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NB-UVB Phototherapy Uraemic Pruritus — ESENeph MCQ

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ModerateHaemodialysisNB-UVB Phototherapy Uraemic PruritusESENeph

A 60-year-old man on HD develops pruritus. After optimising CKD-MBD, trying emollients, and Gabapentin without relief, his dermatologist suggests narrowband UVB phototherapy. What is the evidence for this?

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Correct answer: E — NB-UVB phototherapy has moderate evidence for uraemic pruritus refractory to conventional therapy – it reduces pruritus through immunomodulation (reducing Th1 cytokines, mast cell activity, and cutaneous inflammation); typically 3 sessions/week for 6-8 weeks

NB-UVB phototherapy is an established second/third-line treatment for refractory uraemic pruritus. Multiple controlled studies have shown benefit, though most are small. The mechanism involves: reduction of pro-inflammatory cytokines in the skin, mast cell apoptosis, modulation of cutaneous opioid receptors, and general immunomodulatory effects. Typical protocol: 3 sessions/week for 6-8 weeks. It provides an alternative pathway when pharmacological agents (Gabapentin, Difelikefalin) are insufficient or not tolerated. Side effects include erythema and increased skin cancer risk with prolonged use.

Reference: KDIGO 2017 – CKD-MBD (Pruritus); Ko et al 2011 – UVB for Uraemic Pruritus