Narrowband ultraviolet B phototherapy in recalcitrant vulval psoriasis: A local treatment protocol and pilot study

Introduction: Topical corticosteroids of moderate to high potency are effective in achieving remission in more than 93% of cases of vulval psoriasis.1 However, a small subset of patient’s remains recalcitrant to conventional topical therapies. We present a local treatment protocol and pilot study of the administration of narrowband ultraviolet B (NBUVB) phototherapy in seven patients with recalcitrant vulval psoriasis.
Methods: We identified seven patients with recalcitrant vulval psoriasis, who attended the phototherapy clinic at a tertiary referral hospital between January 2013 and October 2016 for the administration of NBUVB phototherapy. The majority of patients (n=4) commenced at an initial dose of 35 mJ/cm2, and the dose was increased in increments of 20-30 mJ/cm2 depending on clinical response.
Results: At one month, all patients (n=7) experienced at least a reduction in their vulval symptoms. On completion of the NBUVB phototherapy cycle (n=6), the symptoms of vulval psoriasis completely resolved in 66.6% (n=4) of patients, with minimal to no adverse effects.
Conclusion: Recalcitrant vulval psoriasis has the potential to respond positively to NBUVB phototherapy with adjuvant topical therapy. A larger prospective study should be undertaken in the future.
1. Kapila S, Bradford J, Fischer G. Vulvar psoriasis in adults and children: a clinical audit of 194 cases and review of the literature. J Low Genit Tract Dis. 2012; 16(4): 364-71.

Dr. Vincent Wong

Dept of Geriatrics, Westmead Hospital

I am a JMO at Westmead Hospital, with a keen interest in skin disease and research.