The efficacy and safety of phototherapy in geriatric patients: A retrospective study

Abstract

Background
While phototherapy is a well-established treatment for many dermatoses, data from the literature regarding its use in elderly patients are quite limited.

Objective
In this study, we aimed to determine the phototherapy indications in geriatric patients and to evaluate the effectiveness and reliability of phototherapy in this group.

Methods
This study included 95 patients of 65 years of age and older who were treated in our phototherapy unit between 2006 and 2015. The data for this study were collected retrospectively from patient follow-up forms in the phototherapy unit.

Results
Phototherapy was administered to 28 (29.5%) patients for mycosis fungoides, 25 (26.3%) patients foplaque type psoriasis, 12 (12.6%) patients for palmoplantar psoriasis, 12 (12.6%) patients for generalized pruritus, and 18 (19%) for other dermatoses. Of the patients, 64.2% had received a narrowband UVB (NB-UVB), 21.1% oral psoralen UVA (PUVA), and 14.7% local PUVA treatment. A complete response was achieved in 76.9-85.7% of the mycosis fungoides and in 73.71-100% of the psoriasis vulgaris patients treated with NB-UVB and PUVA, respectively. All the patients with generalized pruritus were treated with NB-UVB, and 80% of these patients achieved significant improvement. The erythema rate was found to be 0.43% per session for NB-UVB treatment and 0.46% per session for PUVA treatment as a side effect.

Study limitations
The limitations of our study are that it was retrospective and the remission durations of the patients are not known.

Conclusion
This study showed that phototherapy is effective and reliable in the elderly population with proper dose increases and close follow-up.

Full text

An Bras Dermatol. 2018;93(1):33-8.
investigAtion
The efcacy and safety of phototherapy in geriatric patients:
a retrospective study*
Isil Bulur1 Hilal Kaya Erdogan1
AyseEsraAksu2 TekdenKarapınar1
ZeynepNurhanSaracoglu1
DOI: http://dx.doi.org/10.1590/abd1806-4841.20185468
Abstract: Background: Whilephototherapyisawell-establishedtreatmentformanydermatoses,datafromtheliteraturere-
gardingitsuseinelderlypatientsarequitelimited.
oBjective:Inthisstudy,weaimedtodeterminethephototherapyindicationsingeriatricpatientsandtoevaluatetheeffective-
ness and reliability of phototherapy in this group.
Methods: This study included 95 patients of 65 years of age and older who were treated in our phototherapy unit between
2006 and 2015. The data for this study were collected retrospectively from patient follow-up forms in the phototherapy unit.
results:Phototherapywasadministeredto28(29.5%)patientsformycosisfungoides,25(26.3%)patientsfoplaquetypepso-
riasis,12(12.6%)patientsforpalmoplantarpsoriasis,12(12.6%)patientsforgeneralizedpruritus,and18(19%)forotherder-
matoses.Ofthepatients,64.2%hadreceivedanarrowbandUVB(NB-UVB),21.1%oralpsoralenUVA(PUVA),and14.7%local
PUVAtreatment.Acompleteresponsewasachievedin76.9-85.7%ofthemycosisfungoidesandin73.71-100%ofthepsoriasis
vulgarispatientstreatedwithNB-UVBandPUVA,respectively.Allthepatientswithgeneralizedpruritusweretreatedwith
NB-UVB,and80%ofthesepatientsachievedsignicantimprovement.Theerythemaratewasfoundtobe0.43%persession
forNB-UVBtreatmentand0.46%persessionforPUVAtreatmentasasideeffect.
study liMitations:Thelimitationsofourstudyarethatitwasretrospectiveandtheremissiondurationsofthepatientsarenotknown.
conclusion: This study showed that phototherapy is effective and reliable in the elderly population with proper dose in-
creases and close follow-up.
Keywords: Healthoftheelderly;Phototherapy;Skindiseases
s
Received on 04.12.2015.
ApprovedbytheAdvisoryBoardandacceptedforpublicationon09.08.2016.
* WorkperformedattheDepartmentofDermatology,EskişehirOsmangaziUniversity,FacultyofMedicine,Eskişehir,Turkey.
Financial support: None
 Conictofinterest:None.
1 DepartmentofDermatology,FacultyofMedicine,EskisehirOsmangaziUniversity,Eskişehir,Turkey.
2 DeparrmentofDermatology,IstanbulTrainingandResearchHospital,Istanbul,Turkey.
Mailing address:
Isil Bulur
E-mail: isilbulur@yahoo.com
©2018byAnaisBrasileirosdeDermatologia
INTRODUCTION
Nowadays,thereisanincreaseinthegeriatricpopulationin
bothdevelopedand developingcountries.Accordingto 2014data,
8.3%oftheworldpopulationisolderthan65yearsofage,andthis
ratiois8%inTurkey.1Whenobserveddemographically,thischange
causesimportanthealthproblemsand makes it mandatory to ar-
range healthcare services accordingly. In addition to systemic disor-
ders,dermatologicdiseasesarealsoimportantintermsofaffecting
thequality of lifein this agegroup.2 Being aware of the metabolic
and physiological changes with age and considering the accompa-
nying comorbidities and drug use in these patients are important
in terms of preventing iatrogenic complications when selecting the
treatment method.3Althoughtopicaltreatmentscanalsobeusedfor
some dermatologic disorders in order to prevent the side effects of
systemictreatments,phototherapybecomesanimportanttreatment
choice in cases where topical treatments are ineffective. Photothera-
py is a treatment method with proven effectiveness and reliability in
theadultagegroup,butthedataintheliteratureregardingitsusein
theelderlypopulationareinadequate.
The present study aimed to determine the phototherapy in-
dicationsinpatientsof65yearsofageandolder,whowerefollowed
upinourphototherapyunitbetween2006and2015,andtoevaluate
theefcacyandsafetyofphototherapyincommonlyseendermato-
ses in this age group.
33

METHODS
Thisstudyincluded95patientsof65yearsofageandolder,
who were followed up in our phototherapy unit between 2006 and
2015. The phototherapy data were evaluated retrospectively from
the follow-up forms of the phototherapy unit.
Phototherapy Protocol
Narrowband UVB (NB-UVB) treatment and oral psoralen
UVA(PUVA)were administered withtheDaavlinSpectra305/350
modelUVdevicetothepatientsincludedinthestudy.Alltreatment
protocolswerestartedatthreetimesaweek.NB-UVBtreatmentwas
startedwith70% of theminimalerythema dose (MED),andPUVA
treatment was started with 70% of the minimal phototoxic dose
(MPD).Thesubsequent dosageincreasedby10-20%oftheprevious
dose at each session, according to the clinical situation of the pa-
tientforNB-UVB.8-methoxypsoralenwasadministeredatadoseof
0.6mg/kgforPUVA,andtreatmentwascontinuedwith0.5jincreas-
esweekly.Treatmentwascontinuedwith10%increasesinthecaseof
minimalerythemapresenceduringthetreatmentwithNB-UVB.The
dose was not increased in the case of continuous moderate erythema.
The treatment was interrupted until symptoms regressed in the cases
ofsevereerythema,edemaandbullaedevelopment.Aftersymptoms
regressed,treatment was continued with 50% of the last dose, and
dose increases were determined as 10%. Treatment was continued
withoutanincreaseinPUVAtreatmentinthecaseofthepresenceof
minimal-mild erythema. The treatment was interrupted until symp-
tomsregressedin the cases of severe erythema, edema, and bullae
development.Aftersymptomsregressed,treatmentwasstartedwith
50% of the last dose and continued with 10% increases.
Patientswhousedonlytopical corticosteroids,moisturizers,
or antihistamines were included in the study. Patients who were treat-
edwithphototherapyforlessthan8sessions(duetotheirownrequest)
were excluded from the evaluation of the relationship between the dis-
orderandthephototherapydose,effects,andsideeffects.
The steps followed up before and during the phototherapy
treatment in individuals of 65 years of age and older in our clinic
arepresentedingure1.Besidesliverandrenalfunctiontests,com-
plete blood cell counts were performed monthly for the evaluation
of8-MOPsideeffectsinpatientstreatedwithPUVA.
Evaluation of the treatment response and termination of
treatment.
Earlystage(Stage 1A, 1B, 2A) mycosis fungoidespatients
wereincludedinthestudy.A90-100%disappearanceofthelesions
with histopathological support of treatment response was accepted
asacompleteresponseinmycosisfungoidespatients.PASI75and
overwasevaluatedasaresponseforplaquetypepsoriasisvulgaris.
Improvement of more than 75% in the initial lesion for the other
dermatoses and complete improvements in the symptom of itching
accordingtothefeedbackofthepatientwereacceptedasrecovery.
The treatment was continued until total remission was obtained or
no additional improvement was seen in the following sessions.
Statistical Analysis
The analysis of the data was performed using the SPSS for
Windows 11.5 software program. Descriptive statistics for continuous
variables were shown as mean ± standard deviation or median (mini-
mum-maximum),andcategoricalvariableswereshownasthenumber
of cases (%). Fisher’s exact test was used for the comparison of two
proportions.Thechi-squaredtestwasusedintheanalysisofquantita-
tivedata.Resultswereacceptedasstatisticallysignicantforp<0.05.
RESULTS
This study included 95 patients (43 female, 52 male) with a
meanageof71.6±5.4years.Theskintypewastype2in57(60.0%)pa-
tientsandtype3in 38(40%)patients.Mycosisfungoides(29.5%)was
the most common indication for phototherapy, followed by plaque
typepsoriasis(26.3%),palmoplantarpsoriasis(12.6%),andgeneralized
pruritus(12.6%) (Table1).Other disorderstreated withphototherapy
were lichen planus, contact dermatitis, atopic dermatitis, morphea,
An Bras Dermatol. 2018;93(1):33-8.
34 BulurI,KayaErdoganH,AksuAE,KarapınarT,SaracogluZN
Detailed whole-body dermatologic examination, evaluation of
thepatientforpreinanlignantskinlesions,basalcellcarcinoma,
squamouscellcarcinomaandmalignantmelanoma
Queryingsystemicdisorders,cognitivestatus,vitamindeciencies
and treatment agents causing photosensitivity
Skintype, minimal erythemadoseand minimalphototoxicdose
determination
Evaluation of patients by the phototherapy unit nurse at every
session and by the doctor responsible for the phototherapy unit
montly
FIgure 1: Follow-up steps for elderly patients receiving phototherapy
Table 1: Distribution of patients according to phototherapy
recommendation and phototherapy type
Total Number
of Patients
n (%)
DUVB
n
PUVA
n
Local
PUVA
n
Mycosis fungoides 28(29.5) 14 14
Psoriasis 25(26.3) 22 3
Generalizedpruritus 12(12.6) 12
Palmoplantar psoriasis 12(12.6) 12
Lichen planus 8(8.4) 8
Contact dermatitis 4(4.2) 4
Atopicdermatitis 2(2.1) 2
Morphea 1(1.1) 1
Keratoderma 1(1.1) 1
Pigmented purpuric
dermatosis
1(1.1) 1

Theefcacyandsafetyofphototherapyingeriatricpatients:aretrospectivestudy 35
An Bras Dermatol. 2018;93(1):33-8.
keratoderma, pigmented purpuric dermatitis, and generalized poro-
keratosis(Table1).Ofthepatients,61(64.2%)hadreceivedNB-UVB,20
(21.1%)PUVA,and14(14.7%)localPUVAtreatment(Graph1).
Mycosis Fungoides (n=28)
Mycosis fungoides was the most common at 29.5% among
the disorders with a phototherapy indication. Fourteen (50%) pa-
tientsweretreatedwithNB-UVB,and14(50%)patientsweretreated
withPUVA (Table1). One patient treatedwithPUVA discontinued
the treatment before completing 8 sessions. The median age was 75
(65-82)yearsforthe14patientswhoreceivedNB-UVBtreatmentand
68(65-84)yearsforthe13patientswhoreceivedPUVAtreatment.The
median number of sessions was 55 (10-148), with a median cumu-
lativedose of59.3(5.2-240) j/cm2,for NB-UVBtreatment,while the
mediannumberofsessionswas 39(10-146),withamediancumula-
tivedoseof253.0(35-1242)j/cm2,forPUVAtreatment.Nostatistically
signicantdifferencewasfound betweenNB-UVB andPUVAtreat-
mentsintermsofthe numberofsessions(p=0.616).Erythema was
foundasasideeffectin3(21.4%)patientstreatedwithNB-UVBand
4(28.6%)patientstreatedwithPUVA.Acompleteresponsewas ob-
tainedwithtreatmentin85.7%ofthepatientstreatedwithNB-UVB
andin76.9%ofthepatientstreatedwithPUVA.Nostatisticallysig-
nicantdifferencewasfoundbetweenthose whowere treatedwith
NB-UVBandPUVAintermsoftherateofbeneting fromthetreat-
ment(p=0.367).ParametersregardingNB-UVBandPUVAtreatment
inmycosisfungoidespatientsaresummarizedintable2.
Psoriasis (n=25)
Plaquetype psoriasis waspresentin 26.3%ofthe patients
included in the study (Table 2). NB-UVB treatment was used in
22 (88%) patients and PUVAtreatment in 3 (12%) patients. Three
patients treated with NB-UVB discontinued the treatment before
completing8sessions. Themedianagewas71(65-80)forNB-UVB
and68(66-77)forPUVA.Themedian number of sessions was 42
(14-170),withamedian cumulative dose of 66.8 (4.9-198.9) j/cm2,
forNB-UVBtreatment, whilethemediannumber of sessionswas
25(19-69), withamediancumulativedose of219.8(90-873) j/cm2,
forPUVAtreatment.PASI75responsewasachievedin73.7%ofthe
patientstreatedwithNB-UVBandinallofthepatientstreatedwith
PUVA. Erythema was found as a side effect in 7 (36.8%) patients
whoreceived NB-UVBtreatmentand in1 (33.3%) patientwho re-
ceivedPUVAtreatment.ParametersregardingNB-UVBandPUVA
treatmentinpsoriasispatientsaresummarizedintable3.
Generalized Pruritus (n=12)
Generalizedprurituswaspresent in 12.6% of the patients
includedinthisstudy,inwhichallofthepatientsreceivedNB-UVB
treatment. Two patients who started phototherapy discontinued the
treatment before completing 8 sessions. The median age of the pa-
tientswas69(65-81)years.Themediannumberofsessionswas33.5
(12-108),withamediancumulativedoseof50.5(4.5-205)j/cm2. The
numberofpatients who beneted from NB-UVBtreatmentwas 8
(80%).Erythema wasobservedin 2(20%) patientsasa sideeffect.
Parameters regarding NB-UVB treatment in generalized pruritus
patientsaresummarizedintable4.
Lichen Planus (n=8)
AllthepatientswithlichenplanusreceivedNB-UVBtreat-
ment,andaresponsewasachievedin37.5%ofthepatients,witha
mediancumulativedoseof21.4(4.9-99.7)j/cm2 and a median num-
berof19(9-60)sessions.
graph 1: Distribution of patients based on therapy received
Table 2: Features of Patients with Mycosis Fungoides
Mycosis Fungoides
DUVB (n=14) PUVA(n=13)
Mean±SD Median (range) Mean±SD Median (range)
Age(years) 74.1±6.5 75(65-82) 70.5±6.5 68.0(65-84)
Number of Sessions 55.4±35.4 55.0(10-148) 52.7±41.1 39(10-146)
MED/MFDdose(mj/cm2-j/cm2)540.5±153.2 575(245-800) 3.3±1.4 3.5(1-5)
Firstdose(mj/cm2-j/cm2)335.8±78.8 332(166-420) 2.0±0.9 2.3(1-3)
MaximumDose(mj/cm2-j/cm2)1400±588.4 1336(492-2100) 6.0±2.6 6.0(3-11)
CumulativeDose(j/cm2)70.3±60.4 59.3(5.2-240) 363.2±357.7 253.0(35-1242)
Side Effect 3(21.4%) 4(30.8%)
Treatment Response 12(85.7%) 10(76.9%)
NB-UVB PUVA LocalPUVA
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
64.2%
20.0% 14.7%
MED:minimalerythemadose,MFD:minimalphototoxicdose

Other Dermatoses
Two patients diagnosed with atopic dermatitis were treated
withNB-UVB. The treatmentresponsewasobservedin1patient
whounderwent43 sessions and receiveda64.8 j/cm2 cumulative
dose,whileintheotherpatientsunderwent13sessionsandreceived
an8.7j/cm2cumulativedose.One67-year-oldfemalepatient,with
pigmented purpuric dermatoses, was treated with PUVA, and a
complete response was obtained in 40 sessions with a cumulative
doseof181 j/cm2. Inaddition,one 65-year-old malepatient,with
generalized porokeratosis, received PUVA treatment and a com-
plete response was achieved upon the 42nd session.
Side Effects
The photosensitive drugs that the patients most often used are
summarizedintable5 in their order of frequency. No acute adverse
effectrequiredthediscontinuationoftherapy.Erythemawasobserved
in35%ofthepatientstreatedwithNB-UVBandin33%ofthosetreated
withPUVA.Theincidenceoferythemawasfoundtobe0.43%perses-
sioninNB-UVBtreatmentand 0.46%per sessionin PUVAtreatment.
Theerythemaincidence showednostatisticallysignicant difference
between NB-UVB and PUVAtreatments (p = 0.111).No gastric side 
effectsrequiringthediscontinuationofthetreatmentwasobservedin
anyofthepatientswhoreceivedPUVAtreatment.
DISCUSSION
This study demonstrated that phototherapy is effective and
reliableintheelderlypopulation.Studiesevaluatingskindisorders
andqualityof lifeintheelderlypopulationareavailableinthelit-
erature,but,todate,onlyonestudyhasevaluatedtheuseofphoto-
therapy in this population.4
Powell et al. reported that psoriasis was the most common
skindisorder,with 51% of 37elderlypatientstreated with photo-
therapy,whileinthepresentstudymycosisfungoides(29.5%)was
thedisordertreatedmostfrequentlywithphototherapyintheelder-
ly.4 Mycosisfungoidesismainlyobserved after55-60years ofage,
andphototherapy is included among the rst-step treatments for
earlystage mycosisfungoides(stage 1A,1B, 2A).5-6Therefore,this
result is not unexpected.
Therstoptioninphototherapyforthemycosisfungoides
patientsinourclinicisPUVAtreatment.However,weprefertoap-
plyNB-UVBtreatmentingeriatricpatientswithsystemicdisorders
andmultipledruguseduetothepsoralen’sgastricsideeffectsand
liver toxicity. The clinical response rate varies between 42% and
86%, with PUVA administeredthree times a week in early stage
mycosis fungoides patients.7Inthisstudy,acompleteresponserate
in mycosis fungoides was obtained in 76.9% of the patients treated
withPUVA,withamedianof39sessionsandamediancumulative
doseof253.0j/cm2. Ponte et al. reported that clinical response was
achievedin62.1% of theirearlystage mycosis fungoidespatients,
with a mean number of 31 sessions and a cumulative dose of 123.8
j/cm2.8Ontheotherhand,theypointedoutthatretinoidtreatment
wasgiveninadditiontophototherapyin53.7%,corticosteroidtreat-
mentin3.2%,andmethotrexatetreatmentin 2.1% of the patients
included in their study.9Inanother study,64%ofthepatients with
mycosis fungoides treated with PUVA achieved a complete re-
sponse,withanaverageof19.5(7-50)sessions.9
TheresponseratewithNB-UVBinmycosisfungoidescases
variesbetween54% and 91% in other studies,andthenumber of
sessionsforfull recoverywithNB-UVB is reportedtobe between
19 and 36.7Inourstudy,acompleteresponsewasobservedin85.7%
of the patients with mycosis fungoides who were treated with NB-
UVB,withamediannumberof55sessionsandacumulativedoseof
36 BulurI,KayaErdoganH,AksuAE,KarapınarT,SaracogluZN
An Bras Dermatol. 2018;93(1):33-8.
Table 3: Features of the patients with psoriasis vulgaris
Psoriasis Vulgaris
DUVB (n=19) PUVA (n=3)
Mean±SD Median (range) Mean±SD Median (range)
Age(years) 71.3±5.0 71(65-80) 70.3±5.9 68(66-77)
Number of Sessions 55.1±38.7 42.0(14-170) 36.0±24.4 25(19-69)
Meddose(mj/cm2-j/cm2)504.0±135.7 486(250-800) 2.7±1.4 3.5(1-4)
Firstdose(mj/cm2-j/cm2)285.6±79.2 300(150-480) 1.5±0.9 1(1-3)
MaximumDose(mj/cm2-j/cm2)1466.8±644.7 1368(350-2458) 12.23±7.5 15(4-18)
CumulativeDose(j/cm2)70.0±50.8 66.8(4.9±198.9) 394.3±419.6 219.8(90-873)
Side Effect 7(36.8%) 1(33.3%)
Treatment Response 14(73.7%) 3(100%)
Table 4: Features of the patients with pruritus
DUVB (n=10)
Mean±SD Median (range)
Age(years) 70.9±5.3 69(65-81)
Number of Sessions 43.7±29.3 33.5(12-108)
Meddose(mj/cm2)540.5±153.2 600(245-800)
Firstdose(mj/cm2)360.8±77.3 375(243-480)
MaximumDose(mj/cm2)1516±454.9 1541(751-2148)
CumulativeDose(j/cm2)63.2±56.6 50.5(4.5-205)
Side Effect 2(20.0%)
Treatment response 8(80.0%)
MED:minimalerythemadose,MFD:minimalphototoxicdose
MED: minimal erythema dose

Theefcacyandsafetyofphototherapyingeriatricpatients:aretrospectivestudy 37
An Bras Dermatol. 2018;93(1):33-8.
59.3j/cm2.Boztepeet al. reported that a full response was obtained
in78.6%oftheirpatients,withacumulativedoseof108.8±40.8jcm2
andamediannumber of sessions of 22.7±5.4 for stage1A-1Band
30.2±12.8forstage 2Ainpatientswith NB-UVB in the14mycosis
fungoides patients evaluated by their research team.10
Systemictreatmentadministrationisquitedifcultinmoder-
ate and severe psoriasis in the elderly population due to the accom-
panying comorbidities and multiple drug use. On the other hand,
phototherapy is a reliable treatment method with fewer side effects in
thispatientgroup.However,theevaluationofpreviousphototherapy
dosesandimmunosuppressivedrugsreceivedbythepatientsisquite
important before the phototherapy decision is made in psoriasis. Our
studyrevealeda PASI75 response in73.7%of the 19 psoriasis vul-
garispatientstreated with NB-UVB, withamediannumber of 42.0
sessions and a median cumulative dose of 66.8 j/cm2. All patients
(n=3)treatedwithPUVAachievedaPASI75responsewithamedian
numberof25sessionsandamediancumulativedoseof219.8j/cm2.
Yones et al.observedfullrecoveryin84%oftheirchronicplaquetype
psoriasispatientswhoreceivedPUVA, witha mediannumber of17
sessions,andin65%of thosewhoreceivedNB-UVB,with amedian
number of 28.5 sessions.11Markhamet al. reported that they observed
animprovement inpsoriasis patientsin25.5 (18-32.5)sessions, with
NB-UVBandin19(14.6-25.0)sessionswithPUVA.12
Pruritus is a common dermatologic problem in the elderly
population with a prevalence of 29% and is usually idiopathic in this
age group.13 There is a scarcity of publications on phototherapy in
generalizedpruritus.14-16Seçkinet al. reported obtaining relief in 68%
ofthe25idiopathicprurituscases,withameanageof51.7(range25-
91)years,withameannumberof22sessionsandcumulativedoseof
20801mj/cm2.14Inourstudy,NB-UVBtreatmentwasadministered
toallofthepatientswithidiopathicgeneralizedpruritus,inwhich
completereliefwasobservedin80%ofthepatients,withamedian
numberof33.5sessionsandamediancumulativedoseof50.5j/cm2.
AllofthepatientswithlichenplanusweretreatedwithNB-
UVB,anda signicant improvement wasobtainedfromthe treat-
ment in 37.5% of the patients, with a cumulative median dose of
21.4j/cm2 in a median number of 19 sessions. Gamil et al. reported
that68.8% oftheir patientswhoreceivedNB-UVBatacumulative
doseof84.5±31.6achieveda complete response, while 70% of the
patientswhoreceivedNB-UVBinanotherstudyshowedsignicant
improvementin amean numberof10.9 weeks.17,18 Saricaoğlu et al.
observed a complete response in 50% of the patients treated with
NB-UVBin30sessions.19
This study shares similar results with other studies. How-
ever,thenumberofsessionsinour studyishigherthanintheoth-
er studies in the literature. The reason for this difference may be
explained by the fact that that our patients were generally treated
with a low increment regimen. We could not discuss the impact of
phototherapyfor other dermatosesinelderly patients, duetolow
number of the patients.
Polypharmacy in elderly patients is important due to their
phototoxicandphotoallergicsideeffects,inadditiontotheirhepatic
andrenalsideeffects,during phototherapytreatment.Thepatients
should be advised not to use additional systemic and topical drugs
without asking their doctors. Moreover, we recommend that the
clinician should bear in mind that commonly used non-steroidal
anti-inammatorydrugs andantihistaminesin thispopulationcan
causephototoxic andphotoallergicreactions.Although we didnot
observe severe acute adverse effects that would requirethe inter-
ruptionof treatment inanyof our patientsinthis study,erythema
wasobserved in 35% of the patients treated with NB-UVB and in
33%ofthepatientstreatedwithPUVA.Markhamet al. reported that
rstdegreeerythema was observedin75%of the mycosis fungoi-
despatients treatedwithNB-UVBand in80% ofthe patientstreat-
edwith PUVA.12 Martin et al. reported that an acute adverse event
wasobservedin0.6% ofNB-UVBtreatmentsand1.3% ofsystemic
PUVAtreatmentsintheirstudywheretheyevaluatedtheacuteside
effects of these two methods.20 Inourstudy,theincidenceoferythe-
mapertreatment was 0.43% for NB-UVBtreatmentand 0.46% for
PUVA treatment.No side effect, except slightly elevated liver en-
zymessecondarytopsoralen,whichwouldrequiretheinterruption
oftreatment,wasfoundinanyofthepatientstreatedwithPUVA.No
difference was observed between the two treatment groups in terms
ofsideeffects.However,thelownumberofpatientsandthefactthat
PUVAtreatmentwasnotusedintherisky patientgroup mayhave
caused this result. Late side effects of phototherapy such as photoa-
gingandphotocarcinogenicity,werenotevaluatedinourpatients.
The limitations of our study are that it was retrospective
andthattheremissiondurationsofthepatientsareunknown.How-
ever,thisstudyis valuable asthenumberof patients ishigh,and
there are no other studies in the literature that evaluate the num-
berofphototherapysessions,dose,effectiveness,andsideeffectsof
phototherapy together in the elderly population.
CONCLUSION
In conclusion, the incidence of the response rate and ad-
verse effects in our study is consistent with results from other stud-
iesintheliterature,andourdatashowsthatphototherapyiseffec-
tive and reliable with proper dose increases and close follow-up in
geriatric patients. q
Table 5: Photosensitive drugs most commonly used by the patients
Drugs The Number of the patients (n/%)
Antihistamines Hydroxyzine 43(45.3)
Non-steroidalanti-inammatorydrugs Diclofenac,ibuprofen,ketoprofen,naproxen, 37(38.9)
Cardiovascular drugs Atenolol,nifedipine,captopril 12(12.6)
Diuretics Amiloride,furosemide,hydrochlorothiazide 8(0.1)
Antidiabetics Sulfonylurea 6(0.1)

38 BulurI,KayaErdoganH,AksuAE,KarapınarT,SaracogluZN
An Bras Dermatol. 2018;93(1):33-8.
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