ABSTRACT
As the COVID-19 pandemic hit, many phototherapy centres stopped treating patients completely or limited services to very urgent patients only. As the duration of the pandemic became evident and owing to the need to offer alternatives to systemic immunosuppressive drugs for many patients with inflammatory skin disease, we adapted our service to treat increasing patient numbers. Offering treatment over extended hours and Saturday morning, and reorganizing waiting areas and the flow of how patients entered and exited the unit allowed social distancing. This also provided time for the cleaning of equipment between patients. A survey confirmed that patients felt very safe attending treatment. Our unit has also offered a home phototherapy service since 2016 - initially four units and expanded to eight in 2018. To allow continued access for our cohort of vulnerable, shielding patients, we drew up a compelling business case and submitted a funding application to the Trust's emergency COVID-19 budget, successfully obtaining funding for an additional 10 units. Our existing Waldman home units are no longer manufactured, but we were able to source three units from existing stock and seven additional Daavlin 7 Series units from Scott Medical. The home phototherapy service offers treatment for a wide range of inflammatory skin diseases, including psoriasis, eczema, urticaria, polymorphic light eruption, pruritus and pityriasis lichenoides chronicus. In 2020, despite staff redeployment and before the arrival of the new units, patients receiving home phototherapy included 16 patients with psoriasis who were shielding or could not travel to hospital. Eighty-one per cent of patients achieved clear or minimal residual disease activity within 30 exposures or less by the end of their course, which is comparable to our hospital-based service. Rates of symptomatic erythema (E2) were 1% of total number of exposures delivered in this patient group with no episodes of E3 or E4. Our in-hospital erythema rate for 2020 was 2 2%. There were very high levels of patient satisfaction. This highlights the importance of home phototherapy and provides additional evidence that it is safe and effective. The expansion in our service brought about by the COVID-19 pandemic will allow us to extend this service to more patients in the future.