Trioxsalen bath plus UVA effective and safe in the treatment of psoriasis

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Good results were achieved in psoriasis with trioxsalen baths and UVA in 92% of 158 patients during initial treatment and in 83% of 139 patients during long-term treatment. Grade I-II local burns were encountered in about 7% of the patients. In addition, itchy skin pain was experienced by 2 patients, and in both of these the therapy was discontinued. Neither skin malignomas nor other serious side effects were seen.

Section: Discussionsupporting

confidence: 82%

Section: Methodsmentioning

confidence: 99%

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Long-Term Local Trioxsalen Photochemotherapy in Psoriasis

Väätäinen¹,

Hannuksela²,

Karvonen³

1981

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“…The acronym PUVA was introduced by this same group of investigators. Bath-PUVA was has been first extensively used in Scandinavia [4, 5]. …”

Section: Introductionmentioning

confidence: 99%

Phototherapy of Psoriasis: Comparative Experience of Different Phototherapeutic Approaches

Karrer¹,

Eholzer²,

Ackermann³

et al. 2001

Background: Broad-band UVB alone or in combination with different topical drugs (anthralin, calcipotriol), systemic PUVA and bath-PUVA therapy are very effective and well-established treatment modalities for psoriasis. Objective: The aim of this retrospective study was to assess which of these routinely applied phototherapeutic modalities might be most effective and safe for the treatment of plaque-type psoriasis. Methods: Patients (n = 203) with moderate to severe (pretreatment Psoriasis Area and Severity Index score between 12 and 35) chronic plaque-type psoriasis treated between 1992 and 1998 at our department with either UVB (with/without anthralin or calcipotriol; n = 97), systemic PUVA (n = 19) or bath-PUVA therapy (n = 87) were evaluated for efficacy, duration of treatment, number of treatments necessary for complete remission (CR), cumulative light dose, side effects of therapy and duration of remission after therapy. Results: No statistically significant difference comparing the efficacy of bath-PUVA (CR in 72.4%), PUVA (CR in 89.5%) and UVB phototherapy (CR in 69.1%) was found. Although the duration of therapy was significantly longer for bath-PUVA (66 ± 42 days) as compared to UVB treatment (50 ± 27 days), the mean number of treatments did not differ significantly between bath-PUVA (28 ± 12), UVB therapy (30 ± 12) and PUVA (26 ± 13). Significantly fewer side effects of phototherapy were observed with bath-PUVA (14.9%) therapy compared to UVB treatment (30.9%). Also, the duration of remission after successful therapy was significantly longer for bath-PUVA (8.4 ± 3.5 months) as compared to UVB phototherapy (5.1 ± 4.2 months). Conclusion: Bath-PUVA therapy has some advantages over UVB phototherapy in the treatment of psoriasis: fewer UV-related acute side effects and a longer period of remission after therapy. However, the choice of treatment with either UVB, bath-PUVA or systemic PUVA should also be based on a history of previous response to treatment and patient considerations, including compliance and responsibility for following the precautions to avoid potential side effects.

“…In addition, female patients should still preferably avoid conception during PUVA treatment [7]. Although alternatives for systemic PUVA, such as bath PUVA and topical PUVA, are available, UVB therapy is also widely used [8, 9, 10]. UVB is preferred to PUVA during childhood and because there is no need for posttreatment eye protection.…”

Section: Introductionmentioning

confidence: 99%

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

Rie

Out²,

Bos³

1998

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.