High-dose 308-nm excimer laser for the treatment of psoriasis

BACKGROUND: The excimer laser can deliver high-intensity ultraviolet B (UVB) energy at 308 nm, a wavelength similar to that used in narrow-band UVB phototherapy. OBJECTIVE: The goal of this investigation was to evaluate the role of high-dose single treatments with the excimer 308-nm laser in stable plaque-type psoriasis. METHODS: Eighteen volunteers were enrolled in the study. Two plaques were selected and half of each plaque was held as a control while the other half was treated with a single dose of either 8 or 16 times the minimal erythema dose. RESULTS: Sixteen subjects completed the study. Two patients signed up but never actually participated because of scheduling problems. Eleven showed significant improvement within 1 month, and 5 still demonstrated persistent areas of clearing at 4 months. CONCLUSION: As little as one high-dose excimer laser treatment can be effective for localized plaque-type psoriasis. Multiple treatments or other irradiation schedules with this innovative device may prove even more efficacious.     

Medium-dose 308-nm excimer laser for the treatment of psoriasis

BACKGROUND: The excimer laser delivers targeted ultraviolet B 308-nm radiation. OBJECTIVE: This investigation evaluated the efficacy of multiple, medium-dose excimer 308-nm laser treatments for psoriasis. METHODS: Twenty volunteers with plaque psoriasis were enrolled. Six plaques received treatment 3 times per week for up to 8 weeks; another plaque served as a control. As in standard phototherapy, a flexible dose escalation scheme was implemented during the course of treatment. Modified Psoriasis Area and Severity Index scores were rendered throughout the study with follow-ups at 1, 2, 4, and 6 months. RESULTS: Fifteen subjects completed the study without complications. The mean number of treatments to achieve >95% clearance was 10.6. The mean cumulative UV radiation dose was 6.1 J/cm(2), and the mean remission time was 3.5 months. CONCLUSION: A thrice-weekly, medium-dose irradiation schedule with the 308-nm laser can effectively clear localized plaque-type psoriasis in fewer treatments with an overall lower cumulative dose, compared with standard phototherapy. This innovative UV device allows specific targeting of affected sites without needless exposure of unaffected skin.     

308-nm excimer laser for the treatment of psoriasis: induration-based dosimetry

OBJECTIVE: To determine the response of stubborn psoriatic plaques to the 308-nm excimer laser. DESIGN: Controlled study with a before-after design. SETTING: A university-based clinical research center. PATIENTS: Adult subjects with recalcitrant plaque psoriasis that have not responded to other therapies for at least 2 months. INTERVENTIONS: Selected psoriatic plaques were treated with the 308-nm excimer laser. One lesion was left as a control. Each plaque was treated 2 times a week, with an initial dose based solely on the induration component of the modified Psoriasis Area and Severity Index score for that lesion. Subsequent treatments were twice a week with dosage increments up to 50%, based on the change in induration. Four final consolidation doses were given once the induration score was reduced to zero. RESULTS: Eighteen subjects were treated. There were 4 dropouts because of various scheduling problems. In the remaining 14 subjects, 44 plaques received a mean of 10 treatments (range, 4-14). Treatments were quick and well tolerated. The mean cumulative dose was 8.8 J/cm2 (range, 2.2-22.8 J/cm2). Compared with controls, treated plaques showed significant improvement (P<.001). The only adverse event was a mild sunburn-like reaction in 2 subjects after 1 treatment. CONCLUSIONS: Selective targeting of laser-generated 308-nm excimer radiation with this convenient subblistering dosage schedule based on induration allows for individualized treatment plans for each plaque. Clearing of stubborn psoriatic lesions occurs rapidly and safely.     

Comparison of the 308-nm excimer laser and a 308-nm excimer lamp with 311-nm narrowband ultraviolet B in the treatment of psoriasis

BACKGROUND: Psoriasis is a chronic, genetically determined inflammatory disease, characterized by an immunomediated pathogenesis, which affects approximately 1-3% of the population. Various modalities have been used for psoriasis treatment, including ultraviolet (UV) radiation. Narrowband UVB (311 nm) phototherapy is a well-established, widely used and highly efficient treatment for psoriasis, but a big disadvantage is that large areas of unaffected skin are irradiated along with the psoriatic lesions. OBJECTIVES: This investigation evaluates a 308-nm excimer laser and a 308-nm excimer lamp in comparison with 311-nm narrowband UVB in the treatment of patch psoriasis by using two different dose-increase schemes. MATERIALS AND METHODS: Fifteen patients with plaque psoriasis were enrolled in the study (first regime). Three different psoriatic lesions were treated with the 308-nm excimer laser, the 308-nm excimer lamp or 311-nm narrowband UVB three times per week. UVB doses were increased slowly and stepwise (1, 1, 2, 2, 3, 3, ...multiple MEDs). Sixteen patients were enrolled in the second regime. Two plaques were treated with the 308-nm excimer laser or with the 308-nm lamp with an accelerated scheme (2, 2, 4, 4, 6, 6, ...multiple MEDs) three times per week. We increased the UVB doses every second treatment (first and second regime) during the whole treatment. If blistering occurred, the blistered plaque was not treated on the next scheduled treatment. At every third visit and 1, 2 and 4 months after the last treatment a Psoriasis Severity Index (PSI) score was assigned in both regimes. RESULTS: Using Friedman analysis, the PSI scores did not show a statistically significant difference (P > 0.05) comparing 308-nm laser therapy, 308-nm lamp therapy and 311-nm narrowband therapy after 10 weeks in the first regime. The mean number of treatments to achieve clearance was 24. With the accelerated scheme, clearance could be achieved with fewer treatments and with half the cumulative dose of the first regime. Nevertheless, the side-effects such as blistering and crusting were also increased. CONCLUSIONS: Both 308-nm light sources can clear patch psoriasis in a similar manner to standard phototherapy, with the advantage of the ability to treat exclusively the affected skin and with a reduced cumulative dose, thus perhaps reducing the long-term risk of carcinogenicity.     

308-nm excimer laser for the treatment of psoriasis: a dose-response study

OBJECTIVE: To determine the dose-response relationship of excimer laser-generated 308-nm UV-B radiation for treating psoriasis. DESIGN: Pilot study with a before-after design. SETTING: A university dermatology service. PATIENTS: Thirteen consecutive patients with at least 4 large, stable psoriasis plaques. INTERVENTIONS: Excimer laser-generated 308-nm UV-B radiation was given to each of 4 plaques, which received 1, 2, 4, and 20 treatments, respectively. Untreated areas within each plaque served as controls. Within each plaque, 8 doses based on multiples of a predetermined minimal erythema dose (MED) were tested in distinct sites. The multiples were 0.5 and 1 (low dose); 2, 3, 4, and 6 (medium dose); and 8 and 16 (high dose). At every treatment, the dose for each site remained fixed at the same MED multiple. A psoriasis severity index score was determined for each area before, every 2 weeks during, and 2 and 4 months after treatment. RESULTS: The mean+/-SD MED was 203.03+/-57.84 mJ/ cm2. Treatment with high fluences produced significantly better results than that with medium and low fluences at weeks 4, 6, 8, and 10 (P<.05). At 4 months' follow-up, all sites that received low or medium fluences had recurrences, whereas those that underwent a single treatment at 8 and 16 MED multiples remained in remission. CONCLUSIONS: With 308-nm UV-B radiation generated by an excimer laser, it is possible to clear psoriasis with as little as 1 treatment with moderately long remission. In contrast to traditional phototherapy techniques, this handheld excimer laser UV-B therapy is selectively directed toward lesional skin, thus sparing the surrounding normal skin from unnecessary radiation exposure. Treatment of other inflammatory diseases and limited psoriasis seems reasonable to pursue with this modality.     

A review of the 308-nm excimer laser in the treatment of psoriasis.

The 308-nm excimer laser is a new modality for the treatment of psoriasis. With the 308-nm UVB radiation generated by this laser, it is possible to clear psoriasis with as little as one treatment and to have a moderately long remission. In contrast to traditional phototherapy techniques, this handheld excimer laser UVB therapy is selectively directed toward lesional skin, thus sparing the surrounding normal skin from unnecessary radiation exposure. This modality may offer a new alternative in the treatment of limited psoriasis and other inflammatory diseases.     

022 308 excimer laser treatment of psoriasis

The COLIPA Standard for solar simulators was developed to insure that SPF tested in different laboratories was not different because of the solar simulator used. Indeed for products with lower SPFs 2-10, the solar simulator standard reasonably assures similar SPFs when tested in different laboratories. For products with SPFs greater than 15, the SPF for the same product could be tested at 15 in one laboratory but as an SPF 100 in another.
Differences in SPF due to solar simulator filtration will occur only for sunscreen products that exhibit absorption like cut-off filters. Products which generally absorb all UV wavelengths equally will not exhibit differences in SPF due to solar simulator filtration.
In addition because of different amounts of UVA allowed within the COLIPA standard, the actual response for a given exposure may in one laboratory produce persistent pigment darkening and in another a simple sunburn. Ways to correct this flaw will be examined.     

308nm准分子激光治疗白癜风的疗效

目的 探讨308 nm准分子激光治疗白癜风的疗效及其不同年龄、不同部位和不同病程患者疗效的差异,以及疗效与疗程之间的关系.方法 应用临床分组比较的开放性研究方法,选择稳定期白癜风患者360例,≥14岁及<14岁者皮损各180处,给予308nm准分子激光局部照射,每周2次共10周(20次),并随访3个月.结果 ≥14岁组和<14岁组治疗总有效率分别为62.2%和63.3%,显效率分别为34.4%和44.4%,两组比较差异无统计学意义(P>0.05);不同部位皮损的疗效显示,面颈部疗效最好,躯干四肢部疗效次之,肢端关节部疗效最差,差异有统计学意义(P均<0.05);不同病程的皮损疗效亦不相同,病程越短疗效越好,适当延长疗程可提高疗效.结论 308 nm准分子激光治疗稳定期白癜风疗效好,起效快,不良反应少,患者的年龄差别对疗效的影响不明显,而皮损的部位、病程和治疗次数对疗效有一定的影响.     

Use of the 308-nm excimer laser for psoriasis and vitiligo

The 308-nm excimer laser represents the latest advance in the concept of selective phototherapy. It emits a wavelength in the UV-B spectrum and thus shares the same indications as conventional phototherapy. Like other laser devices, the 308-nm excimer laser emits a monochromatic and coherent beam of light, can selectively treat a lesion while sparing surrounding healthy skin, and can deliver high fluencies. Clinicians have taken advantage of these properties to treat dermatologic disorders since 1997, with psoriasis and vitiligo attracting most attention. Initially, high fluencies (minimal erythemal dose, 8-16) were used, with excellent clinical results, to treat psoriasis vulgaris. The significance of side effects and the potential long-term carcinogenic risk associated with such fluencies have resulted in medium doses (about 3 minimal erythemal dose) being recommended, however. Interestingly, taking advantage of the selectivity of the laser, newer treatment protocols adapt the dose to the lesion and not to the minimal erythemal dose, as is the case for conventional phototherapies. Many prospective study series have also shown the efficacy and the good tolerance of the 308-nm excimer laser in the treatment of localized vitiligo. Induced rates of repigmentation seem to be higher than with narrowband UV-B. Moreover, the selectivity of the treatment prevents irradiation of healthy skin and limits unsightly tanning of surrounding skin. Aesthetically pleasing results are usually not achieved in extremities and bony prominences, which are not good indications for this technique. Combining the 308-nm excimer laser with 0.1% tacrolimus ointment has provided very interesting results, which need to be confirmed in larger series. The absence of actual data concerning the long-term risk for skin cancer after this treatment means that it should be considered with caution. Combination with topical steroids appears to be synergistic and potentially reduces long-term side effects; again, prospective data are lacking.     

Ultraviolet B 308-nm excimer laser treatment of psoriasis: a new phototherapeutic approach

BACKGROUND: Excimer laser-derived 308-nm ultraviolet (UV) B therapy is a new alternative for treating psoriasis by phototherapy. Some studies have been made showing the effectiveness of intralesional phototherapy technology in treating psoriasis. However, there has been no information available so far with regard to the cumulative dosage on a larger group of patients and on therapy optimized treatment strategies. OBJECTIVES: One hundred and twenty psoriatic patients were treated according to standard protocol to define the effectiveness. Our aim was to develop new parameters and determine whether effectiveness could be improved and whether treatment exposure, the cumulative UVB dose and adverse effects could be minimized. METHODS: Initially, the excimer laser's effectiveness in treating psoriasis was evaluated in an open prospective study according to standard protocol. This included 120 adult patients (67 female/53 male) with chronic plaque psoriasis and < 20% involved body surface. The initial dose was based on three multiples of a predetermined minimal erythema dose (MED). Patients were treated twice a week for the first 3 weeks, then once a week until clearance was achieved. The main parameters were the initial starting dose, psoriasis area and severity index (PASI), the number of treatments needed, the time in treatment and the cumulative dose needed to clear psoriatic plaques. Thereafter, 43 patients were treated as a second comparable group. Therapy began with a starter dose, defined as MED-I. MED-I was defined as a UVB 308-nm dose which provoked a visible increase in erythema after 24 h. In addition, the epidermal thickness of the plaques was measured on an individual basis by 20-MHz ultrasound and correlated to the MED-I. RESULTS: Of the patients who met the standard protocol, 65.7% were at least 90% clear after a maximum of 10 treatments; an even greater number (85.3%) showed a > or = 90% improvement in PASI after 13 sessions, while 14.7% of patients had only a < or = 50% PASI improvement. The cumulative UVB dose was 11.25 +/- 4.21 J cm-2 and the average treatment time was 7.2 weeks. Patients treated individually with the MED-I starter dose showed nearly identical rates of clearance (83.7%), but were clear in 7.07 +/- 2.15 sessions with a cumulative dose of 6.25 +/- 4.02 J cm-2. CONCLUSIONS: The majority of our patients benefited greatly from laser-derived 308-nm UVB therapy, which cleared skin lesions faster than conventional phototherapy. As this therapy targets only the involved skin, the thickness of the plaques and individual MED-I should determine the initial dose, thus increasing the effectiveness of the therapy. We propose that light therapy sparing uninvolved skin will become predominant in the future.     

Treatment of palmoplantar psoriasis with monochromatic excimer light (308-nm) versus cream PUVA

Palmoplantar psoriasis is a chronic disease, which is very resistant to treatment and often leads to severe disabilities. Photochemotherapy employing psoralens combined with UVA irradiation (PUVA) is a well-accepted therapy for palmoplantar psoriasis. Its topical application (bath PUVA; cream PUVA) avoids the typical side effects of orally applied psoralens. We compared the efficacy of cream PUVA therapy with monochromatic excimer light therapy, a treatment modality employing 308-nm UVB radiation generated by a new kind of light source. Ten patients with psoriasis of the palms and soles were randomly assigned to receive cream PUVA on one side and 308-nm UVB on the contralateral side. Based on the psoriasis area and severity index (PASI) score, clinical assessment was carried out before and 5 weeks after the beginning of the study. At the end of the treatment period both test groups showed a remarkable PASI score reduction (308-nm UVB, 63.57%; cream PUVA, 64.64%). No relevant adverse effects were observed, except for mild irritation in a few patients. After a 12-week follow-up, a relapse of the disease was only observed in one patient. Thus, mono-chromatic excimer light cleared palmoplantar psoriasis as rapidly as cream PUVA. In contrast to cream PUVA, monochromatic excimer light therapy is not associated with prior drug application. This might lead to a lower incidence of adverse reactions and better compliance. Therefore, monochromatic excimer light therapy seems to be a useful new therapeutic option for palmoplantar psoriasis.     

308-nm Excimer laser treatment of palmoplantar psoriasis

Abstract

Psoriasis is a chronic inflammatory condition affecting 1–3% of the population. The incidence of palmoplantar involvement has been estimated to be between 2.8% and 40.9%. Significant psychosocial distress and difficulty performing activities of daily living can result. Treatment is often challenging. Traditional treatments include topical steroids, anthralin, calcipotriene, PUVA, methotrexate, cyclosporine, retinoids and biologics. In this case series, we report our success with the 308-nm excimer laser in the treatment of palmoplantar psoriasis.     

评估308 nm准分子激光治疗银屑病的疗效

主要综述308 nm准分子激光治疗银屑病的作用机制,临床应用及两种临床方案配置和疗效评估方法.资料显示,308 nm准分子激光治疗银屑病疗效显著、缓解期长、能够靶向选择治疗目标、对局限性银屑病具有独特疗效.其方案的具体配置:一种根据PASI评分来配置,一种根据皮肤类型来配置.疗效评估为根据治疗前后PASI评分的改变来评估及根据患者的病历资料来评价.     

A 308-nm monochromatic excimer light in the treatment of palmoplantar psoriasis

BACKGROUND: Various reports have shown the efficacy of narrow-band UVB (311-313 nm) and excimer laser (308 nm) in the treatment of psoriasis. OBJECTIVE: To prove the efficacy of light produced by xenon-chloride excimer at 308 nm (monochromatic excimer light, MEL) in the treatment of palmoplantar psoriasis (PP). METHODS: Fifty-four patients (29 male and 25 female) affected by PP were treated with MEL every 7-14 days. A mean number of 10 sessions was performed with an increase of the dose depending on patient's skin type and response. RESULTS: All 54 patients completed the treatment. After 4 months of MEL we observed a complete remission in 31 patients, a partial remission in 13 patients, and a moderate improvement in 10 patients. CONCLUSIONS: These results suggest that MEL can be considered as a valid therapeutic option for treatment of selected forms of PP.     

308-nm excimer laser for the treatment of localized vitiligo

BACKGROUND AND OBJECTIVE: Vitiligo is commonly treated with PUVA, and more recently, narrow-band UVB (NBUVB) phototherapy. Given the proximity of the wavelengths of NBUVB (311 nm) and the excimer laser (308 nm), we undertook a clinical trial to test the efficacy of this device. METHODS: Twice-weekly 308-nm UV-B radiation was given to selected vitiligo lesions for a maximum of 60 treatments. These lesions had been unsuccessfully treated previously with at least one other method of treatment. Initial doses were 100 mJ/cm2 with increments of 10-25%. Improvement was assessed on a visual scale via serial photographs. RESULTS: Subjects tolerated the treatment well. Improvement varied with body site. After 60 treatments, lesions on the hands and feet showed grade 2 improvement in 2/10 subjects and grade 1 in 8/10. For the axillae, there was grade 4 improvement in 1/3 subjects and grade 2 improvement in 2/3 by treatment 60. The face demonstrated the most rapid repigmentation with grade 4 repigmentation seen in 3/5 subjects by 40 treatments and grade 3 in 2/5 by 30 treatments. There were no adverse effects. CONCLUSIONS: The user-friendly 308-nm excimer laser allows targeted treatments of localized vitiligo.     

308nm准分子激光治疗面部银屑病42例

摘要】 目的 探讨308nm准分子激光面部银屑病的疗效及不良反应。 方法 48例病人采用巅峰308nm准分子激光治疗,每周3次,10次一个疗程,最多20次治疗,初始剂量2倍MED,观察临床疗效和不良反应,以PASI评分为依据。结果 42例病人完成了治疗,一个疗程治疗后显效率73.8%,两个疗程显效率85.7%,不良反应发生率47.6%,主要为色素沉着、瘙痒等。结论 308nm准分子激光治疗面部银屑病具有起效较快、疗效较高、无严重不良反应、治疗方便的特点。