PD12 Roadmap on how to set up home handheld phototherapy in the National Health Service: implementation of evidence-based treatment in the ‘real world’

Vitiligo is the most common pigmentary disorder, and affects around 0.4% of the population in the UK. Recently conducted, two large retrospective observational studies using the UK Clinical Practice Research Datalink and Hospital Episode Statistics databases demonstrated that adults with vitiligo have an increased risk of subsequently being diagnosed with new-onset depression (25%) and anxiety (23%). The studies also found that people with both vitiligo and a mental health comorbidity have increased use of primary care services and are twice as likely to have recorded time off work and unemployment. Interestingly, the majority of patients (85%) were not prescribed any vitiligo-related treatments within a year of diagnosis for vitiligo. Second-line treatment for vitiligo includes either whole-body or localized phototherapy. Traditionally, narrowband ultraviolet B (NB-UVB) is reserved for people with extensive vitiligo and is delivered in secondary care using full-body units, requiring regular hospital attendance. In the current National Health Service (NHS) crisis, many NHS dermatology departments offer phototherapy either to a very limited number of patients with vitiligo or not at all, due to constraints on phototherapy services. The British Association of Dermatologists guidelines recommend that limited vitiligo can be treated with handheld NB-UVB devices. This recommendation was based on the results of a large, pragmatic, randomized controlled trial of home handheld phototherapy combined with topical corticosteroid for people with active, limited vitiligo (HI-Light trial). The trial was completed almost 5 years ago; however, only one centre in Wales chose to continue with the home handheld phototherapy service on the NHS after the completion of the trial. A new, unique, national, tertiary, research and treatment centre for children and adults with vitiligo has recently been established in England. In our centre, we offer home handheld phototherapy to eligible patients, who are often referred from out of area, therefore making a combination of topicals and NB-UVB more accessible. We designed patient-facing literature, a special pro forma for vitiligo clinic, and several other documents to assist in safety assurance and quality improvement processes. We describe the pathway that we followed when establishing this new service in the NHS. We have trained 20 patients so far. We describe the safety and efficacy results of home handheld phototherapy combined w