Phototherapy for psoriasis: what to choose and how to use: facts and controversies

Matz, Hagit

doi:10.1016/j.clindermatol.2009.04.003

Cited by 27 publications

(15 citation statements)

References 75 publications

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“…Sonuç olarak, günümüzde halen DB-UVB fototerapisinin hangi dozda başlanacağı, haftada kaç seans uygulanacağı ve doz artışlarının nasıl yapılacağı ile ilgili kesinleşmiş optimal bir uygulama protokolü bulunmamaktadır 6,7 . UVB ile başarılı bir tedavi için doğru doz ile başlamak önemli olup dozu çok düşük tutmak daha uzun tedavi gerektirdiği gibi terapotik etkiden ziyade derinin bronzlaşmasına ve fototoleransına neden olmakta, çok yüksek doz ise fototoksisite ve Koebner reaksiyonu ile sonuçlanabilmektedir 2,4 . Yapılan çalışmalarda DB-UVB başlangıç dozu genellikle MED'ye göre belirlenerek MED'nin %50-70'i oranında, daha az sıklıkta deri tipine göre ve nadiren de sabit bir doz ile tedaviye başlanmıştır 1,2 .…”

Section: Discussionunclassified

“…Günümüzde tek başına ya da topikal veya sistemik ajanlarla kombinasyon tedavisi şeklinde kullanılabilen fototerapi yöntemi, hem geleneksel hem de özellikle son yıllarda sayıları giderek artan biyolojik sistemik tedavilerin immunosupresif özelliklerini içermemesi, nispeten iyi bir etkinlik göstermesi, maliyet etkin olması ve yan etkilerinin az olması nedeniyle psoriyasis tedavisindeki değerini korumaktadır 1,2 . Literatürde dar band UVB (DB-UVB) tedavisi ile psoriasisli olgulardaki iyileşme oranlarının %63-80 arasında değişiklik gösterdiği ve genel olarak etkinliğinin geniş band UVB'ye göre daha fazla olmasının yanında PUVA ile neredeyse eşdeğer bulunduğundan söz edilmiştir 1,4 . Bununla birlikte PUVA tedavisine göre daha düşük oranda olsa da derinin erken yaşlanması ve melanom dışı deri karsinomlarının gelişme olasılığı nedeniyle DB-UVB tedavisi dozlarının seçiminde dikkatli olunması gerektiğinden bahsedilmiştir 4,5 .…”

Section: Introductionunclassified

“…Literatürde dar band UVB (DB-UVB) tedavisi ile psoriasisli olgulardaki iyileşme oranlarının %63-80 arasında değişiklik gösterdiği ve genel olarak etkinliğinin geniş band UVB'ye göre daha fazla olmasının yanında PUVA ile neredeyse eşdeğer bulunduğundan söz edilmiştir 1,4 . Bununla birlikte PUVA tedavisine göre daha düşük oranda olsa da derinin erken yaşlanması ve melanom dışı deri karsinomlarının gelişme olasılığı nedeniyle DB-UVB tedavisi dozlarının seçiminde dikkatli olunması gerektiğinden bahsedilmiştir 4,5 . Mevcut fototerapi seçeneklerinden herhangi birinin olası akut ve kronik yan etkilerini en aza indirgemek için en düşük kümülatif dozla en yüksek etkinliği sağlayabilen farklı doz protokollerinin araştırılması her zaman bir gereklilik olmuştur.…”

Section: Introductionunclassified

“…gerektiği ileri sürülmüştür 1,2,4 . Fototerapi protokollerinin bir diğer önemli değişkeni ise tedavi dozundaki artışlardır [14][15][16][17][18][19][20][21] .…”

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Comparison of weekly low-dose and high-dose incremental protocols of narrow band ultraviolet B therapy for psoriasis

Biçak¹,

İlknur²,

Akarsu³

et al. 2015

TURKDERM

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Background and Design: Considering the probable long-term side-effects of narrowband UVB (NB-UVB) therapy, various studies have been conducted to provide more effective and reliable protocols by applying the different initial doses, numbers of sessions or dose increments. The aim of this study was to compare the clinical effectiveness of weekly low-dose increments and weekly high-dose increments of NB-UVB therapy in psoriasis. Materials and Methods: Twenty-nine patients with psoriasis vulgaris underwent NB-UVB therapy with a weekly low-dose (20%) increment protocol (group 1; n=14) or weekly high-dose (40%) increment protocol (group 2; n=15). The patients were monitored weekly for 12 weeks and evaluated by the Psoriasis Area Severity Index (PASI). Results: The PASI scores prior to the therapy and during the 12-week therapy for each week between the groups were compared and no statistically significant difference was found except week 12. The mean PASI scores at week 12 was significantly lower in patients from group 2 than in patients from group 1 (p=0.045). The mean number of patients and therapy sessions required with ≥50%, ≥75% and ≥90% PASI reduction did not differ between the groups. Although comparison of the two groups according to the mean cumulative doses with ≥50% and ≥90% PASI reduction did not reveal a statistically significant difference, however, those of patients with ≥75% PASI reduction at the end of the 12-week therapy were significantly higher in the group with a weekly high-dose increment than in the group with a weekly low-dose increment (p=0.014 and p=0.00, respectively). Conclusion: Although we are aware that our results may need to be supported with large-series studies, we suggest that a weekly low-dose increment regime of NB-UVB therapy is preferable in the treatment of psoriasis as it produces nearly similar effects as a weekly high-dose increment regimen but with the lower cumulative doses. (Turkderm 2015; 49: 101-6)

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Section: Discussionunclassified

Section: Introductionunclassified

“…gerektiği ileri sürülmüştür 1,2,4 . Fototerapi protokollerinin bir diğer önemli değişkeni ise tedavi dozundaki artışlardır [14][15][16][17][18][19][20][21] .…”

unclassified

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Comparison of weekly low-dose and high-dose incremental protocols of narrow band ultraviolet B therapy for psoriasis

Biçak¹,

İlknur²,

Akarsu³

et al. 2015

TURKDERM

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“…Several studies have also examined the effect of UVB radiation exposure on folate status by enrolling psoriasis patients, for whom UVB radiation therapy is often used as a treatment 55 . Narrowband UVB phototherapy was used to investigate the effect of UVB on serum and erythrocyte folate status in patients with psoriasis by Rose et al 56 .…”

Section: Folate and Ultraviolet Radiation: Sunbed And Solar Ultraviolmentioning

confidence: 99%

Folate degradation due to ultraviolet radiation: possible implications for human health and nutrition

Borradale¹,

Kimlin²

2012

Nutrition Reviews

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Folate is essential for human health in the prevention of megaloblastic anemia and neural tube birth defects and plays important roles in cardiovascular disease and cancer. Therefore, research into environmental factors that may impact folate status, such as solar ultraviolet (UV) radiation, is of great health significance. In vitro studies have shown that UV radiation can degrade folate and folic acid in human blood and this has been confirmed in several human studies. Despite these findings, there is a dearth of epidemiological research into investigating the relationship between folate status and the links to solar UV exposure.

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Principles of Phototherapy

McKenna

Ibbotson

2016

Rook's Textbook of Dermatology, Ninth Edition

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Phototherapy or ‘light therapy’ has been used to treat skin diseases since ancient times. Modern phototherapy uses specific wavelengths typically within the ultraviolet part of the electromagnetic spectrum, by means of treatment modalities including UVB phototherapy (narrow‐band UVB 311–313 nm), photochemotherapy (psoralen and UVA; PUVA), UVA‐1 phototherapy and extracorporeal photochemotherapy (photopheresis) to treat a variety of skin diseases. The most frequently treated skin diseases include psoriasis, eczema, cutaneous T‐cell lymphoma (CTCL; mycosis fungoides), vitiligo and various photodermatoses. Narrow‐band UVB is the most commonly used phototherapy and is the phototherapy of first choice for most indications. PUVA is used mainly for UVB phototherapy treatment failures and in specific conditions, such as palmoplantar pustulosis, pustular psoriasis and pityriasis rubra pilaris. UVA‐1 is particularly useful for the treatment of sclerotic skin conditions such as morphoea and for atopic eczema. Photopheresis is indicated for the severe forms of CTCL: Sézary syndrome and graft‐versus‐host disease. The main short‐term hazard of UV therapy is burning of the skin and the primary long‐term concern is of skin cancer risk. Systemic PUVA is associated with a dose‐related increased risk of squamous cell carcinoma. No evidence of increased risk of skin cancer has yet been shown for UVB or UVA‐1 phototherapy. To avoid adverse events, careful patient selection, education and assessment of skin cancer risk is important. In addition, accurate dosimetry and UV lamp maintenance is required. Patient and staff safety is of paramount importance and is ensured by the establishment of good clinical governance pathways.

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Phototherapy for psoriasis: what to choose and how to use: facts and controversies

Cited by 27 publications

References 75 publications

Comparison of weekly low-dose and high-dose incremental protocols of narrow band ultraviolet B therapy for psoriasis

Comparison of weekly low-dose and high-dose incremental protocols of narrow band ultraviolet B therapy for psoriasis

Folate degradation due to ultraviolet radiation: possible implications for human health and nutrition

Principles of Phototherapy

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