PUVA-gel vs. PUVA-bath therapy for severe recalcitrant palmoplantar dermatoses. A randomized, single-blinded prospective study.
OBJECTIVE
In order to avoid unwanted effects of systemic psoralen and ultraviolet A (PUVA) therapy, various topical PUVA treatment modalities have been developed and are being increasingly used. However, up to now very few controlled studies comparing the therapeutic efficacy of different topical photochemotherapy modalities are available. Thus, the aim of our study was to compare the clinical efficacy of conventional PUVA-bath therapy to topical PUVA-gel therapy in patients with recalcitrant dermatoses of the palms and soles.


METHODS
Twenty patients with severe palmoplantar dermatoses or localized psoriatic plaques were enrolled in our observer-blinded, randomized half-sided study. The treatment modalities compared were: (i) aqueous 8-methoxypsoralen (8-MOP)-containing gel plus broadband UVA irradiation (PUVA-gel therapy) and (ii) 8-MOP bath of the hands and/or feet plus broadband UVA (PUVA-bath therapy).


RESULTS
On the body half, which was randomized to PUVA-gel therapy, the median Area and Severity Index for palmoplantar dermatoses (ASIppd) decreased from 28 (range 6-56) to 1.5 (range 1-37, P = 0.00) after a median 33 (13-49) irradiations compared with a reduction from 26.5 (range 6-52.5) to 1.5 (range 0-38, P = 0.00) for PUVA-bath therapy. Both improvements of ASIppd scores were found to be statistically significant, with no significant difference between PUVA-gel and PUVA-bath therapy. Severe phototoxic reactions such as strong erythema, blistering and/or pain were not observed in any patient.


CONCLUSIONS
PUVA-gel therapy seems to be an effective therapeutic alternative to conventional PUVA-bath therapy in treating localized dermatoses of the palms and soles. The advantage of PUVA-gel therapy is reduced organizational efforts and expenses.
Schiener
Ralf
R
Department of Dermatology, Venerology and Allergology, Federal Armed Forces Hospital, Ulm, Germany.
Gottlöber
Petra
P
Müller
Boris
B
Williams
Stefanie
S
Pillekamp
Hans
H
Peter
Ralf Uwe
RU
Kerscher
Martina
M
D000328:Adult; D000368:Aged; D001494:Baths; D004485:Eczema / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005533:Foot Dermatoses / Q000188:drug therapy / Q000473:pathology; D005782:Gels; D006229:Hand Dermatoses / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D008297:Male; D008730:Methoxsalen / Q000008:administration & dosage*; D008875:Middle Aged; D011701:PUVA Therapy; D017319:Photosensitizing Agents / Q000008:administration & dosage*; D011446:Prospective Studies; D012008:Recurrence; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome
D005782:Gels; D017319:Photosensitizing Agents; D008730:Methoxsalen