Sakurai Mai, Enomoto Yuki, Kanayama Yoshifumi, Sakaida Takashi, Yamamoto Aya, Morita Akimichi
Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Photodermatol Photoimmunol Photomed. 2025 Sep;41(5):e70038. doi: 10.1111/phpp.70038.
BACKGROUND/PURPOSE: While biologics and small-molecule inhibitors are first-line systemic treatments for psoriasis, phototherapy remains an alternative for patients unable to access these treatments because of medical or financial constraints. Narrow-band ultraviolet B (NB-UVB) is effective for localized psoriasis but less so for extensive disease. To address this limitation, bathwater delivery of psoralen plus ultraviolet A (bath-PUVA) was introduced in 2004. This study evaluates the efficacy, safety, and patient characteristics associated with bath-PUVA therapy in a large cohort.
This retrospective analysis included 229 patients (180 males, 49 females) treated with bath-PUVA from 2004 to September 2021. Baseline characteristics and treatment outcomes were assessed using the psoriasis area and severity index (PASI). Statistical analyses examined relationships between treatment outcomes and factors, including baseline PASI, body mass index (BMI), and smoking status.
The mean baseline PASI score was 24.9. Bath-PUVA achieved PASI 75 in 80.4% of patients, PASI 90 in 44.1%, and PASI 100 in 2.6%, with efficacy comparable to biologics. Patients achieving PASI 90 had significantly higher baseline PASI scores (p = 0.005), while the number of irradiations required did not differ (p = 0.692). Higher baseline PASI scores correlated with elevated BMI (p = 0.002), but BMI did not influence improvement rates (p = 0.094). Smokers had significantly higher baseline PASI scores (p = 0.004) compared with non-smokers, yet smoking status did not affect improvement rates (p = 0.862).
Bath-PUVA demonstrates efficacy comparable with biologics for psoriasis, regardless of BMI or smoking status. This analysis supports its use as an effective and accessible treatment option for patients with extensive disease.
背景/目的：虽然生物制剂和小分子抑制剂是银屑病的一线全身治疗方法，但对于因医疗或经济限制无法接受这些治疗的患者，光疗仍然是一种选择。窄谱中波紫外线（NB-UVB）对局限性银屑病有效，但对广泛性疾病效果较差。为解决这一局限性，2004年引入了补骨脂素加紫外线A浴水疗法（浴用PUVA）。本研究评估了一大群接受浴用PUVA治疗患者的疗效、安全性及患者特征。
这项回顾性分析纳入了2004年至2021年9月期间接受浴用PUVA治疗的229例患者（男性180例，女性49例）。使用银屑病面积和严重程度指数（PASI）评估基线特征和治疗结果。统计分析检查了治疗结果与包括基线PASI、体重指数（BMI）和吸烟状况等因素之间的关系。
平均基线PASI评分为24.9。浴用PUVA使80.4%的患者达到PASI 75，44.1%的患者达到PASI 90，2.6%的患者达到PASI 100，其疗效与生物制剂相当。达到PASI 90的患者基线PASI评分显著更高（p = 0.005），而所需照射次数无差异（p = 0.692）。较高的基线PASI评分与BMI升高相关（p = 0.002），但BMI不影响改善率（p = 0.094）。吸烟者的基线PASI评分显著高于非吸烟者（p = 0.004），但吸烟状况不影响改善率（p = 0.862）。
无论BMI或吸烟状况如何，浴用PUVA对银屑病的疗效与生物制剂相当。该分析支持将其作为广泛性疾病患者的一种有效且可及的治疗选择。
