Narrowband ultraviolet B (NBUVB) phototherapy is a well-established treatment modality for psoriasis. We performed a retrospective analysis of children of East Asian descent with psoriasis treated with NBUVB phototherapy at the National Skin Centre, Singapore, over a 5-year period between 2004 and 2008 and found that NBUVB phototherapy is safe and effective for the treatment of psoriasis in children of East Asian descent.

1. Role of Narrowband Ultraviolet B
Phototherapy in the Treatment of Childhood
Psoriasis in Asian Children
Abstract: Narrowband ultraviolet B (NBUVB)
phototherapy is a well-established treatment modality
for psoriasis. We performed a retrospective analysis
of children of East Asian descent with psoriasis
treated with NBUVB phototherapy at the National Skin
Centre, Singapore, over a 5-year period between 2004
and 2008 and found that NBUVB phototherapy is safe
and effective for the treatment of psoriasis in children
of East Asian descent.
Psoriasis and its treatment in children pose a unique
challenge to physicians. The aim of this study was to
evaluate the efficacy and safety of narrowband
ultraviolet B (NBUVB) in the treatment of child-
hood psoriasis in an East Asian population in
Singapore.
METHODS AND STUDY DESIGN
This was a retrospective study involving children
younger than 18 years of age with clinically diagnosed
psoriasis who had undergone NBUVB at the National
Skin Centre, Singapore, over a 5-year period between
2004 and 2008. Ethics approval for the study was
obtained before medical records were assessed. The
data collected are summarized in Table 1.
Treatment with NBUVB was determined accord-
ing to Fitzpatrick skin phototype and the dose was
increased according to study protocol. Treatment
frequency was two to three times per week.
An excellent treatment response was defined as a
reduction of more than 90% in body surface area
(BSA) involved, a good response as a 70% to 90%
reduction, a moderate response as a 50% to 70%
reduction, and a poor response as a less than 50%
reduction.
DOI: 10.1111/pde.12632
TABLE1.ClinicalCharacteristicsofChildrenwithPsoriasisWhoUnderwentNarrowbandUltravioletBTherapy
Patient
Age,
yearsSex
BSAbefore
treatment,%
BSAafter
treatment,%
BSA
improvement,%
Treatment
sessions,n
Lengthof
treatmentbefore
improvement,months
Maximum
dose,mJ/cm2
Lengthof
timebefore
recurrence,monthsComplications
18Female2010060241,6316Mildburnoveraxilla
211Male103705762,133NorelapseNone
313Female10DiscontinuedDiscontinued1211,155DiscontinuedNone
411Female152871851,00060None
510Female1501002541,027NorelapseNone
66Female30197125301,129NorelapseNone
78Female10DiscontinuedDiscontinued1211,412DiscontinuedNone
89Female5180136171,09536None
97Female2029095171,783NorelapseNone
1011Female3058373102,333NorelapseBurningandpain
1112Female7069166172,33312Itch
1211Male40253891380NorelapseItch,erythema,pain
BSA,bodysurfacearea.
© 2015 Wiley Periodicals, Inc. e221
Pediatric Dermatology Vol. 32 No. 5 e221–e223, 2015

2. RESULTS
Over the 5 years we identified 12 patients (6 Malay, 4
Chinese, 1 Indian, and 1 of mixed Eurasian parentage;
mean age 9.75 years, with a preponderance of girls)
who fulfilled our study criteria. The indications for
treatment were suboptimal response to appropriate
topical therapy or extensive BSA involvement and
consequent risk of side effects from topical steroids.
BSA involvement before NBUVB phototherapy
ranged from 2% to 70%. Eleven patients presented
with chronic plaque psoriasis and one with guttate
psoriasis.
During phototherapy, patients were allowed top-
ical treatment. The highest doses administered ranged
from 380 to 2,333 mJ/cm2
(mean 1,451 mJ/cm2
). The
number of treatments ranged from 9 to 136 (mean
57.3 treatments). The duration of phototherapy
ranged from 1 to 30 months (mean 11 mos).
Response to NBUVB was excellent in five patients
and good in four. One patient reported poor improve-
ment and stopped treatment after nine sessions
because of increased erythema. Two patients discon-
tinued treatment after 12 sessions of phototherapy for
unknown reasons.
Four patients experienced worsening of their
psoriasis after stopping NBUVB. The length of time
between stopping phototherapy and worsening
ranged from 6 months to 5 years (mean 28.5 mos).
All four had good response after recommencement
of phototherapy. None of the patients required
systemic therapy during or after treatment with
NBUVB. All patients were followed up for at least
1 year.
Four patients experienced a mild burning sensa-
tion, pain, erythema, or itching, none of which
resulted in discontinuation of treatment.
DISCUSSION
Table 2 summarizes past studies that examined the
use of NBUVB in childhood psoriasis. We have
included our study for comparison.
Although NBUVB has been shown to be safe and
effective in children with psoriasis, long-term photo-
carcinogenicity has yet to be evaluated. Therefore
patients should be closely followed.
CONCLUSION
NBUVB is a safe and effective treatment for
childhood psoriasis and should be considered in
children with suboptimal response to topical
therapy.
TABLE 2. Narrowband Ultraviolet B Treatment in Children with Psoriasis: Literature Review
Reference Patients, n Outcome Side effects
Pasic et al (1) 20 45% (n = 9) of patients had excellent response (>90%
reduction in PASI score), 20% (n = 4) had good
response (70%–90% reduction in PASI score), 20%
(n = 4) had moderate response (50%–70% in PASI
score), 15% (n = 3) did not improve after treatment
(<50%
improvement in PASI score)
None reported
Zamberk et al (2) 20 52.2% of patients had >90% improvement of initial
PASI, and median remission period was 8 mos, with 6
patients needing new treatment course due to relapse
35% erythema
Pavlovsky et al (3) 79 51% (n = 40) achieved clearance and 41% (n = 39) had
good response of >75% improvement
15% mild erythema,
1% pruritus,
3% burn
Jury et al (4) 35 63% (n = 22) of patients had cleared or had minimal
residual disease, 9% (n = 13) were not better by the end
of the treatment
30% erythema,
5 had blisters,
1 had varicella zoster
virus reactivation,
2 had herpes simplex
virus reactivation,
5 had anxiety
Tan et al (5) 38 90% of patients had response to treatment (>75%
improvement or clearance)
36% erythema
Wong et al (this study) 12 50% (n = 5) of patients had excellent response (>90%
improvement in BSA), 40% (n = 4) had good response
(70%–90% improvement in BSA), 10% (n = 1) had no
improvement
4 experienced burning
sensation, itch, or erythema
PASI, Psoriasis Area and Severity Index; BSA, body surface area.
e222 Pediatric Dermatology Vol. 32 No. 5 September/October 2015

3. REFERENCES
1. Pasic A, Ceovic R, Lipozencic J et al. Phototherapy
in pediatric patients. Pediatr Dermatol 2003;20:71–77.
2. Zamberk P, Velazquez D, Campos M et al. Paediatric
psoriasis—narrowband UVB treatment. J Eur Acad
Dermatol Venereol 2010;24:415–419.
3. Pavlovsky M, Baum S, Shpiro D et al. Narrow band
UVB: is it effective and safe for paediatric psoriasis and
atopic dermatitis? J Eur Acad Dermatol Venereol
2011;25:727–729.
4. Jury CS, McHenry P, Burden AD et al. Narrowband
ultraviolet B (UVB) phototherapy in children. Clin Exp
Dermatol 2006;31:196–199.
5. Tan E, Lim D, Rademaker M. Narrowband UVB
phototherapy in children: a New Zealand experience.
Australas J Dermatol 2010;51:268–273.
Yisheng Wong, M.B.B.S.*
Mark Jean-Aan Koh, M.B.B.S.†
Wei-Sheng Chong, M.B.B.S.*
*National Skin Centre, Singapore, †Dermatology Service,
KK Women’s and Children’s Hospital, Singapore
Address for correspondence to Mark Jean Aan Koh,
Dermatology Service, KK Women’s & Children’s Hospital, 100
Bukit Timah Road, Singapore 229899, or e-mail: mark.koh.ja@
kkh.com.sg.
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