Successful implementation of phototherapy guidelines during the COVID-19 pandemic

To the Editor: During portions of the COVID-19 pandemic, phototherapy services were largely discontinued due to concerns of sanitation and disease spread. Our safety-net hospital serves a racially diverse neighborhood that experienced some of the highest death rates in New York City (NYC).¹ With the lockdown in March 2020, we suspended all in-person clinic visits and phototherapy sessions until July 2020. As restrictions lessened and in-person clinic visits returned, we began to schedule phototherapy patients. To facilitate the return of phototherapy in the COVID-19 pandemic, we followed the recommendations of Lim et al.² Herein, we describe the successful implementation of the recommendations for phototherapy during the COVID-19 pandemic for the past 6 months at an NYC safety-net hospital.

With in-person clinic visits resuming in July 2020, patients chose to continue or discontinue phototherapy based on their own discretion. Initially, phototherapy sessions were reserved for patients with early-stage Mycosis fungoides. As early as August 2020, sessions resumed for patients with psoriasis, atopic dermatitis, and vitiligo. Narrow-band UV-B phototherapy was administered twice weekly, with all patients starting at beginning doses based on their Fitzpatrick phototype.

From July 1, 2020, to January 1, 2021, 36 patients completed 440 phototherapy appointments (Table I ). Five patients tested negative for COVID-19 infection during this period, and 1 tested positive (Table I). While most of our patients were not tested for COVID-19, we would have expected a surge in positive cases if the infection was transmissible through phototherapy. Instead, as the number of phototherapy visits increased over the last 6 months, there was no surge in COVID-19 cases. In addition, while Lim et al² recommended cotton masks for patients, with the exception of those receiving a total body treatment, we supplied and required all patients to wear surgical masks while in the phototherapy booths. Therefore, low COVID-19 transmissibility may be attributed to our mask requirement for all phototherapy patients, in conjunction with the other safety precautions implemented (Table II ).

Table I.

Phototherapy appointments and patient demographics

	July 1, 2020 to January 1, 2021
Patients	36
Appointments
Completed	440
Canceled	59
No show	87
Sex
Female	19
Male	17
Race
Asian	1
African American/Black	6
Caucasian/White	3
Hispanic	21
Other	5
Insurance type
Commercial	3
Medicaid	18
Medicare	3
Self-pay	15
Diagnoses
Psoriasis	12
Vitiligo	8
Mycosis fungoides	6
Atopic dermatitis	5
Prurigo nodularis	5
COVID-19 status
Positive	1
Negative	5
Unknown	30

Table II.

Phototherapy COVID-19 safety precautions

Appointment instructions

Patients must apply hand sanitizer before entering and exiting the unit

Patients use their individual goggles

Patients must store clothing in a bag during treatment

Clinic protocols

Patients attend phototherapy appointments alone

All patients must remain socially distanced from each other

Patients' appointments are scheduled no more than every 30 minutes∗

Patient screening

Patients complete a symptom questionnaire

Patients undergo a temperature check

^∗The clinic has 1 phototherapy cabinet, and only 1 patient was allowed to attend at a time. To allow for adequate social distancing and cleaning between patients, the clinic limited the number of phototherapy sessions upon returning to the in-person clinic.

Overall, phototherapy declined during the COVID-19 pandemic.³ Lapses in treatment put patients at risk for disease exacerbation, so alternative treatment options have been suggested.⁴ One recommendation for patients in need of UV-B phototherapy during the COVID-19 pandemic is home phototherapy devices; however, most of our phototherapy patients are self-pay or on Medicaid and are unlikely to afford a home device out of pocket (Table I). In addition, online prices for home phototherapy units range from $1650 to $8350,⁵ a cost that is often above our patients' means. Thus, while home devices may be a viable option for some patients, the cost may be a major barrier to our patient population.

The absence of increased COVID-19 infection in our patients suggests that home phototherapy devices are not necessary for those wishing to continue treatment. Patients should be reassured that while the risk of COVID-19 transmission is not eliminated, phototherapy can be safely administered in the clinic during the COVID-19 pandemic with the implementation of recommended guidelines,² in addition to mask usage while in the phototherapy booth.

Conflicts of interest

None disclosed.