Author(s) : Jana Trott, Wolfgang Gerber, Stefan Hammes, Hans-Michael Ockenfels , Department of Dermatology and Allergology, Klinikum Hanau, Leimenstraße 20, 63450 Hanau, Germany, Laserklinik, Karlsruhe, Germany.
Summary : In most cases, patients with moderate to severe psoriasis are treated with narrow-band UVB phototherapy or with psoralen UVA (PUVA-) photochemotherapy. This UV-radiation is given to the whole skin, including unaffected skin. Normally, these two PUVA- and UVB-radiation procedures cannot be combined on account of the phototherapeutic side-effects on unaffected skin. The 308-nm excimer laser has been shown to be safe and effective in the treatment of localized mild-to-moderate plaque-type psoriasis whilst sparing healthy skin. Our aim was to compare the therapeutic response to PUVA plus up to 4 UVB308-nm radiations and PUVA monotherapy in patients with moderate-severe plaque-type psoriasis. 272 hospitalized adult patients were enrolled on this prospective random study. 256 patients completed the full course of treatment. PUVA treatment was given 4 times weekly to all patients. 123 patients received PUVA as a monotherapy. During the first two weeks, 149 patients were additionally treated up to four times with 308-nm excimer-derived UVB on the affected skin and treatment was evaluated for its efficacy, duration, number of times necessary for complete (CR) or partial remission (PASI reduction > 90 or > 50%, respectively), cumulative light dose, side effects of therapy and duration of remission after therapy. Statistically, there is no significant difference when comparing the efficacy of PUVA (CR 67.3%) and PUVA plus excimer (CR 63.6%). On average, patients treated by the combination method went into remission in half the treatment time (15 ± 6 versus 27 ± 7 days) and with half the cumulative UVA dose (22.9 ± 5.8 versus 53.2 ± 26.3), p <\; 0.05. In conclusion, skin heals considerably quicker when treated with a combination of photochemotherapy and a short course of UVB 308 nm laser treatment applied directly to the affected skin, resulting in a shorter hospital stay and quicker rehabilitation of patients with moderate-severe psoriasis.
Keywords : PUVA treatment, psoriasis, laser
Pictures
Figure 1 Minimum erythema dose of involved skin
(MED-I), dose dependend 8 (800 mJ)-14(1400 mJ); blister at
1400 mJ.
Figure 2A) Male Patient age 38, PASI 24,
affected for 12 years, treated ten times with PUVA (12
J/cm2 UV-A) and three times with excimer laser (1800 mJ
UV-B). B) after 2 weeks. C) after 8weeks with
complete remission.
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