A review of protocols for 308 nm excimer laser phototherapy in psoriasis.
BACKGROUND
308 nm excimer laser phototherapy is efficacious in the treatment of localized psoriasis. Different approaches regarding dose fluency, number of treatments, and maintenance have been utilized, and there is yet to be a consensus on standard protocol.


OBJECTIVE
To characterize treatment parameters for 308 nm excimer laser phototherapy.


METHODS
We performed a PubMed search for studies describing excimer laser treatment protocol with particular attention to dosage determination, dose adjustment, dose fluency, number of treatments, and maintenance.


RESULTS
Seven prospective studies were found describing the excimer efficacy for psoriasis. All studies determined the initial treatment dose using either the minimal erythema dose (MED) or induration. Fluency ranged from 0.5 MED (low) to 16 MED (high); one study demonstrated that medium to high fluencies yielded better improvement in fewer number of treatments. Fluency adjustments during the course of treatment were important to minimize phototherapy-associated side effects. The use of higher fluencies was reported to result in higher occurrences of blistering. One study implemented a maintenance tapering of dose-frequency phase to better manage psoriasis flare-ups.


CONCLUSIONS
The 308 nm excimer laser is an effective therapy for psoriasis regardless of the method used to determine initial dosage, dose fluency, or number of treatments. As its usage as a targeted monotherapy increases, future trials should consider evaluating and modifying these parameters to determine the most optimal management of localized psoriasis. Based on our reviewed studies, there is no consensus for a single excimer laser therapy protocol and as a result, patient preferences should continue to be an important consideration for phototherapy regimen planning.
Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Tejaswi
T
Mudigonda
Tushar S
TS
Dabade
Steven R
SR
Feldman
D006801:Humans; D054018:Lasers, Excimer / Q000592:standards / Q000627:therapeutic use*; D057240:Patient Preference / Q000523:psychology; D010789:Phototherapy / Q000379:methods*; D011446:Prospective Studies; D011565:Psoriasis / Q000473:pathology / Q000517:prevention & control / Q000601:surgery*