Phototherapy of psoriasis: Comparative experience of different phototherapeutic approaches

Background: Broad-band UVB alone or in combination with different topical d rugs (anthralin, calcipotriol), systemic PUVA and bath-PUVA therapy are ver y effective and well-established treatment modalities for psoriasis. Object ive: The aim of this retrospective study was to assess which of these routi nely applied phototherapeutic modalities might be most effective and safe f or the treatment of plaque-type psoriasis. Methods: Patients (n = 203) with moderate to severe (pretreatment Psoriasis Area and Severity Index score b etween 12 and 35) chronic plaque-type psoriasis treated between 1992 and 19 98 at our department with either UVB (with/without anthralin or calcipotrio l; n = 97), systemic PUVA (n = 19) or bath-PUVA therapy (n = 87) were evalu ated for efficacy, duration of treatment, number of treatments necessary fo r complete remission (CR), cumulative light dose, side effects of therapy a nd duration of remission after therapy. Results: No statistically significa nt difference comparing the efficacy of bath-PUVA (CR in 72.4%), PUVA (CR i n 89.5%) and UVB phototherapy (CR in 69.1%) was found. Although the duratio n of therapy was significantly longer for bath-PUVA (66 +/- 42 days) as com pared to UVB treatment (50 +/- 27 days), the mean number of treatments did not differ significantly be-tween bath-PUVA (28 +/- 12), UVB therapy(30 +/- 12) and PUVA(26 +/- 13). Significantly fewer side effects of phototherapy were observed with bath-PUVA (14.9%) therapy compared to UVB treatment (30. 9%). Also, the duration of remission after successful therapy was significa ntly longer for bath-PUVA (8.4 +/- 3.5 months) as compared to UVB photother apy(5.1 +/- 4.2 months). Conclusion: Bath-PUVA therapy has some advantages over UVB phototherapy in the treatment of psoriasis: fewer UV-related acute side effects and a longer period of remission after therapy. However, the choice of treatment with either UVB, bath-PUVA or systemic PUVA should also be based on a history of previous response to treatment and patient consid erations, including compliance and responsibility for following the precaut ions to avoid potential side effects. Copyright (C) 2001 S. Karger AG. Base l.