Delrosso G, Bornacina C, Farinelli P, Bellinzona F, Leigheb G, Colombo E
Dermatologic Clinic, University of Oriental Piedmont A. Avogadro, Novara, Italy.
Dermatology. 2008;216(3):191-3. doi: 10.1159/000112924. Epub 2008 Jan 9.
BACKGROUND/AIM: The guidelines of the British Photodermatology Group for topical treatment with psoralen and ultraviolet light (PUVA) recommend starting UVA doses between 0.2 and 0.5 J/cm(2), according to the phototype. Our purpose was to evaluate the therapeutic efficacy and tolerability of bath PUVA, with 8-methoxypsoralen (8-MOP), by using lower UVA doses, regardless of phototype.
We compared 2 groups of patients (group 1: n = 10, group 2: n = 20) with chronic plaque-type psoriasis. Group 1 was treated with the usual starting dose and dose progression; group 2 was treated by using a lower first dose, a slower dose progression and reaching a lower maximum dose. The Psoriasis Area and Severity Index (PASI) score was assessed at the initial stages, and every month until the end of the treatment.
In group 1, the median baseline PASI score decreased from 15.2 to 4.5 (p < 0.005, Student's paired t test), while in group 2, it fell from 13.7 to 4.1 (p < 0.005). No statistical difference between the groups is detectable. Severe phototoxic reactions were observed only in 2 patients of group 1. Side effects were not observed in group 2.
Our data indicate that an aggressive bath PUVA treatment is not substantially more effective in clearing chronic plaque-type psoriasis than a milder therapeutic approach.
背景/目的：英国光皮肤病学组关于补骨脂素和紫外线（PUVA）局部治疗的指南建议，根据皮肤光类型，起始UVA剂量为0.2至0.5 J/cm²。我们的目的是评估使用较低UVA剂量的8-甲氧基补骨脂素（8-MOP）浴用PUVA疗法的疗效和耐受性，而不考虑皮肤光类型。
我们比较了两组慢性斑块型银屑病患者（第1组：n = 10，第2组：n = 20）。第1组采用常规起始剂量和剂量递增方式治疗；第2组采用较低的初始剂量、较慢的剂量递增方式，且达到的最大剂量较低。在初始阶段以及治疗结束前每月评估银屑病面积和严重程度指数（PASI）评分。
在第1组中，PASI评分中位数从15.2降至4.5（p < 0.005，学生配对t检验），而在第2组中，从13.7降至4.1（p < 0.005）。两组之间未检测到统计学差异。仅在第1组的2名患者中观察到严重的光毒性反应。第2组未观察到副作用。
我们的数据表明，积极的浴用PUVA治疗在清除慢性斑块型银屑病方面并不比温和的治疗方法更有效。
