Fifty two psoriatic patients were treated with a new experimental fluorescent lamp (Philips TL-01) emitting a narrow band at 311 +/- 2 nm (UVB) which had the advantage of a reduction in burning and carcinogenic wavelengths when compared with conventional broad band UVB therapy. Results of the '311' treated group when compared with broad band UVB therapy revealed a similar percentage of patients achieving a satisfactory response with fewer burning episodes and an increase in duration of remission.
Forty-five patients with extensive chronic plaque or guttate psoriasis were treated with either narrowband (TL-01) phototherapy, etretinate TL-01 combination therapy (re-TL-01) or etretinate and PUVA (re-PUVA) (15 patients in each group). Re-PUVA was the most effective therapy with 100% satisfactory clearance rate. TL-01 monotherapy had an 80% success rate; the relapse rate compared favourably with re-PUVA (50% in remission after 6 months). In the etretinate-TL-01 group, there was a 93% success rate and a one-third reduction in the total irradiation dose (8.0 J/cm2 vs. 12.7 J/cm2) but the relapse rate was higher, only 33% remaining in remission after 6 months.
SUMMARY In a Study of thirty‐four male subjects suffering from the syndrome of chronic photosensitivity dermatitis and actinic reticuloid the clinical, histological and photobiological features were such as to suggest that they were in fact examples of a single entity in which the degree of response to ultraviolet and visible light varied. Although a wide action spectrum involving UV and visible wavelengths invariably occurred with the classical clinical and histological features of actinic reticuloid (Ive et al., 1969) a broad action spectrum with similar histological appearances was also noted in some of the subjects in whom the morphological changes were those of a chronic dermatitis confined to exposed sites.
Two ultraviolet A (UVA) regimens for oral 8-methoxypsoralen (8-MOP) photochemotherapy (PUVA) for moderate/severe chronic plaque psoriasis using a half body study technique were compared. Each patient received both regimens. A higher-dose regimen based on minimal phototoxic dose (MPD) with percentage incremental increases was given to one-half of the body. The other half received a lower dose regimen based on skin type with fixed incremental UVA increases. Patients were treated twice weekly. Symmetrical plaques were scored to determine the rate of resolution with each regimen. In addition, the number of treatments, cumulative UVA dose and number of days in treatment to achieve overall clearance were recorded. Patients were reviewed monthly for 1 year to record remission data. Thirty-three patients completed the study. Both regimens were effective and well tolerated. With the MPD-based approach, the number of exposures was significantly less for patients with skin types I and II but not III. Although the cumulative UVA dose was higher with the MPD regimen for all skin types studied, the reduced number of exposures required for clearance for skin types I and II but not III, combined with the security of individualized MPD testing, has practical attractions. MPD testing also identified five patients who required an increased psoralen dose and six patients who required a reduction of the initial UVA dose with the skin type regimen. Forty-two percent were still clear 1 year after treatment and there was no significant difference in the number of days in remission between the regimens for those whose psoriasis had recurred. The reduction in the number of exposures required for clearance with the MPD-based regimen may be safer and more cost effective in the long term.
Sixty‐one patients in the Dundee area suffering from psoriasis were typed for HLA—A and HLA—B antigens. On the basis of the typing results, the patients were divided into three groups, and studied with respect to sex, age of onset and familial incidence of the disease. The frequency of HLA—A1 appeared to be increased and HLA—B7 decreased but HLA—B13 and HLA—B17 were highly significantly increased (P < 10−6 and P < 10−10 respectively) in the psoriatic group compared to 204 controls. Of particular interest was a highly significant association of HLA—A1 with HLA—B17 in psoriatic patients. Family studies showed HLA—B17 to be a useful genetic marker for psoriasis in the families of B17 positive patients. Considerations of age of onset, familial incidence and typing data suggest that there is heterogeneity of genetic susceptibility to psoriasis and that one probable mechanism is the dominant inheritance of a “disease allele” in linkage disequilibrium with the allele coding for HLA—B17.
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