5-Methoxypsoralen plus ultraviolet (UV) A is superior to medium-dose UVA1 in the treatment of severe atopic dermatitis: a randomized crossover trial.
BACKGROUND
Ultraviolet (UV) A1 and psoralen plus UVA (PUVA) are effective treatment options for severe atopic dermatitis (AD); however, their relative efficacy has not yet been determined in a head-to-head study.


OBJECTIVE
To compare UVA1 and oral 5-methoxypsoralen (5-MOP) plus UVA with respect to efficacy, tolerability and duration of response in patients with severe generalized AD.


METHODS
Forty patients were included in this randomized observer-blinded crossover trial. The patients received either 15 exposures to medium-dose UVA1 as the first treatment and, in cases of relapse, another 15 exposures to 5-MOP plus UVA as the second treatment, or vice versa. All patients were followed until 12 months after discontinuation of the last treatment. The SCORAD score was determined by a blinded investigator at baseline, after 10 and 15 treatments each and during the follow-up period. In addition, all adverse events were recorded during the whole study period.


RESULTS
Twenty-three patients completed the crossover treatment. Both phototherapies resulted in clinical improvement; however, PUVA reduced the baseline SCORAD score to a significantly greater extent than UVA1 (mean +/- SD 54.3 +/- 25.7% vs. 37.7 +/- 22.8%; P = 0.041). The median length of remission was 4 weeks (interquartile range 4-12) after UVA1 and 12 weeks (interquartile range 4-26) after PUVA therapy (P = 0.012).


CONCLUSIONS
PUVA provides a better short- and long-term response than medium-dose UVA1 in patients with severe AD.
Tzaneva
S
S
Division of Special and Environmental Dermatology, Medical University of Vienna, Vienna, Austria. stanislava.tzaneva@meduniwien.ac.at
Kittler
H
H
Holzer
G
G
Reljic
D
D
Weber
M
M
Hönigsmann
H
H
Tanew
A
A
D000078223:5-Methoxypsoralen; D000293:Adolescent; D000328:Adult; D018592:Cross-Over Studies; D003876:Dermatitis, Atopic / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008730:Methoxsalen / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008875:Middle Aged; D011701:PUVA Therapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D016896:Treatment Outcome; D014466:Ultraviolet Rays; D055815:Young Adult
D017319:Photosensitizing Agents; D000078223:5-Methoxypsoralen; D008730:Methoxsalen