Bath PUVA and psoriasis: is a milder treatment a worse treatment?
OBJECTIVE
The guidelines of the British Photodermatology Group for topical treatment with psoralen and ultraviolet light (PUVA) recommend starting UVA doses between 0.2 and 0.5 J/cm(2), according to the phototype. Our purpose was to evaluate the therapeutic efficacy and tolerability of bath PUVA, with 8-methoxypsoralen (8-MOP), by using lower UVA doses, regardless of phototype.


METHODS
We compared 2 groups of patients (group 1: n = 10, group 2: n = 20) with chronic plaque-type psoriasis. Group 1 was treated with the usual starting dose and dose progression; group 2 was treated by using a lower first dose, a slower dose progression and reaching a lower maximum dose. The Psoriasis Area and Severity Index (PASI) score was assessed at the initial stages, and every month until the end of the treatment.


RESULTS
In group 1, the median baseline PASI score decreased from 15.2 to 4.5 (p < 0.005, Student's paired t test), while in group 2, it fell from 13.7 to 4.1 (p < 0.005). No statistical difference between the groups is detectable. Severe phototoxic reactions were observed only in 2 patients of group 1. Side effects were not observed in group 2.


CONCLUSIONS
Our data indicate that an aggressive bath PUVA treatment is not substantially more effective in clearing chronic plaque-type psoriasis than a milder therapeutic approach.
Delrosso
G
G
Dermatologic Clinic, University of Oriental Piedmont A. Avogadro, Novara, Italy.
Bornacina
C
C
Farinelli
P
P
Bellinzona
F
F
Leigheb
G
G
Colombo
E
E
D000328:Adult; D001494:Baths; D002985:Clinical Protocols; D017484:Dermatitis, Phototoxic / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008730:Methoxsalen / Q000008:administration & dosage*; D008875:Middle Aged; D011701:PUVA Therapy / Q000009:adverse effects / Q000379:methods*; D017319:Photosensitizing Agents / Q000008:administration & dosage*; D011565:Psoriasis / Q000188:drug therapy* / Q000473:pathology; D011829:Radiation Dosage; D012720:Severity of Illness Index; D012867:Skin / Q000473:pathology; D016896:Treatment Outcome
D017319:Photosensitizing Agents; D008730:Methoxsalen