Legat Franz J, Hofer Angelika, Quehenberger Franz, Kahofer Peter, Kerl Helmut, Wolf Peter
Division of Photodermatology, Department of Dermatology, Medical University Graz Austria.
J Am Acad Dermatol. 2004 Nov;51(5):746-54. doi: 10.1016/j.jaad.2004.04.029.
The carcinogenic potential of 8-methoxypsoralen photochemotherapy (psoralen-UVA [PUVA]) is correlated with the total number of treatments and cumulative UVA dose applied during oral PUVA therapy.
We sought to determine whether reducing treatment frequency and UVA dose affects the therapeutic efficacy of oral PUVA for patients with chronic plaque psoriasis.
This was a prospective, randomized, half-side study performed in a photodermatology department in a dermatology hospital. Eighteen consecutive patients with chronic plaque psoriasis received paired PUVA regimens (0.5 minimal phototoxic dose [MPD] 4 times/wk vs 1 MPD twice/wk, 0.5 MPD twice/wk vs 1 MPD twice/wk, and 0.5 MPD twice/wk vs 0.75 MPD twice/wk). The PUVA regimens were assessed for reduction of Psoriasis Area and Severity Index (PASI) score and the number of treatments and cumulative UVA dose required to reduce PASI score to defined end points (ie, PASI reductions of 25%, 50%, and 75%) or to induce complete remission (PASI < 3).
Reducing the number of treatments while maintaining the same UVA dose per week did not reduce overall therapeutic efficacy. Reducing the number of treatments to twice a week and reducing the UVA dose from 1 MPD to 0.75 or 0.5 MPD per treatment only slightly affected intermediate therapeutic efficacy (between the second and seventh weeks of therapy) but had no effect on final clearance rates. The time to complete clearance did not significantly differ between regimens. The mean cumulative UVA dose was significantly lower for the least intensive dose regimen (0.5 MPD twice/wk) than for the more intensive regimens.
Reducing treatment frequency and UVA dose does not substantially compromise the therapeutic efficacy of PUVA.
8-甲氧基补骨脂素光化学疗法（补骨脂素-长波紫外线[PUVA]）的致癌潜力与口服PUVA治疗期间的治疗总次数及累积长波紫外线剂量相关。
我们试图确定减少治疗频率和长波紫外线剂量是否会影响口服PUVA对慢性斑块状银屑病患者的治疗效果。
这是一项在皮肤病医院的光皮肤病科进行的前瞻性、随机、半侧研究。18例连续的慢性斑块状银屑病患者接受配对的PUVA治疗方案（0.5最小光毒性剂量[MPD]，每周4次对比1 MPD，每周2次；0.5 MPD，每周2次对比1 MPD，每周2次；以及0.5 MPD，每周2次对比0.75 MPD，每周2次）。评估PUVA治疗方案在降低银屑病面积和严重程度指数（PASI）评分方面的效果，以及将PASI评分降低至规定终点（即PASI降低25%、50%和75%）或诱导完全缓解（PASI<3）所需的治疗次数和累积长波紫外线剂量。
在保持每周相同长波紫外线剂量的同时减少治疗次数，并未降低总体治疗效果。将治疗次数减少至每周2次，并将每次治疗的长波紫外线剂量从1 MPD降至0.75或0.5 MPD，仅对中期治疗效果（治疗的第二至第七周之间）有轻微影响，但对最终清除率无影响。各治疗方案之间达到完全清除的时间无显著差异。强度最低的剂量方案（0.5 MPD，每周2次）的平均累积长波紫外线剂量显著低于强度更高的方案。
降低治疗频率和长波紫外线剂量不会大幅损害PUVA的治疗效果。
