Low-Dose Narrow-Band UVB Phototherapy Combined with Topical Therapy Is Effective in Psoriasis and Does Not Inhibit Systemic T-Cell Activation

Abstract

Background: Psoriasis is a chronic T-cell-mediated inflammatory skin disease which can be treated with topical medication, phototherapy or systemic medication. A subgroup of psoriatic patients does not respond to monotherapy and needs combination therapy. We used low-dose narrow-band UVB phototherapy, combined with balneotherapy, short-contact anthralin, liquor carbonis detergens and calcipotriol for treatment of psoriatic patients in our day care centre. Objective: Our purpose was to study the efficacy, induction of erythema and effect on systemic T-cell activation of this combination therapy. Methods: Skin reflectance spectrophotometry was used to measure skin erythema. The Psoriasis Area and Severity Index (PASI) was used to evaluate psoriatic patients. Serum soluble IL-2 receptor (sIL2-R) levels were measured by an ELISA. Results: The possible erythematogenic effect of low-dose narrow-band UVB irradiation was studied (skin reflectance spectrophotometer) in a control group of psoriatic patients (n = 11). No induction of skin erythema was seen. Subsequently, this low-dose irradiation regimen was used in combination with topical medication in 26 psoriatic patients. A 90% decrease in the PASI was seen after a mean number of 35 treatment sessions. Seventeen patients (65%) remained in remission during the following 6 months. Serum sIL-2R levels were elevated in all patients (mean 913 U/ml) and did not change during treatment. Conclusion: Our data indicate that low-dose narrow-band UVB can be used successfully, in combination with topical treatment, in a day care setting to treat psoriatic patients. Since sIL-2R serum levels were not decreased, it can be speculated that this treatment does not induce systemic immunosuppression.

Narrow‐band ultraviolet B radiation: a review of the current literature

“…There are several solutions to this perceived disadvantage, however. One is that psoriasis clears with less aggressive NB‐UVB regimens that do not lead to erythema 9,18,54,55 . Treatment times have been shortened in many studies without sacrificing efficacy.…”

“…Physicians should consider that, as NB‐UVB seems to clear psoriasis faster, it should theoretically require fewer treatments, thus compensating partially for the longer treatment times. Finally, it is important to keep in mind that combining NB‐UVB with other modalities, such as tazarotene gel, 56 anthralin, 57 and calcipotriol, 58,59 or even day treatment, 55 can provide faster, more effective, clearance and a reduction in the mean number of treatment sessions and cumulative irradiation doses. Using lower doses of light and additional treatments with complementary modes of action may also minimize side‐effects, such as unpredictable erythema and lesion blistering.…”

Treatment Effects upon Prolactin and Soluble Receptor of Interleukin-2 in Psoriatic Patients

“…De Rie, et al found that sIL2R levels were well correlated with disease activity in patients with PV and closely followed the decrease of disease activity during immunosuppressive therapy (22). Duncan et al revealed that serum levels of sIL2R decreased after treatment with PUVA (psoralen-UVA) and Cyclosporine therapy, but did not change with NB-UVB (narrow-band UVB) treatment (23,24).…”

Narrow‐band ultraviolet B decreases serum interleukin‐2 receptor levels in patients with poikiloderma vasculare atrophicans

“…As the levels of sIL‐2R does not correlate well with Sézary cell and CD25 + blood lymphocyte counts, most of the sIL‐2R appears to be derived from neoplastic cells in the skin or lymph nodes rather than from circulating cells 4 . It is also reported that the levels of sIL‐2R is elevated in patients with psoriasis, but NB‐UVB does not suppress the elevated levels 5 . It is possible that sIL‐2R is released from circulating T cells in patients of psoriasis.…”