According to a report in the BMJ, UVB phototherapy administered at home for patients with psoriasis, is equally safe and equally effective, both clinically and for quality of life, as ultraviolet B phototherapy administered in an outpatient setting.

These findings come from a pragmatic single blind randomised clinical trial (PLUTO study). conducted at the dermatology departments of 14 hospitals in the Netherlands. The study recruited 196 patients who were clinically eligible for narrowband (TL-01) UVB phototherapy and the first 105 consecutive patients were also followed for one year after therapy. Patients were randomised to UVB phototherapy at home using a TL-01 home phototherapy unit or to standard narrowband UVB phototherapy in an outpatient setting (n=98 in each arm). The main outcome measure was effectiveness as measured by the proportion of patients with a 50% or more reduction of the baseline psoriasis area and severity index (PASI 50) or self administered psoriasis area and severity index (SAPASI 50), as well as the percentage reduction in median scores on the PASI and SAPASI. Secondary outcomes were quality of life, burden of treatment, patients’ preferences and satisfaction and short term side effects.

The following findings were reported:

• 82% of the patients treated at home vs. 79% treated in an outpatient setting reached the SAPASI 50 (difference 2.8%, 95% CI, –8.6% to 14.2%), and 70% vs. 73% reached the PASI 50 (–2.3%, –15.7% to 11.1%).

• For patients treated at home the median SAPASI score decreased 82% (from 6.7 to 1.2) and the median PASI score decreased 74% (from 8.4 to 2.2), vs. 79% (from 7.0 to 1.4) and 70% (from 7.0 to 2.1) for patients treated in an outpatient setting.

• Treatment effect as defined by the mean decline in PASI and SAPASI scores was statistically significant (p < 0.001) and similar across groups (p > 0.3).

• Total cumulative doses of UVB light were similar and the occurrence of short term side effects did not differ.

• The burden of undergoing UVB phototherapy was statistically significantly lower for patients treated at home (differences 1.23 to 3.01, all p </= 0.001).

• Quality of life increased equally regardless of treatment, but patients treated at home more often rated their experience with the therapy as "excellent" (42%, 38/90) vs. patients treated in the outpatient department (23%, 20/88; p = 0.001).

An accompanying editorial discusses the implications of these findings for clinical practice.