Sakuntabhai A, Sharpe G R, Farr P M
Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, U.K.
Br J Dermatol. 1993 Feb;128(2):166-71. doi: 10.1111/j.1365-2133.1993.tb15146.x.
In the U.K., PUVA treatment for psoriasis is usually given three times weekly, with the starting dose of UVA chosen according to the skin type of the patient. Observations on the time-course and dose-response characteristics of PUVA erythema suggest that larger doses of UVA could be used safely, provided that the frequency of PUVA treatment is reduced. We have examined this by treating 100 patients with chronic plaque-type psoriasis with a PUVA protocol in which treatment using oral 8-methoxypsoralen was given twice weekly, with the starting dose of UVA based on each patient's minimal phototoxic dose, and with weekly UVA dose increments calculated as a percentage of the dose used in the previous treatment. Clearance of psoriasis was achieved in 92% of patients. The median number of treatments required for clearance was 12, and the median cumulative UVA dose for clearance was 52J/cm2. Although erythema occurred at some stage during the course of PUVA in 48% of patients, in only 16% of cases was the erythema of sufficient intensity to result in more than one treatment being missed. These results compare favourably with previous studies in which treatment was given three or four times weekly. Thus, twice weekly PUVA treatment for psoriasis is at least as effective as treatment given more frequently, and may be safer, as lower cumulative UVA doses are required for clearance. It also allows for more efficient operation of a PUVA unit and is more convenient for patients.
在英国，光化学疗法（PUVA）治疗银屑病通常每周进行三次，起始UVA剂量根据患者的皮肤类型来选择。对PUVA红斑的时间进程和剂量反应特征的观察表明，只要降低PUVA治疗的频率，就可以安全地使用更大剂量的UVA。我们通过用一种PUVA方案治疗100例慢性斑块型银屑病患者对此进行了研究，该方案中口服8-甲氧基补骨脂素的治疗每周进行两次，起始UVA剂量基于每个患者的最小光毒性剂量，每周UVA剂量增量按前一次治疗所用剂量的百分比计算。92%的患者银屑病得到清除。清除所需治疗的中位数为12次，清除所需的累积UVA剂量中位数为52J/cm²。虽然48%的患者在PUVA治疗过程中的某个阶段出现了红斑，但只有16%的病例中红斑强度足以导致错过一次以上治疗。这些结果与之前每周进行三次或四次治疗的研究相比更具优势。因此，每周两次的PUVA治疗银屑病至少与更频繁治疗的效果一样好，而且可能更安全，因为清除所需的累积UVA剂量更低。它还能使PUVA治疗设备运行更高效，对患者也更方便。
