A Systematic Review of Light Emitting Diode (LED) Phototherapy for Treatment of Psoriasis: An Emerging Therapeutic Modality

May 2017 | Volume 16 | Issue 5 | Original Article | 482 | Copyright © 2017

Derek Ho BS,a,b Eugene Koo MS,a,b Andrew Mamalis MD MS,a,b and Jared Jagdeo MD MSa,b,c

aDermatology Service, Sacramento VA Medical Center, Mather, CA bDepartment of Dermatology, University of California Davis, Sacramento, CA cDepartment of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY

Abstract

Background: Psoriasis is a chronic, inflammatory skin condition. The economic burden of psoriasis is approximately $35.2 billion in the United States per year, and treatment costs are increasing at a higher rate than general inflation. Light emitting diode (LED) phototherapy may represent a cost-effective, efficacious, safe, and portable treatment modality for psoriasis.

Objective: The goal of our manuscript is to review the published literature and provide evidence-based recommendations on LED phototherapy for the treatment of psoriasis.

Methods & Materials: A search of the databases Pubmed, EMBASE, Web of Science, and CINAHL was performed on April 5, 2016. Key search terms were related to psoriasis and LED-based therapies.

Results: A total of 7,793 articles were generated from the initial search and 5 original articles met inclusion criteria for our review. Grade of recommendation: B for LED-blue light. Grade of recommendation: C for LED-ultraviolet B, LED-red light, and combination LED-near-infrared and LED-red light.

Conclusion: We envision further characterizing the effects of LED phototherapy to treat psoriasis in patients may increase adoption of LED-based modalities and provide clinicians and patients with new therapeutic options that balance safety, efficacy, and cost.

J Drugs Dermatol. 2017;16(5):482-488.

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INTRODUCTION

Psoriasis is a chronic, inflammatory skin condition characterized by thick plaques with silvery scale.1 These psoriatic plaques commonly occur on the scalp, face, hands, feet, nails, genital regions and skin folds, and often cause pruritus and discomfort. Due to the aesthetically unpleasant appearance of psoriatic plaques, patients often feel self-conscious about their appearance, resulting in depression, anxiety, stress and decreased quality-of-life.2 Comorbidities of psoriasis, such as myocardial infarction, arterial hypertension, dyslipidemia, obesity, and diabetes mellitus, can also negatively impact patient health.3 Furthermore, psoriasis is a significant socioeconomic burden as it affects more than 3% of the United States (U.S.) population.1 Studies evaluating the economic burden of psoriasis estimate the cost to be approximately $26,000 per patient per year with a total cost of $35.2 billion in the U.S. per year, due to a combination of incremental medical costs, reduced quality-of-life, and productivity losses.4,5 Additionally, treatment costs are increasing at a higher rate than general inflation, especially with newer biologic agents compared to traditional treatments.6,7As there is no cure for psoriasis, current treatments are aimed at suppressing the cutaneous and systemic symptoms of psoriasis. The treatment modalities include topical medications (corticosteroids, vitamin D analogues, and calcineurin inhibitors), phototherapies (Psoralen with Ultraviolet A [PUVA] and narrowband ultraviolet B [NB-UVB]), systemic treatments (methotrexate and cyclosporine), and biologic agents (targeting Tumor Necrosis Factor-α [TNF-α], Interleukin 12/23, or Interleukin 17A). However, these treatment modalities are associated with significant side effects, including increased risks of skin atrophy from long-term use of topical corticosteroids, risks of non-melanoma skin cancer (NMSC) from phototherapies, and immune-suppression from systemic treatments. Despite these side effects, phototherapy is commonly performed for treatment of psoriasis due to proven efficacy, moderate cost, and minimal side effects compared to treatments with systemic and biologic agents. A 2015 meta-analysis investigated the efficacy of PUVA and UVB for treatment of psoriasis. This meta-analysis found 77% of PUVA and 61% of UVB studies achieved a 75% or greater reduction in psoriasis area severity index (PASI).8 However, PUVA and UVB treatment systems are often stationary and require a dedicated physical space, are costly to acquire and maintain, and require patients to frequently visit dermatology offices for treatment (three sessions a week is a standard phototherapy regimen). Thus, there exists a need for

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