There are several options to develop a customized protocol for your patients. Detailed information on phototherapy protocols and treatment options is available in PHOTOTHERAPY TREATMENT PROTOCOLS, a book published by Michael D. Zanolli, MD and Steven R. Feldman, MD, PhD [Amazon]. Below are high-level principles to consider.
Protocol Development
ClearLink Controller Guided Mode Protocol (Recommended):
- Starting Dose: 200 mJ is safe for all skin types and indications
- Dose Progression: Automatic 15% increase based on patient response
- Treatment Frequency: 3 times per week (every other day)
- Patient Monitoring: Built-in questionnaire before each treatment
- Automatic Adjustments: Controller maintains or adjusts dose based on responses, and time elapsed since last treatment.
Treatment Frequency Guidelines:
- 3 times per week (Monday, Wednesday, Friday)
- More frequent treatments are sometimes used for faster disease resolution, but there must be at least 16 hours between treatments, and dose increases may need to be smaller with more than 3 treatments per week
- Reduced dose is recommended if patient misses more than one week of treatments
Progress Monitoring Parameters
Built-in Monitoring (ClearLink Controllers):
- Post-treatment questionnaire assesses patient response
- Automatic dose adjustments based on responses
- Treatment compliance tracking
- Progress documentation for provider review
Clinical Monitoring:
- Initial Follow-up: 2-4 weeks after starting treatment
- Regular Assessments: Every 4-6 weeks during active treatment
- Documentation: Progress photos, PASI scores, quality of life measures
- Dose Adjustments: Based on response and tolerance, missed treatments.
Red Flag Symptoms to Monitor:
- Excessive erythema or burning lasting longer then 48 hours
- Blistering or severe skin reactions
- Persistent pain after treatments
- Lack of improvement after 6-8 weeks
- Patient compliance issues
By utilizing the ClearLink Provider Portal and taking advantage of the Device Guided Mode, providers can streamline the prescribing process while ensuring patients receive safe, effective, and accessible phototherapy treatment.