Refer for the condition, not the treatment
Phototherapy is prescribed by a dermatologist once the diagnosis is confirmed, the extent and severity are recorded, the patient's skin type and medication list have been reviewed for photosensitivity, and alternatives have been discussed. For that reason, family physicians and nurse practitioners should refer the patient for the underlying condition, for example psoriasis or vitiligo, rather than "for phototherapy".
If you believe phototherapy is likely to be appropriate, say so in the referral. Note the body surface area involved, what topical therapy has been tried and for how long, and whether the patient is able to attend up to three times a week for several weeks. This lets us book the consultation with phototherapy assessment in mind.
Referrals go by fax to 905 625 5650 as described on how to refer.
What to put in the referral
Beyond the standard referral checklist, the following makes a phototherapy assessment straightforward at the first visit:
- The working diagnosis, the extent of disease and its severity
- Topical and systemic treatments already tried, with duration and response
- The current medication list, with attention to photosensitising drugs
- Prior phototherapy or PUVA exposure, prior skin cancer, and any photosensitive disorder
- Immunosuppression, including transplant medication and biologic therapy
- Two working telephone numbers, and whether attending several times a week is realistic for the patient
Conditions treated
Narrowband UVB is an established treatment for a number of inflammatory and pigmentary skin diseases. At DermCare it is used for:
| Condition | Notes for referrers |
|---|---|
| Plaque and guttate psoriasis | Suited to widespread disease not controlled with topical therapy. Can be combined with topical or systemic treatment. |
| Atopic dermatitis and other eczemas | Adults with widespread disease. Often used as a steroid sparing measure. |
| Vitiligo | Courses are longer than for psoriasis. The face and trunk tend to respond more readily than the hands and feet. |
| Generalised pruritus | Including pruritus of renal or hepatic origin once the underlying cause has been assessed. |
| Other photoresponsive dermatoses | Including lichen planus, pityriasis lichenoides and early stage cutaneous T cell lymphoma, at the dermatologist's discretion. |
Phototherapy is not offered for cosmetic indications, for tanning, or where a patient has a photosensitive disorder, a history of melanoma, or is taking a medication that makes ultraviolet exposure unsafe. These are assessed at the consultation. Paediatric dermatology is not offered at DermCare, so please refer children elsewhere.
Shape of a course
A course of narrowband UVB runs up to three sessions a week over several weeks. Each session is short, usually a few minutes in the cabinet, with a further few minutes for preparation and documentation. Doses are increased step by step according to the patient's skin type and response, under a protocol signed by the ordering physician. Treatment is paused or adjusted if the skin becomes tender or burns.
There is one phototherapy cabinet at the clinic, so appointment times are finite and a patient who can be flexible will start sooner. Patients also need to commit to the schedule, because missed sessions reduce effectiveness and may require the dose to be stepped back. When discussing the option with a patient, it is worth confirming that travelling to the clinic that often is realistic for them.
What patients are told
Patients receive written information before the first treatment covering eye protection, genital shielding, sun avoidance on treatment days, moisturiser use and what to report. The phototherapy service page and the patient information section cover this in patient facing language.
OHIP coverage
Phototherapy is an insured service under OHIP when ordered by a physician for a recognised medical diagnosis. There is no charge to the patient for treatment sessions. The patient must hold a valid Ontario health card, and the referral for the underlying condition must be in place. Cosmetic indications are not insured.