comparable with ultraviolet light panels for treatment purposes. First-line treatment of ultraviolet-sensitive lesions may involve around 6 to 10 office visits; treatment of recalcitrant lesions may involve around 24 to 30 office visits. Maintenance therapy or repeat courses of treatment may be required.

During psoralen plus ultraviolet A therapy, the patient with vitiligo or psoriasis needs to be assessed on a regular basis to determine the effectiveness of the therapy and the development of adverse effects. These evaluations are essential to ensure that the exposure dose of radiation is kept to the minimum compatible with adequate control of disease. Therefore, psoralen plus ultraviolet A is generally not recommended for home therapy.]

Cross-References:

• MP 4.018 Dermatologic Applications of Photodynamic Therapy
• MP 4.019 Oncologic Applications of Photodynamic Therapy Including Barrett’s Esophagus

Product Variations

Esta política solo se aplica a ciertos programas y productos administrados por Capital Blue Cross y está sujeta a variaciones en los beneficios, como se explica en la Sección VI. Consulte la información adicional a continuación.

FEP PPO - Refer to FEP Medical Policy Manual.

Description/Background

Vitiligo is an idiopathic skin disorder that causes depigmentation of sections of skin, most commonly on the extremities. Topical corticosteroids, alone or in combination with topical vitamin D3 analogues, are common first-line treatments for vitiligo. Alternative first-line therapies include topical calcineurin inhibitors, systemic steroids, and topical antioxidants. Treatment options for vitiligo recalcitrant to first-line therapy include, among others, ultraviolet B, light box therapy, and psoralen plus ultraviolet A (PUVA). Targeted phototherapy is also being evaluated.

Light therapy for psoriasis includes phototherapy with ultraviolet B (UVB) light boxes, targeted phototherapy, and photochemotherapy with psoralen plus ultraviolet A (PUVA). Targeted phototherapy describes the use of ultraviolet light focused on specific body areas or lesions. PUVA uses a psoralen derivative in conjunction with long-wavelength ultraviolet A light (sunlight or artificial) for photochemotherapy of skin conditions.

Ultraviolet Light B

Broadband ultraviolet B (UVB) radiation (280 to 320 nm), with or without topical tar, has been used for the treatment of moderate to severe psoriasis for decades. In the early 1980s, the observation that wavelengths around 311 nm were more effective than broad-spectrum UVB in clearing psoriasis led to a major advancement in phototherapy with the development of fluorescent lamps emitting selective UVB spectra in the range of 311 to 313 nm (narrowband UVB). Narrowband UVB has since become the type of phototherapy most frequently used for the treatment of psoriasis and a wide range of skin diseases, including atopic dermatitis, vitiligo, early stages of mycosis fungoides, and pruritic disorders.

Treatment of Psoriasis

Topical therapy (e.g., corticosteroids, vitamin D analogues) is generally considered first-line treatments of psoriasis, especially for mild disease. Phototherapy and systemic therapy are treatment options for patients with more extensive and/or severe disease and those who fail conservative treatment with topical agents. Phototherapy is available in various forms including exposure to natural sunlight, use of broadband ultraviolet B devices, narrowband ultraviolet B (NB-UVB) devices, targeted phototherapy, and psoralen plus ultraviolet A (PUVA). NB-UVB is an established treatment for psoriasis, based on efficacy and safety.

Targeted Phototherapy

Potential advantages of targeted phototherapy include the ability to use higher treatment doses and to limit exposure to surrounding tissue. Broadband ultraviolet B devices, which emit wavelengths from 290 to 320 nm, have been largely replaced by NB-UVB devices. NB-UVB devices eliminate wavelengths below 296 nm, which are considered erythemogenic and carcinogenic, but not therapeutic. NB-UVB is more effective than broadband ultraviolet B and approaches PUVA in efficacy. Original NB-UVB devices consisted of a Phillips TL-01 fluorescent bulb with a maximum wavelength (lambda max) at 311 nm. Subsequently, an excimer (excited dimer) laser using xenon chloride (XeCl) and lamps were developed as targeted NB-UVB treatment devices; they generate monochromatic or very narrow band radiation with a lambda max of 308 nm. Targeted phototherapy devices, either excimer laser/lamps or other non-laser devices, are directed at specific lesions or affected areas, thus limiting exposure to the surrounding normal tissues. They may, therefore, allow higher dosages compared with a light box, which could result in fewer treatments to produce clearing. The original indication of the excimer laser was for patients with mild-to-moderate psoriasis, defined as involvement of less than 10% of the skin. Newer XeCl laser devices are faster and more powerful than the original models, which may allow treatment of patients with more extensive skin involvement (10%-20% body surface area).

Psoralen Plus Ultraviolet A

PUVA uses a psoralen derivative in conjunction with long wavelength ultraviolet A (UVA) light (sunlight or artificial) for photochemotherapy of skin conditions. Psoralens are tricyclic furocoumarins that occur in certain plants and can also be synthesized. They are available in oral and topical forms. Oral PUVA is generally given 1.5 hours before exposure to UVA radiation. Topical PUVA therapy refers to the direct application of the psoralen to the skin with subsequent exposure to UVA light. Bath PUVA is used in some European countries for generalized psoriasis, but the agent used (trimethylpsoralen) is not approved by the Food and Drug Administration (FDA). Paint PUVA and soak PUVA are other forms of topical application of psoralen and are often used for psoriasis localized to the palms and soles. In paint PUVA, 8-methoxypsoralen in ointment or lotion form is put directly on the lesions. With soak PUVA, the affected areas of the body are placed in a basin of water containing psoralen. With topical PUVA, UVA exposure is generally administered within 30 minutes of psoralen application.

PUVA has most commonly been used to treat severe psoriasis, for which there is no generally accepted first-line treatment. Each treatment option (e.g., systemic therapies such as methotrexate, phototherapy, biologic therapies) has associated benefits and risks. Common minor toxicities associated with PUVA include erythema, pruritus, irregular pigmentation, and gastrointestinal tract symptoms; they generally can be managed by altering the dose of psoralen or ultraviolet light. Potential long-term effects include photoaging and skin cancer, particularly squamous cell carcinoma and possibly malignant melanoma. PUVA is generally considered more effective than targeted phototherapy for the treatment of psoriasis. However, the requirement of systemic exposure and the higher risk of adverse reactions (including a higher carcinogenic risk) have generally limited PUVA therapy to patients with more severe disease.

Vitiligo

Vitiligo is an idiopathic skin disorder that causes depigmentation of sections of skin, most commonly on the extremities. Depigmentation occurs because melanocytes are no longer able to function properly. The cause of vitiligo is unknown; it is sometimes considered an autoimmune disease. The most common form of the disorder is nonsegmental vitiligo in which depigmentation is generalized, bilateral, symmetrical, and increases in size over time. In contrast, segmental vitiligo, also called asymmetric or focal vitiligo, covers a limited area of skin. The typical natural history of vitiligo Involves stepwise progression with long periods in which the disease is static and relatively inactive, and relatively shorter periods in which areas of pigment loss increase.

Tratamiento

There are numerous medical and surgical treatments aimed at decreasing disease progression and/or attaining repigmentation. Topical corticosteroids, alone or in combination with topical vitamin D3 analogues, are common first-line treatments for vitiligo. Alternative first-line therapies include topical calcineurin inhibitors, systemic steroids, and topical antioxidants. Treatment options for vitiligo recalcitrant to first-line therapy include, among others, light box therapy with narrow-band ultraviolet B (NB-UVB) and psoralen plus ultraviolet A (PUVA).

Targeted phototherapy with handheld lamps or lasers is also being evaluated. Potential advantages of targeted phototherapy include the ability to use higher treatment doses and to limit exposure to surrounding tissue. Original UVB devices consisted of a Phillips TL-01 fluorescent bulb with a maximum wavelength (lambda max) of 311 nm. Subsequently, xenon chloride lasers and lamps were developed as targeted UVB treatment devices; these devices generate monochromatic or very narrowband radiation with a lambda max of 308 nm. Targeted phototherapy devices are directed at specific lesions or affected areas, thus limiting exposure to the surrounding normal tissues. They may, therefore, allow higher dosages compared with a light box, which could result in fewer treatments.

PUVA uses a psoralen derivative in conjunction with long wavelength ultraviolet A (UVA) light (sunlight or artificial) for photochemotherapy of skin conditions. Psoralens are tricyclic furocoumarins that occur in certain plants and can also be synthesized. They are available in oral and topical forms. Oral PUVA is generally given 1.5 hours before exposure to UVA radiation. Topical PUVA therapy refers to the direct application of psoralen to the skin with subsequent exposure to UVA light. With topical PUVA, UVA exposure is generally administered within 30 minutes of psoralen application. No topical psoralen formulation is currently available in the US.

Regulatory Status

In 2001, XTRAC™ (PhotoMedex), a xenon chloride (XeCl) excimer laser, was cleared for marketing by the U.S. Food and Drug Administration (FDA) through the 510(k) process for the treatment of skin conditions such as vitiligo. The 510(k) clearance has subsequently been obtained for a number of targeted UVB lamps and lasers, including newer versions of the XTRAC system including the XTRAC Ultra™, the VTRAC™ lamp (PhotoMedex), the BClear™ lamp (Lumenis), the 308 excimer lamp phototherapy system (Quantel Medical), MultiClear Multiwavelength Targeted Phototherapy System, Psoria-Light™, and the Excilite™ and Excilite µ™ XeCl lamps. The intended use of all of these devices includes vitiligo among other dermatologic indications. Some light-emitting devices are handheld. FDA product code: GEX.

In 2010, the Levia Personal Targeted Phototherapy^® UVB device (Daavlin; previously manufactured by Lerner Medical Devices) was cleared for marketing by the FDA through the 510(k) process for home treatment of psoriasis.

The oral psoralen product, methoxsalen soft gelatin capsules (previously available under the brand name Oxsoralen Ultra), has been approved by the FDA.

Rational

Summary of Evidence Psoriasis

For individuals who have mild localized psoriasis who receive targeted phototherapy, there is little evidence. Relevant outcomes are symptoms, change in disease status, quality of life, and treatment-related morbidity. Evidence is lacking on the use of targeted phototherapy as first-line treatment of mild psoriasis. The evidence is insufficient to determine the effects of the technology on health outcomes.

For individuals who have mild psoriasis that is resistant to topical medications who receive targeted phototherapy, the evidence includes small within-subject studies. Relevant outcomes are symptoms, change in disease status, quality of life, and treatment-related morbidity. The available pre-post studies have shown that targeted phototherapy can improve mild localized psoriasis (<10% body surface area) that has not responded to topical treatment. Targeted phototherapy is presumed to be safer or at least no riskier than whole body phototherapy, due to risks of exposing the entire skin to the carcinogenic effects of UVB light. The evidence is sufficient to determine that the technology results in a meaningful improvement in the net health outcome.

For individuals who have moderate-to-severe localized psoriasis who receive targeted phototherapy, the evidence includes RCTs and systematic reviews of RCTs. Relevant outcomes are symptoms, change in disease status, quality of life, and treatment-related morbidity. Systematic reviews of small RCTs and non-RCTs in patients with moderate-to-severe psoriasis have found that targeted phototherapy has efficacy similar to whole body phototherapy and supports the use of targeted phototherapy for the treatment of moderate-to-severe psoriasis comprising less than 20% of body surface area for which narrowband UVB or phototherapy with PUVA are indicated. The evidence is sufficient to determine that the technology results in a meaningful improvement in the net health outcome.

For individuals who have generalized psoriasis who receive PUVA, the evidence includes RCTs and systematic reviews. Relevant outcomes are symptoms, change in disease status, quality of life, and treatment-related morbidity. RCTs and systematic reviews of RCTs have found that PUVA is more effective than narrowband UVB, topical steroids, or UVA without psoralens in patients with generalized psoriasis. The evidence is sufficient to determine that the technology results in a meaningful improvement in the net health outcome.

Summary of Evidence Vitiligo

For individuals who have vitiligo who receive targeted phototherapy, the evidence includes systematic reviews of randomized controlled trials, individual RCTs, and 2 retrospective studies. Relevant outcomes are change in disease status, quality of life, and treatment-related morbidity. Individual studies tend to have small sample sizes, and few were designed to isolate the effect of laser therapy. Two meta-analyses were attempted; however, results from a meta-analysis could not be verified because the selected studies were not available in English, and 1 estimate was imprecise due to the small number of studies and participants. Randomized controlled trials have shown targeted phototherapy to be associated with statistically significant improvements in Vitiligo Area Scoring Index scores and/or repigmentation compared to alternate treatment options in some studies, but the results are inconsistent. Overall, there is a lack of clinical trial evidence that compares targeted phototherapy with more conservative treatments or no treatment/placebo. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

For individuals who have vitiligo who have not responded to conservative therapy who receive PUVA (photochemotherapy), the evidence includes systematic reviews and randomized control trials. Relevant outcomes are change in disease status, quality of life, and treatment-related morbidity. There is some evidence from randomized studies, mainly those published before 1985, that PUVA is more effective than placebo for treating vitiligo. When compared with narrowband ultraviolet B in meta-analyses, results have shown that patients receiving narrowband ultraviolet B experienced higher rates of repigmentation than patients receiving PUVA, though the differences were not statistically significant. Based on the available evidence and clinical guidelines, PUVA may be considered in patients with vitiligo who have not responded adequately to conservative therapy. The evidence is sufficient to determine that the technology results in a meaningful improvement in the net health outcome.

Definiciones

510 (K) A premarketing submission made to FDA to demonstrate that the device to be marketed is as safe and effective, that is, substantially equivalent (SE), to a legally marketed device that is not subject to premarket approval (PMA). Applicants must compare their 510(k) device to one or more similar devices currently on the U.S. market and make and support their substantial equivalency claims.

Dermatitis is an inflammatory rash marked by itching and redness.

Eczema is an itchy red rash that initially oozes serum and may become crusted, thickened, or scaly. Eczematous rash may result from various causes, including allergies, irritating chemicals, drugs, or sun exposure. It may be acute or chronic.

Goeckerman Therapy a regimen that consists of exposure to ultraviolet B (UVB) light and application of crude coal tar (CCT).

Laser Ultraviolet Light Blue (UVB) a special type of laser (i.e., narrow band) used to deliver UVB light in the specific range between 310-312 nm.

Light Therapy for Psoriasis includes both targeted phototherapy and photochemotherapy with Psoralen plus ultraviolet A (PUVA).

Phototherapy refers to the treatment of disorders by the use of light, especially ultraviolet light.

Pityriasis Rosea refers to a mild exanthematous inflammation of unknown etiology. It is characterized by the presence of salmon-colored maculopapular lesions. The eruptions are usually generalized, affecting chiefly the trunk, and the course is often self-limiting.

Pruritus is a tingling or faintly burning skin sensation that prompts a person to rub or scratch.

Psoralen refers to a group of substances derived from plants, which are capable of causing a phototoxic dermatitis when applied to the skin and exposed to sunlight or artificial ultraviolet wavelengths.

Psoriasis is a common, chronic disease of the skin that consists of reddened papules that develop to form plaques with distinct borders. As the disease progresses and if it is untreated, a silvery, yellow-white scale develops. New lesions tend to appear at sites of trauma, but frequently are located on the scalp, knees, elbows, and genitalia.

Puva uses a psoralen derivative in conjunction with long wavelength ultraviolet A (UVA) light (sunlight or artificial) for photochemotherapy of skin conditions.

Targeted Phototherapy describes the use of ultraviolet light that can be focused on specific body areas or lesions. It involves application of light energy directly focused on, the lesion through special delivery mechanisms such as fiber-optic cables. It includes different technologies such as excimer laser, intense pulse light systems, and UV light sources with hand-held delivery systems.

Ultraviolet B (UVB) is one of the three types of invisible light rays (together with ultraviolet A and ultraviolet C) given off by the sun.

Vitiligo is a idiopathic skin disorder characterized by a patchy loss of skin pigment. The depigmented areas, which appear most commonly on the hands, face, and genital regions, are flat and pale and surrounded by normal pigmentation.]

Exención de responsabilidad

Las políticas médicas de Capital Blue Cross se utilizan para determinar la cobertura de tecnologías, procedimientos, equipos y servicios médicos específicos. Estas políticas médicas no constituyen un consejo médico y están sujetas a cambios según lo exija la ley o la evidencia clínica aplicable de las pautas de tratamiento independientes. Los proveedores que brindan tratamiento son individualmente responsables de los consejos médicos y el tratamiento de los miembros. These polices are not a guarantee of coverage or payment. El pago de las reclamaciones está sujeto a la determinación del programa de beneficios del miembro y la elegibilidad en la fecha del servicio, y a la determinación de que los servicios son médicamente necesarios y apropiados. El procesamiento final de una reclamación se basa en los términos del contrato que se aplican al programa de beneficios de los miembros, incluidas las limitaciones y exclusiones de beneficios. Si un proveedor o miembro tiene alguna pregunta sobre esta política médica, debe comunicarse con Servicios para proveedores o Servicios para miembros de Capital Blue Cross.

Coding Information

Nota: Es posible que esta lista de códigos no sea exhaustiva y que los códigos estén sujetos a cambios en cualquier momento. La identificación de un código en esta sección no denota cobertura, ya que la cobertura está determinada por los términos de la información de beneficios del miembro. Además, no todos los servicios cubiertos son elegibles para un reembolso por separado. Los códigos deben estar en orden numérico.

Covered when medically necessary:

Referencias

Psoriasis:

1. Callen JP, Krueger GG, Lebwohl M, et al. AAD consensus statement on psoriasis therapies. J Am Acad Dermatol. Nov 2003;49(5):897-899. PMID 14576671
2. Finlay AY. Current severe psoriasis and the rule of tens. Br J Dermatol. May 2005;152(5):861-867. PMID 15888138
3. Legwohl MD, van de Kerkhof P. Psoriasis. In Treatment of Skin Disease: Comprehensive Therapeutic Strategies. London: Mosby; 2005.
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. Sep 2019; 81(3): 775-804. PMID 31351884
5. Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy. J Am Acad Dermatol. Jan 2010;62(1):114-135. PMID 19811850
6. Taneja A, Trehan M, Taylor CR. 308-nm excimer laser for the treatment of psoriasis: induration-based dosimetry. Arch Dermatol. Jun 2003;139(6):759-764. PMID 12810507
7. Taylor CR, Racette AL. A 308-nm excimer laser for the treatment of scalp psoriasis. Lasers Surg Med. Mar 2004;34(2):136-140. PMID 15004825
8. Nistico SP, Saraceno R, Stefanescu S, et al. A 308-nm monochromatic excimer light in the treatment of palmoplantar psoriasis. J Eur Acad Dermatol Venereol. May 2006;20(5):523-526. PMID 16684278
9. Almutawa F, Thalib L, Hekman D, et al. Efficacy of localized phototherapy and photodynamic therapy for psoriasis: a systematic review and meta-analysis. Photodermatol Photoimmunol Photomed. Jan 2015;31(1):5-14. PMID 24283358
10. Mudigonda T, Dabade TS, West CE, et al. Therapeutic modalities for localized psoriasis: 308-nm UVB excimer laser versus nontargeted phototherapy. Cutis. Sep 2012;90(3):149-154. PMID 23094316
11. Goldinger SM, Dummer R, Schmid P, et al. Excimer laser versus narrow-band UVB (311 nm) in the treatment of psoriasis vulgaris. Dermatology. Aug 2006;213(2):134-139. PMID 16902290
12. Kollner K, Wimmershoff MB, Hintz C, et al. Comparison of the 308-nm excimer laser and a 308-nm excimer lamp with 311-nm narrowband ultraviolet B in the treatment of psoriasis. Br J Dermatol. Apr 2005;152(4):750-754. PMID 15840108
13. Chen X, Yang M, Cheng Y, et al. Narrow-band ultraviolet B phototherapy versus broad-band ultraviolet B or psoralen-ultraviolet A photochemotherapy for psoriasis. Cochrane Database Syst Rev. Oct 23 2013;10(10):CD009481. PMID 24151011
14. Archier E, Devaux S, Castela E, et al. Efficacy of psoralen UV-A therapy vs. narrowband UV-B therapy in chronic plaque psoriasis: a systematic literature review. J Eur Acad Dermatol Venereol. May 2012;26 Suppl 3:11-21. PMID 22512676
15. Amirnia M, Khodaeiani E, Fouladi RF, et al. Topical steroids versus PUVA therapy in moderate plaque psoriasis: a clinical trial along with cost analysis. J Dermatolog Treat. Apr 2012;23(2):109-111. PMID 21254854
16. El-Mofty M, Mostafa WZ, Yousef R, et al. Broadband ultraviolet A in the treatment of psoriasis vulgaris: a randomized controlled trial. Int J Dermatol. Sep 2014;53(9):1157-1164. PMID 24697586
17. Sivanesan SP, Gattu S, Hong J, et al. Randomized, double-blind, placebo-controlled evaluation of the efficacy of oral psoralen plus ultraviolet A for the treatment of plaque-type psoriasis using the Psoriasis Area Severity Index score (improvement of 75% or greater) at 12 weeks. J Am Acad Dermatol. Nov 2009;61(5):793-798. PMID 19766350
18. Morita A. Current developments in phototherapy for psoriasis. Journal of Dermatology 2018; Mar;45(3):287-292
19. Khosravi H, Siegel MP, Van Voorhees AS, et al. Treatment of inverse/intertriginous psoriasis: updated guidelines from the Medical Board of the National Psoriasis Foundation. J Drugs Dermatol. Aug 01 2017;16(8):760-766. PMID 28809991
20. Prussick R, Wu JJ, Armstrong AW, et al. Psoriasis in solid organ transplant patients: best practice recommendations from The Medical Board of the National Psoriasis Foundation. J Dermatolog Treat. Oct 24 2017:1-5. PMID 28884635
21. Gupta R, Debbaneh M, Butler D, et al. The Goeckerman regimen for the treatment of moderate to severe psoriasis. J Vis Exp. 2013;(77):e50509. Published 2013 Jul 11. doi:10.3791/50509

Vitiligo:

1. Lopes C, Trevisani VF, Melnik T. Efficacy and Safety of 308-nm Monochromatic Excimer Lamp Versus Other Phototherapy Devices for Vitiligo: A Systematic Review with Meta-Analysis. Am J Clin Dermatol. Feb 2016; 17(1): 23-32. PMID 26520641
2. Whitton ME, Pinart M, Batchelor J, et al. Interventions for vitiligo. Cochrane Database Syst Rev. Feb 24 2015; (2): CD003263. PMID 25710794
3. Sun Y, Wu Y, Xiao B, et al. Treatment of 308-nm excimer laser on vitiligo: A systemic review of randomized controlled trials. J Dermatolog Treat. 2015; 26(4): 347-53. PMID 25428573
4. Yang YS, Cho HR, Ryou JH, et al. Clinical study of repigmentation patterns with either narrow-band ultraviolet B (NBUVB) or 308 nm excimer laser treatment in Korean vitiligo patients. Int J Dermatol. Mar 2010; 49(3): 317-23. PMID 20465673
5. Thind A, Vinay K, Mehta H, et al. Whole-body and targeted narrowband ultraviolet B phototherapy effectively stabilize acral vitiligo with negligible repigmentation beyond wrists and ankles: Results from a split-body randomized controlled trial. Photodermatol Photoimmunol Photomed. Mar 2024; 40(2): e12960. PMID 38480997
6. Poolsuwan P, Churee C, Pattamadilok B. Comparative efficacy between localized 308-nm excimer light and targeted 311-nm narrowband ultraviolet B phototherapy in vitiligo: A randomized, single-blind comparison study. Photodermatol Photoimmunol Photomed. Oct 12, 2020. PMID 33047405
7. Wu Y, Sun Y, Qiu L, et al. A multicentre, randomized, split face and/or neck comparison of 308-nm excimer laser and 0·1% tacrolimus ointment for stable vitiligo plus intramuscular slow-releasing betamethasone for active vitiligo. Br J Dermatol. Jul 2019; 181(1): 210-211. PMID 30644997
8. Nistico S, Chiricozzi A, Saraceno R, et al. Vitiligo treatment with monochromatic excimer light and tacrolimus: results of an open randomized controlled study. Photomed Laser Surg. Jan 2012; 30(1): 26-30. PMID 22054204
9. Oh SH, Kim T, Jee H, et al. Combination treatment of non-segmental vitiligo with a 308-nm xenon chloride excimer laser and topical high-concentration tacalcitol: a prospective, single-blinded, paired, comparative study. J Am Acad Dermatol. Aug 2011; 65(2): 428-430. PMID 21763570
10. Saraceno R, Nisticò SP, Capriotti E, et al. Monochromatic excimer light 308 nm in monotherapy and combined with topical khellin 4% in the treatment of vitiligo: a controlled study. Dermatol Ther. 2009; 22(4): 391-4. PMID 19580584
11. Fa Y, Lin Y, Chi XJ, et al. Treatment of vitiligo with 308-nm excimer laser: our experience from a 2-year follow-up of 979 Chinese patients. J Eur Acad Dermatol Venereol. Feb 2017; 31(2): 337-340. PMID 27538097
12. Dong DK, Pan ZY, Zhang J, et al. Efficacy and Safety of Targeted High-Intensity Medium-Band (304-312 nm) Ultraviolet B Light in Pediatric Vitiligo. Pediatr Dermatol. May 2017; 34(3): 266-270. PMID 28318054
13. Bae JM, Jung HM, Hong BY, et al. Phototherapy for Vitiligo: A Systematic Review and Meta-analysis. JAMA Dermatol. Jul 01 2017; 153(7): 666-674. PMID 28355423
14. Njoo MD, Spuls PI, Bos JD, et al. Nonsurgical repigmentation therapies in vitiligo. Meta-analysis of the literature. Arch Dermatol. Dec 1998; 134(12): 1532-40. PMID 9875190
15. Yones SS, Palmer RA, Garibaldinos TM, et al. Randomized double-blind trial of treatment of vitiligo: efficacy of psoralen-UV-A therapy vs Narrowband-UV-B therapy. Arch Dermatol. May 2007; 143(5): 578-84. PMID 17519217
16. Gawkrodger DJ, Ormerod AD, Shaw L, et al. Guideline for the diagnosis and management of vitiligo. Br J Dermatol. Nov 2008; 159(5): 1051-76. PMID 19036036
17. Taieb A, Alomar A, Bohm M, et al. Guidelines for the management of vitiligo: the European Dermatology Forum consensus. Br J Dermatol. Jan 2013; 168(1): 5-19. PMID 22860621
18. Seneschal J, Speeckaert R, Taïeb A, et al. Worldwide expert recommendations for the diagnosis and management of vitiligo: Position statement from the international Vitiligo Task Force-Part 2: Specific treatment recommendations. J Eur Acad Dermatol Venereol. Sep 15 2023. PMID 37715487
19. Rodrigues M, Ezzedine K, Hamzavi I, et al. Current and emerging treatments for vitiligo. J Am Acad Dermatol. Jul 2017; 77(1): 17-29. PMID 28619557

Untraviolet Light:

1. Richard E. Psoralen plus ultraviolet A (PUVA) photochemotherapy. In: UpToDate Online Journal [serial online]. Waltham, MA: UpToDate; updated December 1, 2022. Literature review current through December 2024
2. Elmets, H. UVB therapy (broadband and narrowband). In: UpToDate Online Journal [serial online]. Waltham, MA: UpToDate; updated March 27, 2024. Literature review current through December 2024
3. Herzinger T, Berneburg M, Ghoreschi K, et al. S1-Guidelines on UV phototherapy and photochemotherapy. J Dtsch Dermatol Ges. 2016; 14(8):853-876. doi:10.1111/ddg.12912

Targeted Phototherapy:

1. Alshiyab D, Edwards C, Chin MF, Anstey AV. Targeted ultraviolet B phototherapy: definition, clinical indications, and limitations. Clin Exp Dermatol. 2015; 40(1):1-5. doi:10.1111/ced.12441
2. Feldman S. Targeted phototherapy. In: UpToDate Online Journal [serial online]. Waltham, MA: UpToDate; updated November 16, 2022. Literature review current through December 2024

Historial de políticas

• MP 2.046 - 5/9/2025 Policy Creation. Complete Adoption