Objective: To determine whether targeted UV-B phototherapy is efficacious and safe in the treatment of localized psoriasis and whether there is a dose-response relationship. Design: Randomized, evaluator-blind, contro...Objective: To determine whether targeted UV-B phototherapy is efficacious and safe in the treatment of localized psoriasis and whether there is a dose-response relationship. Design: Randomized, evaluator-blind, controlled study. Setting: Dermatology clinic in a large university-based hospital in Bangkok,Thailand. Patients: Fourteen patients with stable, localized, plaque-type psoriasis. Interventions: Patientswere randomized to receive different fluences of targeted UV-B phototherapy 3 times weekly based on predetermined minimal erythema doses(MEDs). Treatment fluences were constant throughout the study period of 4weeks. Follow-upwas carried out until lesions returned to original state. Main Outcome Measures: Modified psoriasis area and severity index. Results: All fluences of UV-B produced some clinical improvement and were very well tolerated. Fluences ranging from 1 to 6 multiples of MEDs resulted in clearance of lesions in some patients with 6 MEDs producing clearance in 77% of patients. The number of treatments required to clear psoriatic lesions when 2 to 6MEDs were used was 5.0 to 6.1 treatments. The only adverse events observed were erythema, which was asymptomatic in most subjects, and hyperpigmentation. Conclusions: Incoherent, targeted UV-B phototherapy is a safe and efficacious treatment modality for localized psoriasis. Its value in other UV-B responsive conditions should be further investigated.展开更多
Background: Combining phototherapy with topical and oral agents allows clinicians to treat recalcitrant psoriasis with reduced number of treatments and cumulative UV exposures. Objective: This study was designed to de...Background: Combining phototherapy with topical and oral agents allows clinicians to treat recalcitrant psoriasis with reduced number of treatments and cumulative UV exposures. Objective: This study was designed to determine the number of treatments necessary to clear plaque-type psoriasis when narrowband (NB) UVB is administered with methotrexate (MTX) or placebo in a randomized, controlled fashion. Methods: MTX (15 mg/wk) or placebo was administered 3 weeks before standard NB UVB phototherapy was started. Treatments with the oral agent and phototherapy were continued until Psoriasis Area and Severity Index scores were reduced to less than 10% of the original scores or 24 weeks. Followup was performed until lesional scores returned to 50% of the original ones. Results: A total of 24 patients were enrolled and 19 patients completed the study. Kaplan-Meier analysis revealed that the median time to clear psoriasis in the MTX/NB UVB group was 4 weeks, which was significantly less than that for the placebo/NB UVB group. Limitations: Our sample size was relatively small (24 patients) with 5 dropouts. In addition, the study was conducted in skin types III to IV, Asian patients. Follow-up was limited to 4 to 6 months after completion of phototherapy. Conclusion: MTX pretreatment allows physicians to clear psoriasis in fewer phototherapy sessions than when phototherapy is administered alone.展开更多
文摘Objective: To determine whether targeted UV-B phototherapy is efficacious and safe in the treatment of localized psoriasis and whether there is a dose-response relationship. Design: Randomized, evaluator-blind, controlled study. Setting: Dermatology clinic in a large university-based hospital in Bangkok,Thailand. Patients: Fourteen patients with stable, localized, plaque-type psoriasis. Interventions: Patientswere randomized to receive different fluences of targeted UV-B phototherapy 3 times weekly based on predetermined minimal erythema doses(MEDs). Treatment fluences were constant throughout the study period of 4weeks. Follow-upwas carried out until lesions returned to original state. Main Outcome Measures: Modified psoriasis area and severity index. Results: All fluences of UV-B produced some clinical improvement and were very well tolerated. Fluences ranging from 1 to 6 multiples of MEDs resulted in clearance of lesions in some patients with 6 MEDs producing clearance in 77% of patients. The number of treatments required to clear psoriatic lesions when 2 to 6MEDs were used was 5.0 to 6.1 treatments. The only adverse events observed were erythema, which was asymptomatic in most subjects, and hyperpigmentation. Conclusions: Incoherent, targeted UV-B phototherapy is a safe and efficacious treatment modality for localized psoriasis. Its value in other UV-B responsive conditions should be further investigated.
文摘Background: Combining phototherapy with topical and oral agents allows clinicians to treat recalcitrant psoriasis with reduced number of treatments and cumulative UV exposures. Objective: This study was designed to determine the number of treatments necessary to clear plaque-type psoriasis when narrowband (NB) UVB is administered with methotrexate (MTX) or placebo in a randomized, controlled fashion. Methods: MTX (15 mg/wk) or placebo was administered 3 weeks before standard NB UVB phototherapy was started. Treatments with the oral agent and phototherapy were continued until Psoriasis Area and Severity Index scores were reduced to less than 10% of the original scores or 24 weeks. Followup was performed until lesional scores returned to 50% of the original ones. Results: A total of 24 patients were enrolled and 19 patients completed the study. Kaplan-Meier analysis revealed that the median time to clear psoriasis in the MTX/NB UVB group was 4 weeks, which was significantly less than that for the placebo/NB UVB group. Limitations: Our sample size was relatively small (24 patients) with 5 dropouts. In addition, the study was conducted in skin types III to IV, Asian patients. Follow-up was limited to 4 to 6 months after completion of phototherapy. Conclusion: MTX pretreatment allows physicians to clear psoriasis in fewer phototherapy sessions than when phototherapy is administered alone.
