John Libbey Eurotext

European Journal of Dermatology

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The effectiveness of PUVA treatment in severe psoriasis is significantly increased by additional UV 308-nm excimer laser sessions Volume 18, numéro 1, January-February 2008

Auteurs
Department of Dermatology and Allergology, Klinikum Hanau, Leimenstraße 20, 63450 Hanau, Germany, Laserklinik, Karlsruhe, Germany

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.