Comparison of weekly and daily incremental protocols of narrowband ultraviolet B phototherapy for psoriasis

BACKGROUND: Different protocols have been used for narrowband ultraviolet B (UVB) therapy, commonly used in the treatment of psoriasis; however, more effective and reliable protocols are still required. OBJECTIVE: The aim of this study was to compare the weekly and daily dose increment protocols of narrowband UVB phototherapy in psoriasis patients. METHODS: Thirty patients with plaque psoriasis underwent narrowband UVB treatment three times a week and 15 patients selected consecutively among these patients underwent a weekly (once in three treatments) dose increment whereas the remaining 15 patients underwent a daily dose increment. Patients were monitored for 10 weeks and evaluated by the Psoriasis Area Severity Index (PASI). RESULTS: When the two groups were evaluated according to median PASI scores prior to the treatment and during 10 weeks of treatment, there was no statistically significant difference between the groups (P > 0.05). During the treatment lasting for 10 weeks, four patients in the group with a weekly dose increment and three patients in the group with a daily dose increment recovered and no statistically significant difference was detected between the groups (P > 0.05). The groups were also evaluated according to the median cumulative dose. The median cumulative dose was higher in the group with a daily dose increment and the difference between the groups was statistically significant (P = 0.002). CONCLUSION: The application of daily dose increments was no better than that of weekly dose increments in narrowband UVB treatment for psoriasis. Therefore, although our results may need to be supported by large-series studies, we conclude that application of weekly dose increments with a lower cumulative dose having the same efficacy is preferred in narrowband UVB treatment of psoriasis.     

UVB therapy increases 25(OH) vitamin D syntheses in postmenopausal women with psoriasis

BACKGROUND: Vitamin D3 is produced in the epidermis by ultraviolet (UV) radiation (290-315 nm) of 7-dehydrocholesterol. A similar range of 290-320 nm (broadband UVB) has been successfully used for years to treat psoriasis. The aim of this study was to investigate whether UVB therapy was able to influence vitamin D synthesis in psoriasis patients. METHODS: Twenty-four postmenopausal, white Caucasian women, aged 69 +/- 5.9 (mean +/- SD), with active plaque psoriasis, were treated with broadband UVB two to three times per week for 8-12 weeks. The serum concentrations of calcidiol (25(OH)D3), calcitriol (1,25(OH)2D3), intact parathyroid hormone (PTH), thyroid hormones, osteocalcin, calcium and creatinine were measured before the first and after the last dose of radiation. Bone density was measured using Dual-Energy X-ray Absorptiometry (Hologic Delphi A) at the hip and lumbar spine. RESULTS: Serum levels of 25(OH)D3 increased from 36.8 +/- 17 ng/ml (mean +/- SD) to 59.6 +/- 18.7 ng/ml (P<0.001) after the UVB treatment period. Serum PTH decreased from 62.8 +/- 25.7 ng/l to 48.2 +/- 17.4 ng/l (P<0.001). Secondary hyperparathyroidism (PTH>65 ng/l) was revealed in seven patients (29%) in whom PTH values were suppressed by the UVB therapy. The serum levels of calcitriol, calcium, osteocalcin, thyroid hormones and creatinine were unaltered. CONCLUSION: UVB therapy in elderly psoriatic women improved psoriasis, increased serum 25(OH)D3 synthesis and reduced serum PTH concentrations.     

Efficacy of oral methotrexate (MTX) monotherapy vs oral MTX plus narrowband ultraviolet light B phototherapy in palmoplantar psoriasis

Palmoplantar psoriasis (PPP) is a chronic, inflammatory dermatosis of the palms and/or soles with significant morbidity. It is notoriously difficult to treat and unresponsive to traditional topical agents. We aim to compare the effect of oral methotrexate (MTX) monotherapy vs MTX plus narrowband ultraviolet light B (NB‐UVB) in the treatment of recalcitrant PPP. This was a comparative clinical trial involving 90 patients of PPP. Eligible patients were randomly assigned to one of the two treatment groups. We aim patients in group A received 10 mg oral MTX weekly, and patients in group B received oral MTX 10 mg weekly and NB‐UVB sessions twice weekly for 12 weeks. There was a statistically significant difference in reduction of modified PPP Area Severity Index (m‐PPPASI) of patients in MTX plus NB‐UVB at week 12. The mean m‐PPPASI at week 12 was 3.66 ± 2.11 in MTX plus NB‐UVB group and 6.51 ± 2.04 in MTX only group (P < .001). Marked improvement (m‐PPPASI 75) was achieved in 20 (44.44%) patients in MTX plus NB‐UVB group compared with 6 (13.3%) in MTX monotherapy group (P < .001). Combination of MTX and NB‐UVB phototherapy helps to attain a better clinical response (reduction in m‐PPPASI score) than MTX monotherapy in the treatment of recalcitrant PPP.     

8-Methoxypsoralen cream plus targeted narrowband ultraviolet B for psoriasis

BACKGROUND: Targeted ultraviolet (UV) phototherapy is a recent addition to the therapeutic armamentarium for the treatment of localized psoriasis. Topical psoralens enhance the therapeutic effects of UV-based treatment for various dermatoses, but have never been used in conjunction with targeted UVB. PURPOSE: To compare the efficacy of targeted narrowband UVB phototherapy (NB-UVB) alone with that of the combination of 0.1% 8-methoxypsoralen cream and targeted NB-UVB phototherapy (8-MOP/NB-UVB) for the treatment of plaque-type psoriasis. METHODS: Two areas within the same lesion of stable psoriasis were randomized to receive either targeted NB-UVB alone or 8-MOP/NB-UVB. Fluences of UVB delivered were held constant at four minimal erythema doses. The treatments were continued until lesions cleared or 12 treatments. Follow-ups were done until lesional scores returned to 50% of the baseline values. RESULTS: Ten patients completed this study. Four lesions were cleared by 8-MOP/NB-UVB while three were cleared by NB-UVB alone. The improvement in disease activity as reflected by psoriasis severity index score during treatment was statistically significantly better in the combination group (P=0.005). Mean remission time of lesions which were cleared by 8-MOP/NB-UVB was 8 weeks while that for lesions that were cleared by NB-UVB alone was 4.67 weeks. CONCLUSION: We concluded that addition of 0.1% 8-MOP cream to targeted narrowband UVB significantly enhances the therapeutic effects of the light treatment without increasing the incidence of adverse effects.     

Remission period in psoriasis after multiple cycles of narrowband ultraviolet B phototherapy

The aim of this study was to investigate the duration of remission periods in psoriasis after narrowband ultraviolet B (NB‐UVB) phototherapy, especially during multiple cycles of treatment. We analyzed 63 patients (101 cases) demonstrating marked improvement after NB‐UVB phototherapy. The remission period was defined as the duration of time from the end of phototherapy until treatment using either phototherapy or systemic treatments was required again. It was found that an age of 60 years or older, history of systemic therapy within 6 months and three or more phototherapy cycles were significantly associated with shorter remission periods. Furthermore, multivariate analysis confirmed that three or more phototherapy cycles (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.73–9.33; P = 0.001) and a history of systemic therapy (OR, 2.2; 95% CI, 1.27–3.95; P = 0.005) were independently associated with the shorter remission period. In conclusion, when planning NB‐UVB phototherapy for psoriatic patients who have undergone multiple phototherapy cycles, clinicians should consider the possibility of shorter remission periods.     

Comparison of clinical effects of psoriasis treatment regimens among calcipotriol alone,narrowband ultraviolet B phototherapy alone,combination of calcipotriol and narrowband ultraviolet B phototherapy once a week,and combination of calcipotriol and narrowband ultraviolet B phototherapy more than twice a week

We compared the clinical efficacy of various psoriasis treatments among: (i) topical application of calcipotriol ointment twice daily (group I); (ii) topical application of calcipotriol ointment twice daily and narrowband ultraviolet B NB‐UVB phototherapy once a week (group II); (iii) topical application of heparinoid ointment twice daily and NB‐UVB phototherapy more than twice a week (group III); and (iv) topical application of calcipotriol ointment twice daily and NB‐UVB phototherapy more than twice a week (group IV). Ten patients were randomly selected for each group and treated by the indicated regimens for 12 weeks. All treatments were effective and significantly improved Psoriasis Area and Severity Index (PASI) scores, self‐administered PASI scores and visual analog scale scores of pruritus. Group IV showed most marked and rapid reduction in PASI and self‐PASI scores among the four regimens. Although the serum levels of interleukin (IL)‐17, IL‐20 and IL‐22 and psoriasis disability index were significantly decreased after the treatments, no significant difference was detected among the four groups. Our study indicates that combination of calcipotriol ointment plus NB‐UVB more than twice a week is superior to other treatment regimens, rapidly improving psoriasis lesions.     

Paediatric psoriasis – narrowband UVB treatment

Narrowband UV‐B is a safe and efficacious option for the treatment of adult psoriasis. However, the use of this therapy has been limited in children due to its long‐term carcinogenic potential. It has proven to be an adequate alternative in patients whose condition is refractory to topical treatment. Aims To evaluate the efficacy and short‐term safety of narrowband UV‐B in the treatment of paediatric psoriasis, and to compare our results with those obtained in other studies on paediatric psoriasis. Materials and methods Over a period of 2 years and 4 months, we administered narrowband UV‐B to 20 children diagnosed with psoriasis that was refractory to topical therapy. The therapeutic response was measured using the Psoriasis Area and Severity Index (PASI). Results Between August 2005 and December 2007, 20 children received narrowband UV‐B. Their median age was 13 years (range, 5–17 years), and the median initial PASI score was 8.25 (2.7–22.2). A median of 28 (10–59) sessions was required to achieve clearance, reaching almost complete or total remission (median final PASI) in all but two patients. Six patients required a new therapeutic course because of relapse, and the mean duration of remission was 8 months (4–18). No patients experienced severe adverse events during therapy, and only one discontinued treatment, for unrelated reasons. Discussion and conclusion Narrowband UV‐B for the treatment of paediatric psoriasis has received little attention in the literature. This treatment has been limited in children because of its potential long‐term carcinogenic effects, and most information has been extrapolated from adults. Nevertheless, narrowband UV‐B phototherapy is an effective and well‐tolerated therapeutic alternative in paediatric patients with severe psoriasis.     

Effect of climate therapy at Gran Canaria on vitamin D production, blood glucose and lipids in patients with psoriasis

Background Climate therapy (heliotherapy) of psoriasis is an effective and natural treatment. Ultraviolet radiation (UVB) from the sun improves psoriasis and induces vitamin D₃ synthesis. Objective The aim of the study was to investigate the effect of climate therapy on vitamin D₃ synthesis, blood glucose, lipids and vitamin B12 in psoriasis patients. Methods Twenty Caucasian patients (6 women and 14 men; mean age, 47.2 years; range, 24–65) with moderate to severe psoriasis [mean Psoriasis Area and Severity Index (PASI) score 9.8; range, 3.8–18.8] received climate therapy at the Gran Canarias for 3 weeks. Blood samples were drawn before and after 15 days of sun exposure. In addition, the patients’ individual skin UV doses based on UV measurements were estimated. Results Sun exposure for 15 days lead to a 72.8% (± 18.0 SD) reduction in the PASI score in psoriasis patients. Although no direct correlation was observed between PASI score improvement and UVB dose, the sun exposure improved the vitamin D, lipid and carbohydrate status of the patients. The serum concentrations of 25‐hydroxyvitamin D [25(OH)D] increased from 57.2 ± 14.9 nmol/L before therapy to 104.5 ± 15.8 nmol/L (P < 0.0001) after 15 days of sun exposure; the serum levels of 1,25‐dihydroxyvitamin D [1,25(OH)₂D] increased from 146.5 ± 42.0 to 182.7 ± 59.1 pmol/L (P = 0.01); the ratio of low‐density lipoprotein cholesterol and high‐density lipoprotein cholesterol decreased from 2.4 to 1.9 (P < 0.001); and the haemoglobin A₁c (HbA₁c) levels decreased from 5.6 ± 1.7% to 5.1 ± 0.3% (P < 0.0001). Conclusion Climate therapy with sun exposure had a positive effect on psoriasis, vitamin D production, lipid and carbohydrate status.     

Topical 8-methoxypsoralen increases the efficacy of narrowband ultraviolet B in psoriasis

Background: A combination of oral psoralen with narrowband ultraviolet B (UVB), defined as 'psoralen-narrowband UVB', was shown to have a superior efficacy than UVB alone and even a comparable efficacy to psoralen and ultraviolet A in psoriasis.
Objective: To find out whether topical psoralen-narrowband UVB provides any additional benefit to narrowband UVB alone in psoriasis.
Methods: Nineteen patients with plaque psoriasis were included. Phototherapy was given three times per week. Two symmetrical lesions were selected as target lesions. In the first 12 sessions of phototherapy, the target lesion on one side was treated with 1% 8-methoxypsoralen (MOP) gel 30 min before UVB radiation whereas the target lesion on the other side served as a control. Target lesion scores were assessed at baseline, third, sixth, ninth and 12th sessions. Side effects were recorded.
Results: Sixteen patients completed the study. Target lesion scores decreased significantly on both sides ( P <0.0001). The mean percentage of decreases was greater on the 8-MOP-applied sides compared with the control sides for all assessments, but the difference was statistically significant only at the ninth session (37.7% vs. 58.6%, P =0.043). Pigmentation was frequently seen in 8-MOP gel-applied lesions.
Conclusion: Topical 8-MOP gel plus narrowband UVB has greater efficacy than narrowband UVB alone in psoriasis.     

Comparison of the efficacy of calcipotriol and maxacalcitol in combination with narrow-band ultraviolet B therapy for the treatment of psoriasis vulgaris

BACKGROUND: Combination treatment with topical vitamin D(3) and narrow-band ultraviolet B (UVB) radiation is effective against psoriasis vulgaris. We compared the efficacy of the topical vitamin D(3) derivatives calcipotriol and maxacalcitol in combination therapy. MATERIALS AND METHODS: In this retrospective observational study, 21 patients admitted to Nagoya City University Hospital between April 2001 and September 2004 were enrolled. RESULTS: Combination treatment with calcipotriol or maxacalcitol and narrow-band UVB was effective against psoriasis vulgaris. Calcipotriol induced a more rapid improvement and required lower levels of narrow-band UVB irradiation to be effective. Serum calcium levels were slightly increased after 4 weeks of treatment, but there was no significant difference between the two groups. No other adverse effects were observed in either of the two groups. CONCLUSION: The findings of this retrospective observational study indicated that combination treatment with topical vitamin D(3) derivatives and narrow-band UVB is effective against psoriasis without any obvious side-effects. These findings provide further evidence that calcipotriol has advantages over maxacalcitol regarding the narrow-band UVB-accumulated treatment dose and improvement rate of psoriasis area and severity index (PASI) scores.     

Serum 5-S-cysteinyldopa levels in patients with psoriasis undergoing narrowband ultraviolet B phototherapy

Background. Ultraviolet (UV) B radiation from sunlight can result in tanning or burning of the skin. Narrowband UVB (NB‐UVB), a relatively new light source that is not yet widely available, is effective for treating generalized psoriasis without the use of psoralens. Aims. The melanin‐related metabolite 5‐S‐cysteinyldopa (5‐S‐CD), which reflects pheomelanin production, has been used as a biological marker of melanoma progression, but there are no studies available on therapeutic UVB effects on serum 5‐S‐CD of human subjects. In the present study, we measured the time course of changes in serum levels of 5‐S‐CD in patients with psoriasis undergoing NB‐UVB phototherapy. Methods. In total, 11 Japanese patients with generalized psoriasis vulgaris received NB‐UVB treatment five times per week, at an initial dose of 0.1 J/cm². The dose was increased by 10–20% per treatment for > 20 treatments. Serum samples were taken before and 3, 7, 10, 14 and 28 days after phototherapy. Results. After 4 weeks of NB‐UVB treatment, 9 of 11 patients were in remission, confirming the effectiveness of NB‐UVB for treating Japanese patients with psoriasis. Two patients withdrew before day 28 because of other complications. Mean level of 5‐S‐CD in serum was significantly increased on day 7, 10 14 and 28 compared with the level before phototherapy and it peaked on day 10. Conclusions. Serum 5‐S‐CD levels were significantly increased by therapeutic UVB exposure. Sustained levels of 5‐S‐CD in serum appear to reflect the degree of skin injury during NB‐UVB phototherapy.     

Tumour necrosis factor alpha (TNF-alpha)-converting enzyme (TACE) and soluble TNF-alpha receptor type 1 in psoriasis patients treated with narrowband ultraviolet B

PURPOSE: The aim of the study was to examine the tumour necrosis factor alpha (TNF-alpha)-converting enzyme (TACE) concentration in peripheral blood mononuclear cells (PBMC) and its relationship with plasma concentration of soluble TNF-alpha receptor type 1 (sTNF-R1) and with the disease severity in psoriasis patients treated with narrowband ultraviolet B (NB-UVB). METHODS: The study has been conducted among 40 patients with plaque-type psoriasis vulgaris: 23 had only skin lesions (PV) and 17 had co-existing, inactive, psoriatic arthritis (PsA). Control blood samples were obtained from 20 healthy subjects. The assessment of the severity of skin lesions (using Psoriasis Area and Severity Index - PASI), TACE and sTNF-R1 concentrations (using quantitative sandwich enzyme immunoassays) have been performed at baseline (T 0) and after 20 NB-UVB irradiations (T 20). RESULTS: The baseline sTNF-R1 and TACE concentrations in all patients was higher than that in controls (2.55 +/- 1.67 vs. 1.70 +/- 0.15 ng/ml, P<0.001, respectively, and 2.62 +/- 0.32 vs. 1.31 +/- 0.30 ng/ml, P<0.001, respectively). The sTNF-R1 and TACE concentrations were lower in PV than in PsA patients (2.47 +/- 0.16 vs. 2.65 +/- 0.13 ng/ml, and 2.52 +/- 0.22 vs. 2.76 +/- 0.39 ng/ml, P<0.05, respectively). The baseline PASI correlated with sTNF-R1 and to TACE concentrations (R=0.48 and 0.39, P<0.05, respectively). The sTNF-R1 correlated to TACE concentration (R=0.52, P<0.05). The significant decline in sTNF-R1 and TACE concentrations at T 20 was noticed, TACE reached control values (1.20 +/- 0.44 ng/ml in PV patients and 1.16 +/- 0.48 ng/ml in PsA patients, respectively). CONCLUSION: TACE from PBMC can contribute to up-regulation of sTNF-R1 in patients with active psoriasis vulgaris and with psoriatic arthritis. It also can serve as a sensitive marker of the disease severity.     

Efficacy of ultraviolet B phototherapy for psoriasis in patients infected with human immunodeficiency virus

To evaluate the efficacy of ultraviolet B (UVB) phototherapy for the treatment of psoriasis in patients infected with human immunodeficiency virus (HIV), the response of 14 patients was compared to that of matched seronegative control individuals. All patients were evaluated prior to treatment (baseline) and after 21 treatments for the extent of total body surface area (TBSA) involvement and the quantification of scale, erythema, and thickness of plaques using a scale of 0 (absent) to 4 (severe). The only concomitant medication allowed was salicylic acid in petrolatum. The cumulative score for scale, erythema, and thickness improved 1.9± 0.5 [mean± standard error of mean (SEM)] in the HIV group and 2.4± 0.3 in controls. There was 40.9± 7.3 % reduction of TBSA involvement in the former and 38.4± 7.6 % reduction in the latter group. None of the differences was statistically significant. There was no statistically significant difference in the response to therapy among various stages of immunosuppression in the HIV group. There was also no deterioration of immune status in this group. UVB phototherapy is an effective treatment for psoriasis in patients infected with HIV. The response is identical to that of matched control individuals.