LOW-DOSE NARROW-BAND UVB PHOTOTHERAPY COMBINED WITH TOPICAL THERAPY IS EFFECTIVE IN PSORIASIS AND DOES NOT INHIBIT SYSTEMIC T-CELL ACTIVATION

Background: Psoriasis is a chronic T-cell-mediated inflammatory skin d isease which can be treated with topical medication, phototherapy or s ystemic medication. A subgroup of psoriatic patients does not respond to monotherapy and needs combination therapy. We used low-dose narrow- band UVB phototherapy, combined with balneotherapy, short-contact anth ralin, liquor carbonis detergens and calcipotriol for treatment of pso riatic patients in our day care centre, Objective: Our purpose was to study the efficacy, induction of erythema and effect on systemic T-cel l activation of this combination therapy. Methods: Skin reflectance sp ectrophotometry was used to measure skin erythema. The Psoriasis Area and Severity Index (PASI) was used to evaluate psoriatic patients. Ser um soluble IL-2 receptor (sIL2-R) levels were measured by an ELISA. Re sults: The possible erythematogenic effect of low-dose narrow-band UVB irradiation was studied (skin reflectance spectrophotometer) in a con trol group of psoriatic patients (n=11). No induction of skin erythema was seen. Subsequently, this low-dose irradiation regimen was used in combination with topical medication in 26 psoriatic patients. A 90% d ecrease in the PASI was seen after a mean number of 35 treatment sessi ons. Seventeen patients (65%) remained in remission during the followi ng 6 months. Serum sIL-2R levels were elevated in all patients (mean 9 13 U/ml) and did not change during treatment. Conclusion: Our data ind icate that low-dose narrow-band UVB can be used successfully, in combi nation with topical treatment, in a day care setting to treat psoriati c patients. Since sIL-2R serum levels were not decreased, it can be sp eculated that this treatment does not induce systemic immunosuppressio n.