Lack of consensus among experts on the choice of UV therapy for psoriasis

Context: Each lear tens of thousands of patients in the United States are t reated with UV-B radiation or psoralen plus UV-A radiation (PUVA) for a var iety of skin disorders. Although PUVA is generally considered more effectiv e, it is also more toxic and more expensive. The degree of consensus among experts in prescribing these alternative treatments has not been quantified . Objectives: To quantify variation among specialty clinics in the type of ul traviolet therapy used to treat specific skin conditions and assess factors associated with the use of specific treatments. Design: Survey conducted during two 2-week periods in the late fall of 1994 and early spring of 1995. Setting: Thirty-nine specialty clinics in 17 US geographic areas in 14 stat es and Washington, DC. Participants: A total of 3401 patients treated with UV radiation one or mor e times. Outcome Measures: Type of UV therapy used and indications for treatment, ag e, sex, number of patients treated, and geographic location of each clinic. Results: The proportion of patients at each center treated with PUVA ranged from 0% to 93% (mean, 41%). Clinic size and geographic location, demograph ic characteristics of the patients, and diagnosis did not explain these lar ge intercenter differences. Conclusions: Among specialized clinics, there is little consistency in the use of alternative therapies, which differ substantially in safety and cost , but whose relative efficacy is not well quantified. There is a lack of co nsensus among experts about the circumstances in which the greater risks an d costs of PUVA are outweighed by its possibly greater efficacy, especially in the treatment of psoriasis.