Phototherapy of Psoriasis: Comparative Experience of Different Phototherapeutic Approaches

Karrer, Sigrid; Eholzer, Christian; Ackermann, Günther; Landthaler, Míchael; Szeimies, Rolf‐Markus

doi:10.1159/000051608

Cited by 29 publications

(22 citation statements)

References 16 publications

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“…Topical PUVA therapy, such as PUVA bath therapy, in which patients are immersed in an 8-MOP dilute bath water solution immediately followed by UVA irradiation, has been shown to be effective in the treatment of various inflammatory skin diseases including psoriasis vulgaris [3, 4, 8, 9]. It has been developed to avoid unwanted effects due to absorption of psoralens.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Genito-Anal Lesions in Inflammatory Skin Diseases with PUVA Cream Photochemotherapy: An Open Pilot Study in 12 Patients

Reichrath¹,

Reinhold²,

Tilgen³

2002

Dermatology

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Background: Localized skin lesions of the genito-anal region such as in lichen sclerosus et atrophicus or in lichen planus are a burden for many patients, and therapeutic efforts, including therapies with potentially hazardous side-effects, are often unsatisfactory. Recently, PUVA bath photochemotherapy has been proven highly effective in the treatment of various inflammatory skin diseases, including localized scleroderma. Another form of topical PUVA therapy, 8-methoxypsoralen-containing cream or gel preparations, has been proven to be as effective as PUVA bath therapy for palmoplantar dermatoses. Objective: We evaluated the clinical effects of PUVA cream photochemotherapy in patients with genital lesions of inflammatory skin diseases. Methods: Twelve patients with lichen sclerosus et atrophicus, lichen planus, vulvar eczema and pruritus vulvae were included in the study. PUVA cream therapy was performed up to 4 times a week. Results: PUVA cream photochemotherapy induced a significant clinical improvement of genital lesions in most patients, as revealed by clinical examination. Clinical improvement (reduction in size of lesions of erythema, and/or of pruritus) was achieved in most patients after 10–20 treatments and was reduced in patients that had only received 5–15 treatments. Cumulative doses ranged between 4.5 and 180 J/cm²; all patients tolerated PUVA cream phototherapy well without any side-effects. Conclusion: PUVA cream phototherapy represents a highly effective therapy that should be further investigated as an alternative treatment for patients with genital lesions of inflammatory skin diseases.

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Section: Discussionmentioning

confidence: 99%

Treatment of Genito-Anal Lesions in Inflammatory Skin Diseases with PUVA Cream Photochemotherapy: An Open Pilot Study in 12 Patients

Reichrath¹,

Reinhold²,

Tilgen³

2002

Dermatology

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“…UV photo-photochemotherapy are effective and well-established treatment modalities for psoriasis (3)(4)(5)(6)(7)(8). This study highlights that the clearing of psoriasis can be achieved faster by using PUVA than by using UVB-NB even though PUVA exposes the patient to a higher UV dose (p=O.OOl).…”

Section: Discussionmentioning

confidence: 80%

“…Photochemotherapy (Psoralen plus UVA, 365 nm) (PUVA) and DVB narrow-band (311 nm) phototherapy (UVB-NB) are well established and very efficient treatments for moderate-to-severe psoriasis (3)(4)(5)(6)(7)(8)(9).…”

mentioning

confidence: 99%

The Duration of Clinical Remission of Photochemotherapy and Narrow-Band UV-B Phototherapy in the Treatment of Psoriasis: A Retrospective Study

Brazzelli

Barbagallo

Trevisan

et al. 2008

Int J Immunopathol Pharmacol

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PUVA and UVB-NB phototherapy have an established role in the treatment of moderate-to-severe psoriasis. Even though psoriasis patients often require continuous treatments, inadequate attention is devoted to the duration of remission after the treatment. The purpose of this retrospective study is to assess which phototherapeutic regimen induces a longer remission. Twenty patients with psoriasis were included: 10 patients received PUVA and 10 patients received UVB-NB. We consider as a "cycle" the therapeutic period needed to reach clinical remission. The comparison between the average number of days in remission revealed that PUVA induces a longer remission period than UVB-NB: PUVA 386 days (ds ±321), UVB-NB 298 days (ds ± 257). Although the difference of the duration of remission is not statistically significant, a trend is seen and patients treated with PUVA remain clear for a period about 88 days longer than that of patients treated with UVB-NB. The differences in the duration of remission of psoriasis therapies must be considered in planning a patient's course of treatment.Psoriasis is a chronic inflammatory skin disease that affects about 0.5-4.6% of the general population (1). A variety of therapeutic options to treat psoriasis is available. The choice of treatment depends on the type, spread and severity of psoriasis, on the patient's age, the quality oflife and the consideration of treatment-associated long-term side risks (2).Photochemotherapy (Psoralen plus UVA, 365 nm) (PUVA) and DVB narrow-band (311 nm) phototherapy (UVB-NB) are well established and very efficient treatments for moderate-to-severe psoriasis (3-9).In literature, many trials evaluate the efficacy and adverse effects of therapies, but inadequate attention is devoted to the duration of remission (10), although it is one of the elements that most affects psoriatic patients' quality of life (11)(12). For this reason, the aim of our study is to assess which phototherapeutic regimen induces a longer remission. MATERIALS AND METHODSTwenty patients with moderate-to-severe psoriasis, resistant to topical treatments, were included in the study. The choice between PUVA or UVB-NB therapy was dictated only by the clinical and/or pharmacologic contraindications connected to PUVA therapy, and it had nothing to do with the different clinical forms, the extension or the gravity of psoriasis itself. Ten patients

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“…Fototerapi protokollerinin bir diğer önemli değişkeni ise tedavi dozundaki artışlardır [14][15][16][17][18][19][20][21] . Doz artışı hastanın klinik yanıtı ve toleransına bağlı olarak değişiklik göstermekle birlikte, asıl hedef yanık olmaksızın hafif fark edilebilen bir eritem oluşturmaktır.…”

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“…Bazı klinisyenler her seansta MED'nin %10-20'si oranında artış yapılmasını önermekte, bazıları ise erken dönemde daha yüksek artışları (%15-20) takiben sonraki seanslarda daha küçük (%10) doz artışlarını kullanmaktadır 2,6,7 . Deri tipine göre her seansta 15-65 mJ/cm 2 'lik doz artışı 1,15,19, haftalık sabit %30-40'lık artışlar 20 , alterne bir şemaya göre doz artışları (ilk iki seans başlangıç dozunda, daha sonra 16. seansa kadar her iki seansta bir sırasıyla %40, %30, %25, %20, %15, %10 ve %5 oranlarında artış olacak şekilde) 11 veya 0,01-0,05 J/cm 2 /gün artış 21 olmasını öneren yazarların yanında, daha düşük (%5-10) doz artışlarının da etkili olabildiğini bildiren çalışmalar mevcuttur 11,17 . Psoriasisli olgularda DB-UVB tedavisinde yüksek oranlı ve düşük oranlı doz artışı protokollerini karşılaştıran az sayıda klinik çalışma mevcuttur [15][16][17] .…”

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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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Phototherapy of Psoriasis: Comparative Experience of Different Phototherapeutic Approaches

Cited by 29 publications

References 16 publications

Treatment of Genito-Anal Lesions in Inflammatory Skin Diseases with PUVA Cream Photochemotherapy: An Open Pilot Study in 12 Patients

Treatment of Genito-Anal Lesions in Inflammatory Skin Diseases with PUVA Cream Photochemotherapy: An Open Pilot Study in 12 Patients

The Duration of Clinical Remission of Photochemotherapy and Narrow-Band UV-B Phototherapy in the Treatment of Psoriasis: A Retrospective Study

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

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