Narrow band UVB phototherapy for the treatment of refractory renal pruritus among patients on hemodialysis

الملخص EN

Objective: To assess the efficacy of narrowband ultraviolet B phototherapy for the treatment of refractory renal pruritus among patients on hemodialysis.

Methods: This prospective multi-centered cohort study included 106 adult patients with renal failure on maintenance hemodialysis.

These patients who presented with severe renal pruritus unresponsive to previous therapies, were treated with narrowband ultraviolet B phototherapy three times a week for four months.

The initial therapeutic ultraviolet B dose was dependent on the skin phototype.

The dose was increased by 20% if erythema appeared or by 40% if it did not.

Evaluation of pruritus was carried out monthly during treatment and three months following treatment cessation using the 12-Item pruritus severity scale (PSS).

Results: There was a significant improvement in the degree of pruritus in the first three months of phototherapy.

However, the improvement at the fourth visit was not significant.

Pruritus severity scale decreased from a mean of 19.1 ± 1.9 at the initiation of phototherapy to 9.2 ± 3.9 at the end of treatment (P < .001), but increased to 12.9 ± 4.0 three months after cessation of treatment.

The overall response rate was 78%.

Although the relapse rate was 52%, the overall improvement from pretreatment state was significant (p < .001).

Conclusion: Since there was no significant improvement after the third visit and given that there was a high relapse rate after treatment discontinuation, we recommend starting an induction therapy (3 times a week) in the first three months, then continuing for maintenance therapy with the possibility of combining phototherapy with other systemic therapies.

Narrowband ultraviolet B phototherapy is highly effective for the treatment of renal pruritus, but the clinical response is short-lived with a high relapse rate after discontinuation of phototherapy.