Failure of short-term psoralen and ultraviolet A light maintenance treatment to prevent early relapse in patients with chronic recurring plaque-type psoriasis.
BACKGROUND
Photochemotherapy using psoralen and ultraviolet A light (PUVA) is a highly effective treatment option for patients with severe psoriasis. Maintenance treatment has been advocated to provide for sustained remission. However, only a few studies have been conducted to assess the efficacy of maintenance treatment and these have provided inconsistent results.


METHODS
We performed a prospective intrapatient left-right comparison study in 34 patients with chronic relapsing plaque psoriasis. PUVA treatment for clearing was given four times weekly. After complete or near-complete clearing, all patients were placed on a halfside maintenance schedule with irradiation twice weekly and then once weekly for 4 weeks each. The psoriasis area and severity index score was determined at baseline, end of the clearing phase and at 2-monthly intervals after discontinuation of treatment.


RESULTS
Using a short-term maintenance protocol, a moderate delay in relapse of psoriasis was observed in only three patients (8.8%; 95% CI: 1.8-23.6%). In the remaining patients (91.2%), maintenance treatment had no effect on the length of remission. The mean time interval until relapse without and with maintenance irradiation was 4.5 +/- 3.4 and 4.6 +/- 3.4 months, respectively.


CONCLUSIONS
Our data indicate that short-term maintenance treatment is not effective in preventing early relapse of psoriasis and should be avoided.
Radakovic
Sonja
S
Department of Dermatology, Division of Special and Environmental Dermatology, University of Vienna Medical School, Vienna, Austria.
Seeber
Arno
A
Hönigsmann
Herbert
H
Tanew
Adrian
A
D000328:Adult; D002908:Chronic Disease / Q000628:therapy; D005363:Ficusin / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011565:Psoriasis / Q000628:therapy*; D055502:Secondary Prevention; D013997:Time Factors; D017211:Treatment Failure; D014467:Ultraviolet Therapy / Q000379:methods*
D017319:Photosensitizing Agents; D005363:Ficusin