Photodermatoses are common skin disorders. Diagnosis may be difficult because clinical manifestations are often spontaneously self remitting and phototesting is almost always necessary. Unfortunately, special equipments that are no more available on the market are needed and there is the need of a standardization of procedures. Treating photosensitivity diseases with UV-based therapies appears at first glance paradoxical, but clinical practice proves that such methods are still leading interventions in patients with difficult-to-manage UV sensitive conditions. The idiopathic photodermatoses are the primary targets of photo therapeutic management, including polymorphous light eruption (PMLE), chronic actinic dermatitis (CAD), actinic prurigo (AP), solar urticaria (SU), and hydroa vacciniforme. For patients that do not respond to usual strategies of photoprotection, phototherapy is likely the next best option by itself or in combination with other treatments. The choice of UVB, UVA1 or PUVA depends most often not on specific therapeutic considerations but rather on availability of the hardware. Recently, there have been encouraging developments in managing CAD and SU. JAK inhibitors, which have shown encouraging results in e.g. autoimmune disease and atopic dermatitis, have also been helpful in managing otherwise non-responsive CAD patients. Omalizumab targets IgE and has been used to manage patients with SU. These developments are encouraging and we look forward to additional agents coming to enlarge the range of options for these often desperate patients. Still, the main obstacle for new therapies may be the concern for side effects and for cost. Phototherapies if used correctly have a very favorable side effect profile and costs are not excessive.