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These interactive case studies were developed with support from Christos Evangelou, MedRight Medical Writing & Editing, San Diego, California, USA.
This content was funded by Phothera®
These are hypothetical patient cases and outcomes may not be reflective of clinical studies or real-life circumstances.
Case by Case: Where Phototherapy Fits in the Treatment Algorithm
Dermatology
2/20
These interactive case studies were developed with support from Kevin LaGuerre, Associate Medical Director, Global Medical; and Nathan Rodeberg, Associate Director, Scientific Communications, Biogen.
The following patient cases are based on clinical experiences but are fictitious and intended for educational purposes only. Individual patient experiences may vary. This resource is not intended for medical advice or as a substitute for consultation and review of reference materials and medical literature pertaining to individual clinical circumstances. HCPs should make all medical decisions based on the context of the situation and their independent clinical judgement. The screening tools presented are provided for your information only and are not endorsements, referrals, or recommendations from Biogen. The use of tools in practice is at the discretion of an HCP's independent medical judgement. Use of the screening and rating tools for PPD provided in this deck should be accompanied by further evaluation for complete diagnosis.
Before we get started, let’s explore some facts about the role of phototherapy today.
Introduction
Case 1
Case 2
Case 3
Takeaways
B
False
A
True
Question 1: Phototherapy is an outdated treatment that has largely been replaced by biologics and targeted therapies.
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Learn more about the history of phototherapy in dermatology.
Phototherapy is a guideline-supported treatment across multiple inflammatory and lymphoproliferative skin diseases.
The AAD guidelines conditionally recommend phototherapy for adults and children with AD, including for moderate-to-severe AD and AD refractory to optimized topical therapy.4,5 Learn more in Case 2.
AD
Narrowband ultraviolet B light phototherapy (NB-UVB) is the preferred first-line treatment for widespread or rapidly progressive vitiligo and is supported as a first-line treatment by the VWG and international expert consensus guidelines.1-3 Learn more in Case 1.
Vitiligo
NB-UVB is a recommended treatment option in psoriasis guidelines and is appropriate for use as monotherapy or as combination therapy for patients requiring more than topical medications.6 Learn more in Case 3.
Psoriasis
CTCL
Expert consensus recommendations include phototherapy as monotherapy for early-stage mycosis fungoides or as part of a multimodality regimen for more extensive or resistant disease.7
Listed as a skin-directed therapy for early-stage CTCL in the NCCN Primary Cutaneous Lymphomas guideline.8
AAD: American Academy of Dermatology; AD: atopic dermatitis; CTCL: cutaneous T cell lymphoma; NB-UVB: narrowband ultraviolet B light phototherapy; NCCN: National Comprehensive Cancer Network; VWG: Vitiligo Working Group.
Phototherapy has been used in dermatology for more than 100 years, making it one of the longest-established treatment modalities still used for modern dermatologic treatment.9 Phototherapy is among the most extensively studied treatment modalities in dermatology. Its efficacy, safety, mechanisms of action, and long-term outcomes have been studied in well-controlled clinical trials in thousands of patients across indications.9
Mohammad TF et al. The Vitiligo Working Group recommendations for narrowband ultraviolet B light phototherapy treatment of vitiligo. J Am Acad Dermatol. 2017;76(5):879-88. van Geel N et al. Worldwide expert recommendations for the diagnosis and management of vitiligo: position statement from the International Vitiligo Task Force part 1: towards a new management algorithm. J Eur Acad Dermatol Venereol. 2023;37(11):2173-84. Seneschal J 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. 2023;37(11):2185-95. Davis DMR et al. Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies. J Am Acad Dermatol. 2024;90(2):e43-e56. Davis DMR et al. Guidelines of care for the management of atopic dermatitis in pediatric patients. J Am Acad Dermatol. 2026;95(1):121.e1-121.e26. Elmets CA 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. 2019;81(3):775-804. Olsen EA et al. Guidelines for phototherapy of mycosis fungoides and Sézary syndrome: a consensus statement of the United States Cutaneous Lymphoma Consortium. J Am Acad Dermatol. 2016;74(1):27-58. National Comprehensive Cancer Network (NCCN). NCCN Guidelines: cutaneous lymphomas. Version 2.2026. Available at: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1549. Last accessed: July 31, 2026. Hönigsmann H. History of phototherapy in dermatology. Photochem Photobiol Sci. 2013;12(1):16-21.
aPercentage of participants who received at least 24 treatments. NB-UVB: narrowband ultraviolet B light phototherapy.
Gelfand JM et al. Home- vs office-based narrowband UV-B phototherapy for patients with psoriasis: the LITE randomized clinical trial. JAMA Dermatol. 2024;160(12):1320-8.
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D
C
Home phototherapy is as effective as office-based phototherapy but has more burden to patients.
Question 2: Which of the following statements is correct regarding home phototherapy, as compared with office-based phototherapy?
Home phototherapy is less effective, and patients are less likely to complete treatment.
The LITE randomized trial in 783 patients with psoriasis demonstrated that home NB-UVB achieved outcomes comparable to office-based treatment while substantially improving adherence.1
None of the above.
Home phototherapy is as effective as office-based phototherapy and has less burden to patients.
Home NB-UVB:1
Office NB-UVB:1
Non-inferior efficacy
Reference comparator
15.9% adherencea
51.4% adherencea
Requires no weekly office visits
Requires visiting the office three times per week
Previous childbirth without perinatal complications
Age <30 years
Question 3: Today's phototherapy devices are the same light boxes used 30 years ago.
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Learn more about home phototherapy devices.
NB-UVB: narrowband ultraviolet B light phototherapy; UV: ultraviolet; UVB: ultraviolet B.
Home UVB phototherapy offers a convenient alternative with comparable efficacy to clinic-based treatment.5 The prescription must include medical necessity letter, last clinic note, demographics, and insurance information.5 Up to 80% of patients receive partial or full coverage.5 Phothera (Bryan, Ohio, USA; evolved from Daavlin and NatBio, with 80+ years combined experience) offers phototherapy systems for both home or in-clinic light therapy.6
Grzybowski A et al. A brief report on the history of phototherapy. Clin Dermatol. 2016;34(5):532-7. Kemény L et al. Advances in phototherapy for psoriasis and atopic dermatitis. Expert Rev Clin Immunol. 2019;15(11):1205-14. Kurz B et al. Phototherapy: theory and practice. J Dtsch Dermatol Ges. 2023;21(8):882-97. U.S. Food and Drug Administration. Product classification: light, ultraviolet, dermatological. Available at: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpcd/classification.cfm?id=6057. Last accessed: July 23, 2026. Bhutani T, Liao W. A practical approach to home UVB phototherapy for the treatment of generalized psoriasis. Pract Dermatol. 2010;7(2):31-5. Phothera. Introducing Phothera: a new era in phototherapy. Available at: https://www.phothera.com/introducing-phothera/. Last accessed: August 23, 2026.
Current phototherapy devices differ substantially from early phototherapy systems.1,2 Modern phototherapy devices incorporate NB-UVB wavelength (311–313 nm), which is less erythematogenic and highly effective in improving skin lesions.1-3 Current UV systems for dermatologic disorders are FDA‑cleared Class II prescription devices.4
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BSA: body surface area.
Case 1: Patient Background and Medical History
34-year-old male, Fitzpatrick Skin Type V Extensive depigmentation (~24% BSA) Previous treatment with topical tacrolimus 0.1% ointment twice daily for 3 months with minimal stabilization and limited repigmentation Wood's lamp examination confirms chalky-white macules characteristic of nonsegmental vitiligo
“I've noticed these patches spreading across my chest and arms over the last 6 months, and topical creams just aren't keeping up.”
Progressive, symmetrical depigmented macules and patches involving the anterior trunk, bilateral arms, neck, and face.
BSA: body surface area; NB-UVB: narrowband ultraviolet B light phototherapy; TCI: topical calcineurin inhibitor; VWG: Vitiligo Working Group.
Mohammad TF et al. The Vitiligo Working Group recommendations for narrowband ultraviolet B light phototherapy treatment of vitiligo. J Am Acad Dermatol. 2017;76(5):879-88. Bae JM et al. Phototherapy for vitiligo: a systematic review and meta-analysis. JAMA Dermatol. 2017;153(7):666-74. Lee JH et al. Treatment outcomes of topical calcineurin inhibitor therapy for patients with vitiligo: a systematic review and meta-analysis. JAMA Dermatol. 2019;155(8):929-38.
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Switch to systemic immunosuppressive therapy with oral corticosteroids.
Case 1: Clinical Case Questions Question 4: What is the most appropriate next step in management for this patient with extensive nonsegmental vitiligo (BSA ≥20%)?
Continue TCI monotherapy for an additional 6 months.
Advise cosmetic camouflage only, as repigmentation in extensive vitiligo is rarely achievable.
Initiate NB-UVB as a primary therapeutic strategy (monotherapy or combined with topical therapy).
International guidelines, including the VWG recommendations, establish NB-UVB as a first-line treatment for widespread vitiligo.1 Meta-analyses demonstrate high rates of repigmentation with NB-UVB.2 Repigmentation rates are 2.6× higher with phototherapy plus TCI than with TCI monotherapy.3 Long-term systemic corticosteroids carry toxicity risks and are not recommended for ongoing maintenance.1
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mo: months; NB-UVB: narrowband ultraviolet B light phototherapy; PUVA: psoralen–UV-A; TCI: topical calcineurin inhibitor; vs: versus.
Bae JM et al. Phototherapy for vitiligo: a systematic review and meta-analysis. JAMA Dermatol. 2017;153(7):666-74. Lee JH et al. Treatment outcomes of topical calcineurin inhibitor therapy for patients with vitiligo: a systematic review and meta-analysis. JAMA Dermatol. 2019;155(8):929-38.
What Can My Patient Expect Regarding Repigmentation?
A meta-analysis of 35 studies investigating NB-UVB in 1,428 patients with vitiligo demonstrated: 74.2% mild responses (≥25% repigmentation) at 6 months1 35.7% marked responses (≥75% repigmentation) at 12 months1 The greatest anatomical response was observed on the face and neck (44% achieving marked repigmentation after at least 6 months of NB-UVB)1
Click to learn more.
Treatment response to NB-UVB and PUVA phototherapy according to treatment duration, and treatment response to NB-UVB depending on body site.1
Treatment response to TCI monotherapy or TCI plus phototherapy in patients with vitiligo.2
A meta-analysis of 46 studies (1,499 patients) showed that combining phototherapy with a TCI is: 2.6× more effective than TCI monotherapy (≥75% repigmentation in 47.5% vs 18.1%)2 Especially effective for facial/neck repigmentation (55.2% achieved ≥75% facial/neck repigmentation)2
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aNB-UVB therapy was added to the treatment regimen of patients with Pandya AG et al. Efficacy and safety of ruxolitinib cream combined with narrow-band UVB phototherapy for treatment of vitiligo. J Invest Dermatol. 2026;146(7):1867-75.e4. Silpa-Archa N et al. Treatment outcome and persistence of repigmentation from narrow-band ultraviolet B phototherapy in vitiligo. J Dermatolog Treat. 2019;30(7):691-6. Further Evidence for Combination Therapy in Vitiligo “I've noticed these patches spreading across my chest and arms over the last 6 months, and topical creams just aren't keeping up.” Progressive, symmetrical depigmented macules and patches involving the anterior trunk, bilateral arms, neck, and face. A Phase II study in 55 patients with nonsegmental vitiligo showed that adding NB‑UVB after 12 weeks of topical JAK inhibitor ruxolitinib accelerates repigmentation in patients who initially respond poorly to ruxolitinib alone, without introducing new safety concerns.a,b,1 Retrospective analysis of 58 patients receiving NB-UVB for vitiligo showed that approximately 85% maintained repigmentation at 1 year after NB-UVB discontinuation.c,2 Click to learn more. Click to learn more. Mean (95% CI) percentage change from baseline in T-VASI and F-VASI for patients who received combination ruxolitinib cream and NB-UVB therapy after Week 12.a,b,1 Kaplan–Meier survival analysis showing duration until vitiligo relapse.2 Introduction Case 1 Case 2 Case 3 Takeaways
Pandya AG et al. Efficacy and safety of ruxolitinib cream combined with narrow-band UVB phototherapy for treatment of vitiligo. J Invest Dermatol. 2026;146(7):1867-75.e4. Silpa-Archa N et al. Treatment outcome and persistence of repigmentation from narrow-band ultraviolet B phototherapy in vitiligo. J Dermatolog Treat. 2019;30(7):691-6.
Further Evidence for Combination Therapy in Vitiligo
A Phase II study in 55 patients with nonsegmental vitiligo showed that adding NB‑UVB after 12 weeks of topical JAK inhibitor ruxolitinib accelerates repigmentation in patients who initially respond poorly to ruxolitinib alone, without introducing new safety concerns.a,b,1 Retrospective analysis of 58 patients receiving NB-UVB for vitiligo showed that approximately 85% maintained repigmentation at 1 year after NB-UVB discontinuation.c,2
Mean (95% CI) percentage change from baseline in T-VASI and F-VASI for patients who received combination ruxolitinib cream and NB-UVB therapy after Week 12.a,b,1
Kaplan–Meier survival analysis showing duration until vitiligo relapse.2
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NB-UVB: narrowband ultraviolet B light phototherapy.
Case 1: Clinical Outcome
A personalized treatment plan was created to improve repigmentation. NB-UVB was added to his current topical treatment regimen; the patient was treated with NB-UVB three times per week. This enabled the patient to gain better repigmentation, with marked responses seen in the face and neck at 6 months.
Click to explore clinical case photographs.
Before treatment
After treatment
Consent has been granted for the use of all images within this case study.
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AD: atopic dermatitis; BSA: body surface area.
Eichenfield LF et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014;70(2):338-51.
Case 2: Patient Background and Medical History
5-year-old male presenting with moderate-to-severe AD (18% total BSA) Flares repeatedly despite mid- to high-potency topical corticosteroids and emollients
AD is primarily a childhood disease, affecting up to 25% of children, compared with 2–3% of adults.1 Approximately 60% of cases develop during the first year of life and 90% by age 5 years.1
Learn more about pediatric AD.
“He's itching constantly. Itching is affecting his sleep quality, and he’s missing school frequently. He’s scared of needles, and we’re really nervous about putting him on pills.”
Generalized xerosis, lichenified flexural plaques, and severe pruritus impacting sleep.
AD: atopic dermatitis; NB-UVB: narrowband ultraviolet B light phototherapy.
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Advise strict emollient monotherapy and decline further intervention.
Case 2: Clinical Case Questions Question 5: What is the most appropriate next step for this 5-year-old child with refractory AD whose parents decline systemic therapy?
Prescribe a continuous course of high-potency oral systemic corticosteroids.
Insist on injectable biologic therapy, despite parent refusal and severe needle phobia.
Initiate NB-UVB as a safe, effective non-systemic add-on or primary therapy.
Both the 2026 pediatric AD guidelines and the 2024 adult AD guidelines conditionally recommend phototherapy for AD, including for moderate-to-severe AD and AD refractory to optimized topical therapy.1,2 Guidelines recommend against systemic corticosteroids for routine AD management, citing evidence of rebound flares and toxicity.1,2 The guidelines recommend shared decision‑making, considering the severity of AD, its impact on the patient and their caregivers, and the efficacy, safety, and accessibility of the interventions.1
Davis DMR et al. Guidelines of care for the management of atopic dermatitis in pediatric patients. J Am Acad Dermatol. 2026;95(1):121.e1-121.e26. Davis DMR et al. Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies. J Am Acad Dermatol. 2024;90(2):e43-e56.
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Darné S et al. Narrowband ultraviolet B phototherapy in children with moderate-to-severe eczema: a comparative cohort study. Br J Dermatol. 2014;170(1):150-6. Jury CS et al. Narrowband ultraviolet B (UVB) phototherapy in children. Clin Exp Dermatol. 2006;31(2):196-9. Choi JY et al. Narrowband ultraviolet B phototherapy is associated with a reduction in topical corticosteroid and clinical improvement in atopic dermatitis: a historical inception cohort study. Clin Exp Dermatol. 2021;46(6):1067-74.
What Does the Clinical Evidence Show Regarding Phototherapy in Pediatric AD?
In a prospective pediatric study, a 12-week course of twice-weekly NB-UVB reduced disease severity by 61% in treated children, compared to a 6% increase in severity in untreated controls; benefits were maintained for 6 months after treatment.1 Prospective and retrospective studies have demonstrated that NB-UVB is well tolerated and safe in pediatric populations, with adverse events limited to mild, transient erythema.1,2 In adults with AD, NB-UVB is associated with a reduction in topical corticosteroid use.3
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Case 2: Clinical Outcome
A personalized treatment plan was created to reduce AD severity while avoiding the use of injectable treatments. NB-UVB was initiated as primary therapy, administered at home three times per week. This reduced AD severity and reduced the need for topical corticosteroids within 7 weeks of starting treatment. At-home treatment made it convenient for the parent and child, who can plan treatments around work, school, and activities.
aNB-UVB therapy was added to the treatment regimen of patients with 15/20 Case 3: Patient Background and Medical History 31-year-old female with psoriasis (12% total BSA) Mild baseline hepatic impairment; immunocompromised status Suboptimal response after 2 years on biologic therapy “My psoriasis plaques have plateaued on my current biologic, and now my husband and I are planning to start a family.” Erythematous, scaly plaques on arms, hands, and extensor surfaces; persistent itching. BSA: body surface area. Dermatology Introduction Case 1 Case 2 Case 3 Takeaways
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Case 3: Patient Background and Medical History
31-year-old female with psoriasis (12% total BSA) Mild baseline hepatic impairment; immunocompromised status Suboptimal response after 2 years on biologic therapy
“My psoriasis plaques have plateaued on my current biologic, and now my husband and I are planning to start a family.”
Erythematous, scaly plaques on arms, hands, and extensor surfaces; persistent itching.
AAD: American Academy of Dermatology; NB-UVB: narrowband ultraviolet B light phototherapy; NPF: National Psoriasis Foundation.
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Add NB-UVB as a combination strategy to overcome the plateau.
Case 3: Clinical Case Questions Question 6: What is the most appropriate management approach for this patient plateauing on therapy who is planning pregnancy?
Switch immediately to an oral systemic immunosuppressive agent like methotrexate.
Increase topical steroid application to maximum daily limits across all plaques indefinitely.
Discontinue all active treatment and avoid any therapy until after pregnancy and lactation.
Elmets CA 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. 2019;81(3):775-804. Bae YS et al. Review of treatment options for psoriasis in pregnant or lactating women: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2012;67(3):459-77.
Joint AAD-NPF guidelines support NB-UVB as an effective, safe modality for patients with psoriasis:1 NB-UVB is recommended as monotherapy or in combination for patients with plaque psoriasis or guttate psoriasis. Home NB-UVB is recommended for appropriate patients with generalized plaque psoriasis as an alternative to in-office NB-UVB. NB-UVB is recommended for pregnant women with generalized plaque psoriasis and guttate psoriasis. NB-UVB can be used in combination with topical therapy to improve efficacy, or in combination with oral retinoids or apremilast for appropriate patients with generalized plaque psoriasis who do not respond adequately to monotherapy. Exposure to high-potency topicals carries risks of systemic absorption, and systemic agents such as methotrexate can be teratogenic and contraindicated during pregnancy planning.2
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Almutawa F et al. Systematic review of UV-based therapy for psoriasis. Am J Clin Dermatol. 2013;14(2):87-109. Foerster J et al. Narrowband UVB treatment is highly effective and causes a strong reduction in the use of steroid and other creams in psoriasis patients in clinical practice. PLoS One. 2017;12(8):e0181813. Bae YS et al. Review of treatment options for psoriasis in pregnant or lactating women: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2012;67(3):459-77.
What Clinical Outcomes and Safety Parameters Support the Use of NB-UVB in This Patient with Psoriasis?
A meta-analysis of NB-UVB monotherapy trials in psoriasis showed that 62% of patients achieve 75% clearance threshold, with an average lesion clearance of 68%.1 In a real-world study, 75% of patients with psoriasis achieved clear or minimal disease at 16 weeks following a single course of NB-UVB.2 Successful NB-UVB therapy reduces reliance on topical corticosteroids (24% fewer patients requiring topical steroids and 31% fewer requiring psoriasis-specific topicals at 12 months).2 NB-UVB has not been associated with an increased risk of fetal abnormalities or premature delivery, and phototherapy would not be anticipated to be a problem in lactating patients.3
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Case 3: Clinical Outcome
A personalized treatment plan was created to improve lesion clearance while avoiding the use of topical steroids or oral systemic immunosuppressive agents such as methotrexate. NB-UVB was added as a combination strategy to overcome the plateau; the patient was treated with NB-UVB three times per week. This enabled the patient to experience reduced psoriasis severity and reduced the requirement for topical steroids.
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Mohammad TF et al. The Vitiligo Working Group recommendations for narrowband ultraviolet B light phototherapy treatment of vitiligo. J Am Acad Dermatol. 2017;76(5):879-88. Bae JM et al. Phototherapy for vitiligo: a systematic review and meta-analysis. JAMA Dermatol. 2017;153(7):666-74. Bae YS et al. Review of treatment options for psoriasis in pregnant or lactating women: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2012;67(3):459-77. Foerster J et al. Narrowband UVB treatment is highly effective and causes a strong reduction in the use of steroid and other creams in psoriasis patients in clinical practice. PLoS One. 2017;12(8):e0181813. Elmets CA 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. 2019;81(3):775-804. Jury CS et al. Narrowband ultraviolet B (UVB) phototherapy in children. Clin Exp Dermatol. 2006;31(2):196-9. Darné S et al. Narrowband ultraviolet B phototherapy in children with moderate-to-severe eczema: a comparative cohort study. Br J Dermatol. 2014;170(1):150-6. Davis DMR et al. Guidelines of care for the management of atopic dermatitis in pediatric patients. J Am Acad Dermatol. 2026;95(1):121.e1-121.e26. Torres AE et al. Role of phototherapy in the era of biologics. J Am Acad Dermatol. 2021;84(2):479-85. AAAAI/ACAAI JTF Atopic Dermatitis Guideline Panel; Chu DK et al. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations. Ann Allergy Asthma Immunol. 2024;132(3):274-312.
Your Next Clinic Day: Who is a Good Candidate for NB-UVB?ᵃ
The principal treatment for widespread vitiligo; safe and effective for repigmentation.1,2
Plateauing/ combination patients5
Individuals who are immunocompromised9
Pregnant/planning pregnancy3
Widespread vitiligo (BSA ≥20%)1,2
Needle-averse1,5,10
Pediatric patients with AD or psoriasis6-8
High topical steroid reliance4
Patients at risk of corticosteroid toxicity where steroid-sparing is required.4
Children needing effective non-systemic control without frequent injections.6-8
Phototherapy is safe to use in immunocompromised patients (e.g., individuals with HIV infection).9
Patients needing non-teratogenic disease control without systemic drug exposure.3
Partial responders on topicals, systemics, or biologics who need a safe add-on to achieve complete clearance.5
Several dermatology guidelines support phototherapy as a needle-free treatment for patients who are averse to injections or cannot tolerate systemic medications.1,5,10
aPatient profiles are based on the case studies and are not an exhaustive list. AD: atopic dermatitis; BSA: body surface area; NB-UVB: narrowband ultraviolet B light phototherapy.
Thank you
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