Momtaz-T K, Parrish J A
J Am Acad Dermatol. 1984 Mar;10(3):481-6. doi: 10.1016/s0190-9622(84)80098-5.
Forty-two adults with psoriasis vulgaris were treated total body thrice weekly with both ultraviolet B (UVB) and psoralens and ultraviolet A (PUVA) with the use of protocols shown to be effective with either treatment alone. Patients previously difficult to manage with either UVB or PUVA and at least 25% psoriasis were selected. No other treatment was used for 2 months prior to initiation or during the study. All patients tolerated treatments well and cleared in an average of only 11.3 treatments, less than half the number of treatments usually required with either PUVA or UVB. The mean UVB dose at clearing and the mean cumulative PUVA dose were less than half that normally required with either therapy alone. The total cumulative UVB dose was only 18% of that normally required with UVB. Bilateral comparison studies comparing the PUVA-UVB combination with PUVA and UVB found that whenever there was a clear difference it was always the combination that cleared more rapidly. The marked reduction of total cumulative energy required more rapidly. The marked reduction of total cumulative energy required may be a significantly smaller insult to skin and the marked reduction in joules/cm2 of UVB and joules/cm2 of PUVA at clearing may make it possible to provide effective maintenance therapy with either treatment at a markedly lower treatment dose. Hopefully, long-term side effects may thereby be markedly diminished.
42例寻常型银屑病成人患者，采用单独使用时均已证明有效的方案，每周3次全身接受中波紫外线（UVB）和补骨脂素及长波紫外线（PUVA）治疗。入选患者为之前单独使用UVB或PUVA治疗效果不佳且银屑病面积至少达25%者。在开始治疗前及研究期间的2个月内未使用其他治疗。所有患者对治疗耐受性良好，平均仅接受11.3次治疗即获清除，少于单独使用PUVA或UVB通常所需的治疗次数。清除时的平均UVB剂量及平均累积PUVA剂量均不到单独使用任一疗法时正常所需剂量的一半。总的累积UVB剂量仅为单独使用UVB时正常所需剂量的18%。将PUVA-UVB联合疗法与PUVA及UVB进行双侧比较研究发现，只要存在明显差异，总是联合疗法清除得更快。所需总累积能量的显著降低可能对皮肤的损伤明显更小，而且清除时UVB的焦耳/平方厘米及PUVA的焦耳/平方厘米的显著降低可能使得以明显更低的治疗剂量用任一疗法进行有效的维持治疗成为可能。有望由此显著减少长期副作用。
