Phototherapy of psoriasis: review and update.

Along with topical and systemic therapy, phototherapy is one of the three fundamental treatment options for managing psoriasis. The use of UVB continues to be one of the most important therapeutic interventions for mild to moderate psoriasis. An advance in UVB phototherapy has been the introduction of narrowband UVB lamps (311 nm). UVB lamps are superior to conventional broadband UVB in clearing psoriasis. PUVA is very effective therapy and is still the most effective form of phototherapy for severe, extensive form od the disease. There has been a trend towards whole-body PUVA-bath. Advantages of PUVA bath are lack of gastrointestinal side effects and no need for post-treatment eye photoprotection because there is no systemic photosensitization. UVB and PUVA can be administered in combination with a variety of topical and systemic treatments to achieve more effective results more quickly. The most recent form of phototherapy, 308-nm excimer laser, holds promise for becoming a useful tool in the treatment of stable, localized psoriasis.

[1]  R. Stern,et al.  Combined methotrexate--ultraviolet B therapy in the treatment of psoriasis. , 1982, Journal of the American Academy of Dermatology.

[2]  Bruynzeel Dp,et al.  Ocular findings in 340 long-term treated PUVA patients. , 1985 .

[3]  M. Green,et al.  Inhibition of RNA and DNA synthesis in UV-irradiated normal human fibroblasts is correlated with pyrimidine (6-4) pyrimidone photoproduct formation. , 1996, Mutation research.

[4]  R. Stern,et al.  Squamous-cell cancer of the skin in patients given PUVA and ciclosporin: nested cohort crossover study , 2001, The Lancet.

[5]  O. Braun-falco,et al.  Efficiency of acitretin in combination with UV-B in the treatment of severe psoriasis. , 1990, Archives of dermatology.

[6]  Karvonen,et al.  Trioxsalen bath PUVA did not increase the risk of squamous cell skin carcinoma and cutaneous malignant melanoma in a joint analysis of 944 Swedish and Finnish patients with psoriasis , 1999, The British journal of dermatology.

[7]  P. Kerkhof,et al.  Multiple squamous cell carcinomas in a psoriatic patient following high–dose photochemotherapy and cyclosporin treatment: response to long–term acitretin maintenance , 1997 .

[8]  P. C. Llins,et al.  Bath‐water compared with oral delivery of 8‐methoxypsoralen PUVA therapy for chronic plaque psoriasis , 1992 .

[9]  O. Larkö.  Treatment of psoriasis with a new UVB-lamp. , 1989, Acta dermato-venereologica.

[10]  T. Meola,et al.  Are topical corticosteroids useful adjunctive therapy for the treatment of psoriasis with ultraviolet radiation? A review of the literature. , 1991, Archives of dermatology.

[11]  G. Szabó,et al.  308 nm UVB excimer laser for psoriasis , 1997, The Lancet.

[12]  M. Šitum,et al.  PHOTOTHERAPY (UVB) AND PHOTOCHEMOTHERAPY (PUVA) FOR PSORIASIS , 2002 .

[13]  R. Stern.  Ocular lens findings in patients treated with PUVA. Photochemotherapy Follow-Up-Study. , 1994, The Journal of investigative dermatology.

[14]  R. Stern,et al.  Ocular findings in patients treated with PUVA. , 1985, The Journal of investigative dermatology.

[15]  O. Kristensen,et al.  Topical salicylic acid interferes with UVB therapy for psoriasis. , 1991, Acta dermato-venereologica.

[16]  J. Parrish,et al.  Oral methoxsalen photochemotherapy for the treatment of psoriasis: a cooperative clinical trial. , 1977, The Journal of investigative dermatology.

[17]  G. Plewig,et al.  Narrow-band UVB (311 nm) versus conventional broad-band UVB with and without dithranol in phototherapy for psoriasis. , 1993, Journal of the American Academy of Dermatology.

[18]  A. Hannuksela-Svahn,et al.  Cancer incidence among Finnish psoriasis patients treated with 8-methoxypsoralen bath PUVA. , 1999, Journal of the American Academy of Dermatology.

[19]  D. Pariser,et al.  Toxic hepatitis from oral methoxsalen photochemotherapy (PUVA). , 1980, Journal of the American Academy of Dermatology.

[20]  J. Parrish,et al.  Controlled study of PUVA and adjunctive topical therapy in the management of psoriasis , 1978, The British journal of dermatology.

[21]  M. Zanolli.  Phototherapy treatment of psoriasis today. , 2003, Journal of the American Academy of Dermatology.

[22]  Priestley,et al.  A comparison of bathwater and oral delivery of 8‐methoxypsoralen in PUVA therapy for plaque psoriasis , 2000, Clinical and experimental dermatology.

[23]  G. Plewig,et al.  Psoralen bath plus UV-A therapy. Possibilities and limitations. , 1997, Archives of dermatology.

[24]  R. Stern,et al.  The carcinogenic risk of treatments for severe psoriasis , 1994, Cancer.

[25]  J. Cadet,et al.  Photochemistry of nucleic acids in cells. , 1992, Journal of photochemistry and photobiology. B, Biology.

[26]  M. Trehan,et al.  Medium-dose 308-nm excimer laser for the treatment of psoriasis. , 2002, Journal of the American Academy of Dermatology.

[27]  Lowe,et al.  Optimizing therapy: tazarotene in combination with phototherapy , 1999, The British journal of dermatology.

[28]  M. Šitum,et al.  Treatment of vitiligo: current methods and new approaches. , 2003, Acta dermatovenerologica Croatica : ADC.

[29]  E. Tanzi,et al.  Lasers in dermatology: four decades of progress. , 2003, Journal of the American Academy of Dermatology.

[30]  J. Krueger,et al.  Suberythemogenic narrow-band UVB is markedly more effective than conventional UVB in treatment of psoriasis vulgaris. , 1999, Journal of the American Academy of Dermatology.

[31]  M. Lebwohl,et al.  Consensus conference: acitretin in combination with UVB or PUVA in the treatment of psoriasis. , 2001, Journal of the American Academy of Dermatology.

[32]  J. Boer,et al.  Combined treatment of psoriasis with acitretin and UVB phototherapy compared with acitretin alone and UVB alone , 1989, The British journal of dermatology.

[33]  M. Kerscher,et al.  Rapid decrease of phototoxicity after PUVA bath therapy with 8-methoxypsoralen. , 1996, Archives of dermatology.

[34]  J. Thivolet,et al.  Calcipotriol in combination with PUVA: a randomized double blind placebo study in severe psoriasis , 1993 .

[35]  J. Youn,et al.  Positive effect of using calcipotriol ointment with narrow‐band ultraviolet B phototherapy in psoriatic patients , 2002, Photodermatology, photoimmunology & photomedicine.

[36]  S. Ibbotson,et al.  A randomized controlled trial of narrowband ultraviolet B vs. bath‐psoralen plus ultraviolet A photochemotherapy for psoriasis , 2003, The British journal of dermatology.

[37]  R. Armstrong,et al.  Acitretin plus UVB therapy for psoriasis. Comparisons with placebo plus UVB and acitretin alone. , 1991, Journal of the American Academy of Dermatology.

[38]  M. Kripke,et al.  Pyrimidine dimers in DNA initiate systemic immunosuppression in UV-irradiated mice. , 1992, Proceedings of the National Academy of Sciences of the United States of America.

[39]  N. Lowe,et al.  PUVA therapy for psoriasis: comparison of oral and bath-water delivery of 8-methoxypsoralen. , 1986, Journal of the American Academy of Dermatology.

[40]  S. Rogers,et al.  Narrowband UV-B (TL-01) phototherapy vs oral 8-methoxypsoralen psoralen-UV-A for the treatment of chronic plaque psoriasis. , 2003, Archives of dermatology.

[41]  M. Lebwohl.  Acitretin in combination with UVB or PUVA. , 1999, Journal of the American Academy of Dermatology.

[42]  T. Reunala,et al.  Comparison of trioxsalen bath and oral methoxsalen PUVA in psoriasis. , 1985, Acta dermato-venereologica.

[43]  K. McKenna,et al.  Combination TL01 ultraviolet B phototherapy and topical calcipotriol for psoriasis: a prospective randomized placebo‐controlled clinical trial , 2003, The British journal of dermatology.

[44]  G. Weinstein,et al.  Treatment of psoriasis. , 1976, The New England journal of medicine.

[45]  L. Meunier,et al.  Treatment of psoriasis with a 311‐nm UVB lamp , 1992, The British journal of dermatology.

[46]  Behrens,et al.  Combination treatment of psoriasis with photochemotherapy and tazarotene gel, a receptor‐selective topical retinoid , 1999, The British journal of dermatology.

[47]  J. Ferguson,et al.  311 nm UVB phototherapy—an effective treatment for psoriasis , 1988, The British journal of dermatology.

[48]  R. Stern,et al.  Risk of squamous cell carcinoma and methoxsalen (psoralen) and UV-A radiation (PUVA). A meta-analysis. , 1998, Archives of dermatology.

[49]  H. Hönigsmann,et al.  Photochemotherapy for severe psoriasis without or in combination with acitretin: a randomized, double-blind comparison study. , 1991, Journal of the American Academy of Dermatology.

[50]  R. Knobler,et al.  CYTOKINE RELEASE BY PERIPHERAL BLOOD MONONUCLEAR CELLS IS AFFECTED BY 8‐METHOXYPSORALEN PLUS UV‐A , 1994, Photochemistry and photobiology.

[51]  R. Stern,et al.  Oral psoralen and ultraviolet-A light (PUVA) treatment of psoriasis and persistent risk of nonmelanoma skin cancer. PUVA Follow-up Study. , 1998, Journal of the National Cancer Institute.

[52]  G. Plewig,et al.  Rapid decline in photosensitivity after 8-methoxypsoralen bathwater delivery. , 1996, Archives of dermatology.

[53]  F. Nestle,et al.  Clinical Efficacy of Narrow-Band UVB (311 nm) Combined with Dithranol in Psoriasis , 2000, Dermatology.

[54]  H. Ockenfels,et al.  Ultraviolet B 308‐nm excimer laser treatment of psoriasis: a new phototherapeutic approach , 2003, The British journal of dermatology.

[55]  P. Farr,et al.  Calcipotriol improves the response of psoriasis to PUVA , 1994, The British journal of dermatology.

[56]  H. Lui.  Phototherapy of Psoriasis: Update with Practical Pearls , 2002 .

[57]  E. Christophers,et al.  Evaluation of PUVA, topical corticosteroids and the combination of both in the treatment of psoriasis , 1978, The British journal of dermatology.

[58]  K. Papp,et al.  Calcipotriol Cream Combined with Twice Weekly Broad-Band UVB Phototherapy: A Safe, Effective and UVB-Sparing Antipsoriatric Combination Treatment , 2000, Dermatology.

[59]  L. Molin.  Topical Calcipotriol Combined with Phototherapy for Psoriasis , 1999, Dermatology.

[60]  E. Abel.  British Photodermatology Group guidelines for PUVA. , 1994, The British journal of dermatology.

[61]  M. Kerscher,et al.  Combination phototherapy of psoriasis with narrow-band UVB irradiation and topical tazarotene gel. , 2000, Journal of the American Academy of Dermatology.

[62]  B. Berne,et al.  PUVA and cancer risk: the Swedish follow‐up study , 1999, The British journal of dermatology.

[63]  H. Hönigsmann,et al.  Safety and effectiveness of an aggressive and individualized bath-PUVA regimen in the treatment of psoriasis. , 1994, Dermatology.

[64]  W. Morison,et al.  Phototherapy and photochemotherapy: an update. , 1999, Seminars in cutaneous medicine and surgery.

[65]  H. Hönigsmann,et al.  Phototherapy for psoriasis , 2001, Clinical and experimental dermatology.

[66]  F. Kokelj,et al.  UVB versus UVB plus calcipotriol (MC 903) therapy for psoriasis vulgaris. , 1995, Acta dermato-venereologica.