Trott Jana, Gerber Wolfgang, Hammes Stefan, Ockenfels Hans-Michael
Department of Dermatology and Allergology, Klinikum Hanau, Leimenstrasse 20, 63450 Hanau, Germany.
Eur J Dermatol. 2008 Jan-Feb;18(1):55-60. doi: 10.1684/ejd.2008.0311. Epub 2007 Dec 18.
In most cases, patients with moderate to severe psoriasis are treated with narrow-band UVB phototherapy or with psoralen UVA (PUVA-) photochemotherapy. This UV-radiation is given to the whole skin, including unaffected skin. Normally, these two PUVA- and UVB-radiation procedures cannot be combined on account of the phototherapeutic side-effects on unaffected skin. The 308-nm excimer laser has been shown to be safe and effective in the treatment of localized mild-to-moderate plaque-type psoriasis whilst sparing healthy skin. Our aim was to compare the therapeutic response to PUVA plus up to 4 UVB308-nm radiations and PUVA monotherapy in patients with moderate-severe plaque-type psoriasis. 272 hospitalized adult patients were enrolled on this prospective random study. 256 patients completed the full course of treatment. PUVA treatment was given 4 times weekly to all patients. 123 patients received PUVA as a monotherapy. During the first two weeks, 149 patients were additionally treated up to four times with 308-nm excimer-derived UVB on the affected skin and treatment was evaluated for its efficacy, duration, number of times necessary for complete (CR) or partial remission (PASI reduction > 90 or > 50%, respectively), cumulative light dose, side effects of therapy and duration of remission after therapy. Statistically, there is no significant difference when comparing the efficacy of PUVA (CR 67.3%) and PUVA plus excimer (CR 63.6%). On average, patients treated by the combination method went into remission in half the treatment time (15 +/- 6 versus 27 +/- 7 days) and with half the cumulative UVA dose (22.9 +/- 5.8 versus 53.2 +/- 26.3), p < 0.05. In conclusion, skin heals considerably quicker when treated with a combination of photochemotherapy and a short course of UVB 308 nm laser treatment applied directly to the affected skin, resulting in a shorter hospital stay and quicker rehabilitation of patients with moderate-severe psoriasis.
在大多数情况下，中重度银屑病患者采用窄谱中波紫外线（UVB）光疗或补骨脂素长波紫外线（PUVA）光化学疗法进行治疗。这种紫外线辐射作用于整个皮肤，包括未受影响的皮肤。通常，由于对未受影响皮肤的光疗副作用，这两种PUVA和UVB辐射程序不能联合使用。已证明308纳米准分子激光在治疗局限性轻度至中度斑块型银屑病时安全有效，同时可 sparing 健康皮肤。我们的目的是比较中重度斑块型银屑病患者对PUVA加最多4次308纳米UVB辐射与PUVA单一疗法的治疗反应。272名住院成年患者参与了这项前瞻性随机研究。256名患者完成了整个疗程。所有患者每周接受4次PUVA治疗。123名患者接受PUVA单一疗法。在前两周，149名患者在受影响的皮肤上额外接受了多达4次308纳米准分子衍生的UVB治疗，并对治疗的疗效、持续时间（完全缓解（CR）或部分缓解（分别为银屑病面积和严重程度指数（PASI）降低>90%或>50%）所需的次数）、累积光剂量、治疗副作用以及治疗后缓解持续时间进行了评估。在统计学上，比较PUVA（CR 67.3%）和PUVA加准分子（CR 63.6%）的疗效时没有显著差异。平均而言，联合治疗组的患者在一半的治疗时间内（15±6天对27±7天）进入缓解期，且累积UVA剂量减半（22.9±5.8对53.2±26.3），p<0.05。总之，对于中重度银屑病患者，当采用光化学疗法与直接应用于受影响皮肤的短疗程308纳米UVB激光治疗相结合时，皮肤愈合明显更快，从而缩短住院时间并加快康复速度。
