Phototherapy in Geriatric Patients: Ten Years of Clinical Experience in a Tertiary Dermatology Clinic.

Background

Phototherapy is a well-established treatment for various chronic inflammatory dermatoses, yet data on its safety and efficacy in geriatric populations remain limited. Older adults face unique clinical challenges due to age-related physiological changes, comorbidities, and polypharmacy, which may impact treatment responses and tolerance.

Objective

This study aimed to evaluate the safety, efficacy, and clinical outcomes of phototherapy in elderly patients treated over a 10-year period at a tertiary dermatology center. Materials and

Methods

A retrospective analysis was conducted on patients aged ≥65 years who received ≥8 sessions of phototherapy between 2013 and 2023. Narrowband UVB (NB-UVB), systemic psoralen plus ultraviolet A (PUVA), and localized PUVA therapies were administered using standardized protocols. Diagnosis-specific clinical criteria were used to assess treatment response. Data on adverse events, recurrence, and the need for additional sessions were recorded.

Results

The study included 149 patients (mean age 70.2 ± 5.0 years; 44.3% female, 55.7% male) with 19 distinct dermatologic diagnoses. The most common indications were psoriasis (24.8%), generalized pruritus (18.1%), mycosis fungoides (11.4%), and lichen planus (6.7%). NB-UVB was used in 85.2% patients, while 10.1% received local PUVA and 4.7% underwent systemic PUVA. Overall, 83.2% of patients demonstrated clinical improvement. The highest treatment durations and cumulative doses were observed in mycosis fungoides (mean 9.3 months, 88.7 J/cm2) and lichen planus (9.5 months, 59.6 J/cm2). Adverse events occurred in 12.8%, predominantly mild erythema and pruritus. Recurrence was noted at 18.1%, and 16.1% required additional sessions. Despite 40.9% of patients using photosensitizing medications, no severe phototoxic reactions were observed.

Conclusions

Phototherapy is a safe, effective, and well-tolerated treatment option for elderly patients with a variety of dermatologic conditions. The high clinical response rates, even in complex and refractory cases, support its continued use in this population. With its favorable safety profile and non-systemic nature, phototherapy remains a particularly suitable modality in the context of multimorbidity and polypharmacy. Further large-scale, multicenter prospective studies are warranted to establish standardized protocols tailored for geriatric populations.