ReportReduction of treatment frequency and UVA dose does not substantially compromise the antipsoriatic effect of oral psoralen-UVA☆
Section snippets
Study design and participants
Our study was a prospective randomized trial of paired PUVA regimens compared bilaterally in individual patients. Participants included 18 patients (14 male and 4 female) treated for chronic plaque-type psoriasis (Psoriasis Area and Severity Index [PASI] >10) at our institution between 1998 and 2001. Exclusion criteria were as follows: age <16 years; pregnancy or lactation; presence of a dysplastic nevus syndrome, photosensitive dermatosis, autoimmune disease, or severe renal or hepatic
Results
Most patients achieved complete remission of psoriatic symptoms. Of 18 patients, 16 completed the study to the point where the PASI scores on both body halves were reduced by 75% or more. Of those 16 patients, 15 agreed to continue half-side treatments and ultimately achieved complete clearance of psoriatic lesions (PASI < 3, complete remission as defined in this study).
MPDs for contralateral body halves, which were determined after each of the first 4 weeks of PUVA therapy, were similar in
Discussion
In this study, bilateral comparisons of pairs of PUVA regimens revealed that reducing the frequency of PUVA treatments from 4 to 2 times/wk did not diminish the ability of PUVA to clear psoriatic skin lesions, provided similar weekly UVA doses were applied. For PUVA regimens of 2 treatments/wk, reducing the UVA dose from 1 MPD to 0.5 MPD per treatment did not affect overall therapeutic efficacy, although PUVA with the lesser MPD required a small increase (15%) in the number of PUVA treatments
References (26)
- et al.
Recombinantly engineered human proteins: transforming the treatment of psoriasis
Clin Immunol
(2002) - et al.
Oral methoxsalen photochemotherapy for the treatment of psoriasis: a cooperative clinical trial
J Invest Dermatol
(1977) - et al.
Oral 8-methoxypsoralen photochemotherapy of psoriasis. The European PUVA study: a cooperative study among 18 European centers
Lancet
(1981) - et al.
Phototherapy utilization for psoriasis is declining in the United States
J Am Acad Dermatol
(2002) The PUVA follow up study: the risk of melanoma in association with long-term exposure to PUVA
J Am Acad Dermatol
(2001)- et al.
A randomized, double-blind, placebo-controlled phase III study evaluating efficacy and tolerability of 2 courses of alefacept in patients with chronic plaque psoriasis
J Am Acad Dermatol
(2002) - et al.
Half-side comparison of erythemogenic versus suberythemogenic UVA doses in oral photochemotherapy of psoriasis
J Am Acad Dermatol
(1999) Psoriasis—epidemiology and clinical spectrum
Clin Exp Dermatol
(2001)- et al.
Treatment of psoriasisPart I. Topical therapy and phototherapy
J Am Acad Dermatol
(2001) Phototherapy and photochemotherapy of skin disease
(1991)
Phototherapy of psoriasis
Photochemotherapy of psoriasis with oral methoxypsoralen and longwave ultraviolet light
N Engl J Med
British Photodermatology Group guidelines for PUVA
Br J Dermatol
Cited by (29)
A deep dive into UV-based phototherapy: Mechanisms of action and emerging molecular targets in inflammation and cancer
2021, Pharmacology and TherapeuticsCitation Excerpt :However, in a retrospective study, we have shown that PUVA may be superior to certain biologics including alefacept (anti-CD2), efalizumab (anti-CD11a), and etanercept (anti-TNFα) and, depending on the type of comparison, equal or superior to adalimumab (anti-TNFα) and ustekinumab (anti-IL-12/23) (Inzinger et al., 2011). In an effort to minimize UVA exposure, we have shown that low-dose PUVA given twice weekly does not compromise clinical outcomes and is associated with a high rate of improvement in chronic plaque psoriasis patients (Legat et al., 2004). Similarly, low-dose, low-frequency PUVA was also highly effective in early-stage MF patients (P. Vieyra-Garcia, et al., 2019b).
How It Works: The Immunology Underlying Phototherapy
2020, Dermatologic ClinicsCitation Excerpt :The viewpoint of investigators of several recent reviews stress the potential role of Tregs in the antipsoriatic activity of phototherapy, although clinical data are still lacking to confirm this.49,50 As in CTCL, the therapeutic effect of phototherapy in psoriasis is limited to the site of UV exposure,74–77 indicating that local factors, such as direct elimination of keratinocytes and/or immunocytes, are involved in the therapeutic response, in addition to systemic induction of regulatory immune cells, such as Tregs. The role of LCs in the pathophysiology of psoriasis is controversial; as in the skin of healthy subjects, UV irradiation was found to deplete LCs in nonlesional skin of psoriasis patients, possibly contributing to the therapeutic effect of phototherapy.78,79
A review of phototherapy protocols for psoriasis treatment
2011, Journal of the American Academy of DermatologyCitation Excerpt :Recent studies have sought to decrease the frequency and aggressiveness of oral and topical phototherapy regimens and reduce cumulative PUVA exposure while still maintaining remission time. Reducing PUVA frequency to twice weekly in light-skinned patients does not compromise PUVA efficacy.63-66 A randomized half-body controlled study of twice versus 3-times weekly PUVA involving 28 patients showed no difference in Psoriasis Area and Severity Index (PASI) score after 25 sessions, 92.9% for twice weekly and 94.8% for thrice weekly.
Platelet-activating factor blockade inhibits the T-helper type 17 cell pathway and suppresses psoriasis-like skin disease in K5.hTGF-β1 transgenic mice
2011, American Journal of PathologyCitation Excerpt :However, the differential outcome of COX-2 regulation by PAF may be explained by differences between the cytokine networks under pathologic conditions occurring in a disease model such as K5.hTGF-β1 transgenic mice compared with physiologic conditions in normal cell culture5 or healthy mice. The observation that IL-10 induced by PAF blockade may be responsible for inhibiting progression of the psoriatic phenotype in K5.hTGF-β1 transgenic mice is intriguing because recombinant IL-10 has been shown to be clinically effective in the treatment of psoriasis in humans41,42 and is one of the main mediators of the effects of PUVA,27 another highly effective treatment modality of psoriasis.43 Importantly, the functional relevance and significance of PAF receptor blockade and the subsequent reduction of PAF in the K5.hTGF-β1 transgenic mouse model are supported by findings from a previous study16 in which treatment during a 4-week period with the same doses of PUVA as used in this study led to improvement of the psoriatic phenotype of transgenic mice, accompanied by normalization of abnormally elevated cytokine levels in the skin and serum, including the Th1 and Th17 pathway and induction of IL-10.
The effects of sunlight on the skin
2008, Drug Discovery Today: Disease MechanismsDirect detection of singlet oxygen generated by UVA irradiation in human cells and skin
2007, Journal of Investigative DermatologyCitation Excerpt :To visualize the singlet oxygen generation in tissue under UVA radiation, primary keratinocytes, porcine skin specimen, or human skin in vivo was irradiated using the third harmonic of an Nd:YAG laser (λem: 355 nm). That wavelength is in the middle of the UVA irradiation spectrum ranging from 320 to 400 nm and can be considered UVA-1 (340–400 nm), which is frequently used in clinical UV therapy for skin diseases such as psoriasis (Legat et al., 2004) or morphea (Gruss et al., 1997). The luminescence signal of the skin at 1,270 nm contains a short-lived part (time: 0–2 μs) and a long-lived part (time: >16 μs) (Figure 1a).
- ☆
Funding sources: None.
Conflicts of interest: None identified.