1. Number of phototherapy treatments for Psoriasis and Eczema: Audit of data collected at Whipps Cross over a three year period. Jane Watts Senior Nurse Melissa Macqueen, Steve Isaac, Avinash Nanayakkara

3. Phototherapy can be used as a second line treatment for Eczema and psoriasis

4. In our unit: All Patients have MED/MPD prior to treatment. A weekly review session is held, to review patients with problems or near the end of treatment. This is with the consultant, specialist nurses, Registrar and the team.

5. Data Base We have kept a data base of all patients who have been treated in our phototherapy unit since 2004. In 2005 when we introduced Narrow Band UVB, an audit of practice showed that patients with psoriasis needed an average of 23 treatments of NBUVB to clear.

7. Questions ? We wanted to look at numbers of patients we treat each year with Eczema and Psoriasis. (full body treatments not hand and foot) Also, most importantly to look at the number of NBUVB treatments on average we used to treat our patients with Eczema and Psoriasis. We focused on NBUVB as it is now the most common form of phototherapy used to treat skin disease.

8. Questions ? We also looked at the response to treatment, as recorded by the nurse. ( observational) And The DLQI scores recorded by the patients. We wanted to answer the following questions…….

9. 1)In the 3 years (2011, 2012 and 2013), how many patients were treated for : i)Psoriasis ii)Eczema ? iii)Numbers in each year ? 2) In the 3 years, the average number of NBUVB treatments for: i)Psoriasis ? ii)Eczema? 3) Treatment response (observational) for: i)Psoriasis ii)Eczema 4) The % DLQI forms were completed? 5) Difference in DLQI index for i)Psoriasis ii)Eczema

10. In the 3 years, how many patients were treated for PS? 217 In the 3 years, how many patients were treated for EC? 50 1

11. YearPSEC 2011 (04/01/11- 03/30/12)7024 2012 (04/01/12-03/30/13)7113 2013 (04/01/13- 03/30/14)7613 Total21750 Number Of Patients Treated Each Year with phototherapy 1

12. % of Patients who had NBUVB for Psoriasis Total number of patients TLO1PUVA% of TLO1 20117061987.14 20127372198.63 20137668889.47

13. % of Patients who had NBUVB for Eczema Total number of patients TLO1PUVA% of TLO1 20112420483.33 20121312192.31 201397277.77

14. Average number of treatments for Psoriasis (NBUVB only) 2 Average # of Treatments 201127.66 201226.27 201322.57 Total25.5 Audit done in 2005 for average number of treatments of NBUVB= 23

15. Average number of treatments for Eczema (NBUVB) only Average # of Treatments 201126.42 201226.86 201320.53 Total24.60 2

16. Treatment Response for Psoriasis Patients 79% had a positive response ResponseNo. of Patients 0 ( No response)39 1 ( Moderate improvement)55 2 ( Large improvement)91 3

17. Treatment Response for Eczema Patients 77% had a positive response ResponseNo. of Patients 0 ( No response)9 1 ( Moderate improvement)9 2 ( Large improvement)21 3

18. % of Completed DLQI for eczema and psoriasis patients YearTotal # Of Records# Incomplete% Complete 2011602361.66 2012702465.71 2013663350.00 4

19. Difference in DLQI Psoriasis Average Difference in DLQI Interpretation 2011-8.69improvement 2012-7.91improvement 2013-5.20improvement 4

20. Difference in DLQI Eczema Average Difference in DLQI Interpretation 2011-9.69improvement 2012-8.00improvement 2013-2.33improvement 4

21. Scottish phototherapy managed network, Photonet, the standard for the median number of treatments for clearance with NBUVB is <30. We met this standard.

22. Photobiology unit Dundee: Cameron et al 2002, in a study,. found the number of treatments needed for clearance /minimal residual activity of psoriasis was 24. Our unit has continued to be in line with this.

23. Conclusions Number of treatments: in line with other studies/ audits Approx. 90% having NBUVB for PS Approx. 85% having NBUVB for EC Improvement observational, almost 80% positive response but, would be more accurate with PASI DLQI, need to improve numbers, ensure we get a start and finish DLQI

24. Actions: Presenting the audit to all members of the team so they can see importance of accurate data collection. Created a new post in phototherapy who will work in there three days a week, but also have daily input. Mini audit of notes to be carried out regularly to ensure data is collected, and that patients are started on the correct dose for their MED/MPD Ensure all patients are reviewed at or before 25 treatments.

25. References Narrowband UV-B (TLO1) Phototherapy vs. Oral 8-Methoxypsolaren Psolaren- UV- A for the treatment of Chronic Plaque Psoriasis, Arch Dermatol. 2003;139:325-328 Photonet, National Managed Clinic Network for Phototherapy, Audit Vhttp://www.photonet.scot.nhs.uk/wp-content/uploads/2013/11/Audit-Report- 06_07.pdft 2006- 2007 A randomized, observer-blinded trial of twice vs.three times weekly narrowband ultraviolet B phototherapy for chronic plaque psoriasis, British journal of Dermatology, 2002:147:973-978. Colour Atlas and Synopsis of Clinical Dermatology, Common and Serious Diseases, Third Edition, Thomas B. Fitzpatrick, Richard Allen Johnson