Nguyen Thao, Gattu Shilpa, Pugashetti Rupa, Koo John
Curr Probl Dermatol. 2009;38:59-78. doi: 10.1159/000232304. Epub 2009 Jul 28.
This chapter will discuss the entire spectrum of phototherapy, including narrowband UVB photo-therapy, broadband UVB phototherapy, PUVA, targeted excimer laser phototherapy, and combination treatments. Phototherapy can range from simple treatments in a UVB phototherapy box, with or without concurrent use of various tar preparations, to more elaborate modalities in which the intensity of UVB radiation applied varies according to different anatomical regions. Combining PUVA or UVB phototherapy with topical and systemic agents can also enhance phototherapy. Certain forms of phototherapy, such as the traditional Goeckerman regimen of using black tar daily with UVB light, induce a prolonged remission. Outpatient phototherapy is usually reserved for patients whose disease is not adequately controlled with topical medications, including steroids, vitamin D analogues, tazarotene, tar, or anthralin. It is also indicated for patients with such extensive psoriasis that topical therapy is nearly impossible. Additionally, phototherapy may be an excellent option for patients with specific medical problems for whom systemic medications such as methotrexate, cyclosporine, or biological agents may not be suitable. For patients with generalized psoriasis, phototherapy is a reasonable first choice among the available options because of its superior systemic safety profile in comparison to systemic or biological agents. As with all other forms of psoriasis therapy, it is essential to consider the impact of the treatment on the patient's lifestyle when selecting the treatment plan. Important points to consider when initially discussing phototherapy are the patient's employment schedule, commitment, flexibility, location of the phototherapy unit, and transportation.
本章将讨论光疗的全谱，包括窄谱中波紫外线光疗、宽谱中波紫外线光疗、补骨脂素加长波紫外线光疗、靶向准分子激光光疗以及联合治疗。光疗范围涵盖在中波紫外线光疗箱中进行的简单治疗（可同时或不同时使用各种焦油制剂），到更精细的方式，即根据不同解剖区域施加不同强度的中波紫外线辐射。将补骨脂素加长波紫外线光疗或中波紫外线光疗与局部和全身用药联合使用也可增强光疗效果。某些形式的光疗，如传统的格克曼疗法，即每日使用黑焦油并结合中波紫外线照射，可诱导长期缓解。门诊光疗通常适用于局部用药（包括类固醇、维生素D类似物、他扎罗汀、焦油或蒽林）无法充分控制病情的患者。对于银屑病面积广泛以至于几乎无法进行局部治疗的患者，光疗也适用。此外，对于患有特定医疗问题且不适合使用甲氨蝶呤、环孢素或生物制剂等全身用药的患者，光疗可能是一个极佳选择。对于泛发性银屑病患者，光疗因其相较于全身用药或生物制剂具有更好的全身安全性，是现有治疗选择中的合理首选。与银屑病治疗的所有其他形式一样，在选择治疗方案时，考虑治疗对患者生活方式的影响至关重要。初次讨论光疗时需要考虑的要点包括患者的工作时间表、投入程度、灵活性、光疗单位的位置以及交通情况。
