Phototherapy of psoriasis: comparative experience of different phototherapeutic approaches.
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).


CONCLUSIONS
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.
Karrer
S
S
Department of Dermatology, University of Regensburg, Germany.
Eholzer
C
C
Ackermann
G
G
Landthaler
M
M
Szeimies
R M
RM
D000287:Administration, Topical; D000328:Adult; D000875:Anthralin / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001494:Baths; D002117:Calcitriol / Q000031:analogs & derivatives / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008730:Methoxsalen / Q000008:administration & dosage; D008875:Middle Aged; D011701:PUVA Therapy / Q000009:adverse effects / Q000379:methods; D011565:Psoriasis / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014467:Ultraviolet Therapy / Q000009:adverse effects
D000893:Anti-Inflammatory Agents; D003879:Dermatologic Agents; C055085:calcipotriene; D002117:Calcitriol; D008730:Methoxsalen; D000875:Anthralin