Karrer S, Eholzer C, Ackermann G, Landthaler M, Szeimies R M
Department of Dermatology, University of Regensburg, Germany.
Dermatology. 2001;202(2):108-15. doi: 10.1159/000051608.
Broad-band UVB alone or in combination with different topical drugs (anthralin, calcipotriol), systemic PUVA and bath-PUVA therapy are very effective and well-established treatment modalities for psoriasis.
The aim of this retrospective study was to assess which of these routinely applied phototherapeutic modalities might be most effective and safe for the treatment of plaque-type psoriasis.
Patients (n = 203) with moderate to severe (pretreatment Psoriasis Area and Severity Index score between 12 and 35) chronic plaque-type psoriasis treated between 1992 and 1998 at our department with either UVB (with/without anthralin or calcipotriol; n = 97), systemic PUVA (n = 19) or bath-PUVA therapy (n = 87) were evaluated for efficacy, duration of treatment, number of treatments necessary for complete remission (CR), cumulative light dose, side effects of therapy and duration of remission after therapy.
No statistically significant difference comparing the efficacy of bath-PUVA (CR in 72.4%), PUVA (CR in 89.5%) and UVB phototherapy (CR in 69.1%) was found. Although the duration of therapy was significantly longer for bath-PUVA (66 +/- 42 days) as compared to UVB treatment (50 +/- 27 days), the mean number of treatments did not differ significantly between 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 significantly longer for bath-PUVA (8.4 +/- 3.5 months) as compared to UVB phototherapy (5.1 +/- 4.2 months).
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 considerations, including compliance and responsibility for following the precautions to avoid potential side effects.
单纯宽带紫外线B（UVB）或与不同外用药物（蒽林、卡泊三醇）联合使用、系统光化学疗法（PUVA）及浴用PUVA疗法是治疗银屑病非常有效且成熟的治疗方式。
这项回顾性研究的目的是评估这些常规应用的光疗方式中哪一种对斑块型银屑病的治疗可能最有效且安全。
对1992年至1998年在我们科室接受治疗的203例中重度（治疗前银屑病面积和严重程度指数评分在12至35之间）慢性斑块型银屑病患者进行评估，这些患者分别接受UVB（联合/不联合蒽林或卡泊三醇；n = 97）、系统PUVA（n = 19）或浴用PUVA疗法（n = 87），评估内容包括疗效、治疗持续时间、完全缓解（CR）所需的治疗次数、累积光剂量、治疗副作用以及治疗后的缓解持续时间。
未发现浴用PUVA（CR率72.4%）、PUVA（CR率89.5%）和UVB光疗（CR率69.1%）疗效之间存在统计学显著差异。尽管与UVB治疗（50±27天）相比，浴用PUVA治疗持续时间（66±42天）明显更长，但浴用PUVA（28±12次）、UVB疗法（30±12次）和PUVA（26±13次）之间的平均治疗次数无显著差异。与UVB治疗（30.9%）相比，浴用PUVA治疗（14.9%）观察到的光疗副作用明显更少。此外，与UVB光疗（5.1±4.2个月）相比，成功治疗后浴用PUVA的缓解持续时间（8.4±3.5个月）明显更长。
在银屑病治疗中，浴用PUVA疗法比UVB光疗具有一些优势：紫外线相关的急性副作用更少，治疗后缓解期更长。然而，选择UVB、浴用PUVA或系统PUVA治疗也应基于既往治疗反应史以及患者因素，包括依从性和遵守预防措施以避免潜在副作用的责任性。
