van de Kerkhof P C M, de Gruijl F R
Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Department of Dermatology, Leids Universitair Medisch Centrum, Nijmegen, The Netherlands.
J Eur Acad Dermatol Venereol. 2020 May;34(5):926-931. doi: 10.1111/jdv.16245. Epub 2020 Feb 27.
According to the guidelines for the treatment of psoriasis, phototherapy is given in courses of UVB exposure starting at 50-70% of the minimal erythema dose, MED, with subsequently incremental dosages, but keeping erythemal skin reactions to a minimum by restraining the dosages when necessary. In this review, this classical principle of short-term near erythematogenic UVB therapy without further UVB maintenance therapy is challenged as it is evidently not optimal for psoriasis as a chronic condition. There is old experimental evidence supplemented with growing knowledge on the mode of action of phototherapy and more recent data on low-level UVB regimens as maintenance therapy that should urge us to revisit our guidelines on phototherapy to address psoriasis for what it is: a chronic condition.
根据银屑病治疗指南，光疗采用紫外线B（UVB）照射疗程，起始剂量为最小红斑量（MED）的50%-70%，随后逐渐增加剂量，但必要时通过限制剂量将皮肤红斑反应降至最低。在本综述中，这种短期接近致红斑量的UVB治疗且无需进一步UVB维持治疗的经典原则受到了挑战，因为显然它对于作为一种慢性疾病的银屑病并非最佳方案。有旧的实验证据，加上对光疗作用方式的不断了解以及关于低剂量UVB方案作为维持治疗的最新数据，这些都应促使我们重新审视光疗指南，以应对银屑病这一慢性疾病的本质。
