Old Dog, New Tricks: Rethinking Phototherapy for Psoriasis and Beyond

In this clinically deep and surprisingly modern discussion, host Jamie Restivo, MPAS, PA-C sits down with Lawrence Green, MD, board-certified dermatologist, clinical professor at George Washington University, and Chair of the National Psoriasis Foundation Research Committee, to reexamine a decades-old therapy through a fresh lens: narrowband UVB phototherapy.   Dr Green traces phototherapy’s evolution from the cumbersome Goeckerman tar regimens of the 1990s to today’s safe, targeted narrowband UVB devices (310–312 nm), which drastically limit carcinogenic wavelengths and offer a more precise inflammatory response. “Phototherapy of the 1990s is not the phototherapy we use today,” he emphasizes, calling it a niche therapy that remains the best choice for very specific patient groups.   Together, Restivo and Green outline where light treatment truly shines: guttate psoriasis, pregnancy, pediatric cases, episodic flares, extensive vitiligo, severe pruritus, and moderate plaque disease that is too widespread for topicals but not appropriate for biologics. Narrowband UVB, Green stresses, is “local therapy that leads to a systemic immune response,” allowing treatment without placing medication into the body.   The conversation then shifts to at-home phototherapy, a modality Dr Green once avoided due to safety concerns, user error, and poor adherence. That changed with modern guided systems that mimic in-office decision-making through dose-adjusted protocols, Fitzpatrick-based starting points, and real-time compliance reporting back to the prescriber. Green highlights findings from the landmark LITE study, led by Joel Gelfand, MD, which showed home treatment to be non-inferior to office-based phototherapy, equally safe, and three times more likely to be completed, across diverse skin types.   He concludes with a pragmatic reminder: clinicians no longer need light boxes in their offices to prescribe phototherapy. “Phototherapy is for everyone,” Green says. “It’s an older therapy that’s now a new therapy because of the technology… We’ve taught an old dog new tricks.”