NARROW-BAND UVB (311 NM) PHOTOTHERAPY AND PUVA PHOTOCHEMOTHERAPY - A COMBINATION

Background: Psoralen-UVA (PUVA) photochemotherapy is widely used for t he treatment of psoriasis despite concerns of skin carcinogenesis from high cumulative UVA doses and number of treatments. Objective: We att empted to determine whether combined bath-PUVA with narrow-band (311 n m) phototherapy improves efficacy and reduces long-term toxicity. Meth ods: Twelve psoriatic patients underwent phototesting with 311 nm lamp s and, after topical bath-water psoralen sensitization, with 311 nm, U VA, or both radiations. Patients were treated with bath-PUWA on one si de of the body and with bath-PUVA plus 311 nm exposures (bath-PUVA-311 nm) on the other side. On both sides, four weekly treatments were del ivered and UVA doses were increased once weekly whereas 311 nm doses w ere adjusted at each exposure. Results: Psoralen sensitization did not modify the erythematous threshold to 311 nm radiation. However, 311 n m exposures enhanced the phototoxic activity of bath-PUVA. Bath-PUVA-3 11 nm cleared psoriasis with fewer exposures and lower cumulative UVA doses under the same minimally erythemogenic conditions. Conclusion: C ombination with 311 nm exposures enhanced the phototoxic and therapeut ic activities of bath-PUVA.