Background: Broad-band UVB alone or in combination with different topical drugs (anthralin, calcipotriol), systemic PUVA and bath-PUVA therapy are very effective and well-established treatment modalities for psoriasis. Objective: The aim of this retrospective study was to assess which of these routinely applied phototherapeutic modalities might be most effective and safe for the treatment of plaque-type psoriasis. Methods: Patients (n = 203) with moderate to severe (pretreatment Psoriasis Area and Severity Index score between 12 and 35) chronic plaque-type psoriasis treated between 1992 and 1998 at our department with either UVB (with/without anthralin or calcipotriol; n = 97), systemic PUVA (n = 19) or bath-PUVA therapy (n = 87) were evaluated for efficacy, duration of treatment, number of treatments necessary for complete remission (CR), cumulative light dose, side effects of therapy and duration of remission after therapy. Results: No statistically significant difference comparing the efficacy of bath-PUVA (CR in 72.4%), PUVA (CR in 89.5%) and UVB phototherapy (CR in 69.1%) was found. Although the duration of therapy was significantly longer for bath-PUVA (66 ± 42 days) as compared to UVB treatment (50 ± 27 days), the mean number of treatments did not differ significantly between bath-PUVA (28 ± 12), UVB therapy (30 ± 12) and PUVA (26 ± 13). Significantly fewer side effects of phototherapy were observed with bath-PUVA (14.9%) therapy compared to UVB treatment (30.9%). Also, the duration of remission after successful therapy was significantly longer for bath-PUVA (8.4 ± 3.5 months) as compared to UVB phototherapy (5.1 ± 4.2 months). Conclusion: Bath-PUVA therapy has some advantages over UVB phototherapy in the treatment of psoriasis: fewer UV-related acute side effects and a longer period of remission after therapy. However, the choice of treatment with either UVB, bath-PUVA or systemic PUVA should also be based on a history of previous response to treatment and patient considerations, including compliance and responsibility for following the precautions to avoid potential side effects.

1.
Goeckerman W: The treatment of psoriasis. NW Med 1925;24:229–231.
2.
Ingram J: The approach to psoriasis. Br Med J 1953;ii:591–594.
3.
Parrish JA, Fitzpatrick TB, Tannenbaum L, Pathak MA: Photochemotherapy of psoriasis with oral methoxsalen and long wave ultraviolet light. N Engl J Med 1974;291:1207–1212.
4.
Fischer T, Alsins J: Treatment of psoriasis with trioxsalen baths and dysprosium lamps. Acta Derm Venereol (Stockh) 1976;56:383–390.
5.
Hannuksela M, Karvonen J: Trioxsalen bath plus UVA effective and safe in the treatment of psoriasis. Br J Dermatol 1978;99:703–707.
6.
Fitzpatrick TB: Soleil et peau. J Méd Esthét 1975;2:33–34.
7.
Ortel B: Lanzeitwirkung von Psoralenen? Hautarzt 1993;44:249.
8.
Shelk JL: Nursing for psoriasis; in Roenigk HH, Maibach HI (eds): Psoriasis, ed 3. New York, Dekker, 1998, pp 807–813.
9.
Koo JY: Current consensus and update on psoriasis therapy: A perspective from the US. J Dermatol 1999;26:723–733.
10.
Calzavara-Pinton PG, Ortel B, Hönigsmann H, Zane C, De Panfilis G: Safety and effectiveness of an aggressive and individualized bath-PUVA regimen in the treatment of psoriasis. Dermatology 1994;189:26–259.
11.
Collins P, Rogers S: Bath-water compared with oral delivery of 8-methoxypsoralen PUVA therapy for chronic plaque psoriasis. Br J Dermatol 1992;127:392–395.
12.
Lowe JN, Weingarten D, Bourget T, Moy LS: PUVA therapy for psoriasis: Comparison of oral and bath-water delivery of 8-methoxypsoralen. J Am Acad Dermatol 1986;14:754–760.
13.
Van Weelden H, Young E, van der Leun JC: Therapy of psoriasis: Comparison of photochemotherapy and several variants of phototherapy. Br J Dermatol 1980;103:1–9.
14.
Boer J, Hermans J, Schothorst AA, Suurmond D: Comparison of phototherapy (UV-B) and photochemotherapy (PUVA) for clearing and maintenance therapy of psoriasis. Arch Dermatol 1984;120:52–57.
15.
Young E: The external treatment of psoriasis: A controlled investigation of the effects of dithranol. Br J Dermatol 1970;82:516–520.
16.
Bowers RE, Dalton D, Fursdon D, Knoweldon J: The treatment of psoriasis with UVR, dithranol paste and tar baths. Br J Dermatol 1966;78:273–281.
17.
Boer J, Smeenk G: Effect of short-contact anthralin therapy on ultraviolet B irradiation of psoriasis. J Am Acad Dermatol 1986;15:198–204.
18.
Kragballe K: Combination of topical calcipotriol and UVB radiation for psoriasis vulgaris. Dermatologica 1990;181:211–214.
19.
Kokelij F, Lavaroni G, Guadagnini A: UVB versus UVB plus calcipotriol therapy for psoriasis vulgaris. Acta Derm Venereol (Stockh) 1995;75:386–387.
20.
Ramsay CA, Schwartz BE, Lowson D, Papp K, Bolduc A, Gilbert M: Calcipotriol cream combined with twice weekly broad-band UVB phototherapy: A safe, effective and UVB-sparing antipsoriatic combination treatment. Dermatology 2000;200:17–24.
21.
Stern RS, Armstrong RB, Anderson TF, Bickers DR, Lowe NJ, Harber L, Voorhees J, Parrish FA: Effect of continued ultraviolet B phototherapy on the duration of remission of psoriasis: A randomized study. J Am Acad Dermatol 1986;15:546–552.
22.
Vella-Briffa D, Greaves MW, Warin AP, Rogers S, Marks J, Shuster S: Relapse rate and long-term management of plaque psoriasis after treatment with photochemotherapy and dithranol. Br Med J Clin Res Ed 1981;282:937–940.
23.
Larkö O: Phototherapy of psoriasis: Clinical aspects and risk evaluation. Acta Derm Venereol Suppl (Stockh) 1982;103:1–42.
24.
Cripps DJ, Lowe NJ: Photochemotherapy for psoriasis remission times: Psoralens and UVA and combined photochemotherapy with anthralin. Clin Exp Dermatol 1979;4:477–483.
25.
Hesse G, Wichmann-Hesse AC, Bercher M: PUVA-therapy with low UV-A dose. Z Hautkr 1987;62:935–936.
26.
Collins P, Wainwright NJ, Amorin I, Lakshmipathi T, Ferguson J: 8-MOP PUVA for psoriasis: A comparison of minimal phototoxic dose-based regimen with a skin-type approach. Br J Dermatol 1996;135:248–254.
27.
Melski JW, Tannenbaum L, Parrish JA, Fitzpatrick TB, Bleich HL: Oral methoxsalen photochemotherapy for the treatment of psoriasis: A cooperative clinical trial. J Invest Dermatol 1989;92:153–156.
28.
Marks JM, Lawrence CM, Corbett M, Coburn P, Parker S, Shuster S: Influence of prophylactic photochemotherapy on incidence of relapse of psoriasis cleared initially with dithranol. Br Med J 1984;288:95–96.
29.
David M, Lowe NJ, Halder RM, Borok M: Serum 8-methoxypsoralen (8-MOP) concentrations after bath water delivery of 8-MOP plus UVA. J Am Acad Dermatol 1990;23:931–932.
30.
Berne B, Fischer T, Michaelsson G, Norden P: Long-term safety of trioxsalen bath PUVA treatment: An 8-year follow-up of 149 psoriasis patients. Photodermatology 1984;1:18–22.
31.
Talwar HS, Griffiths CE, Fisher GJ, Hamilton TA, Voorhees JJ: Reduced type I and type III procollagens in photodamaged adult human skin. J Invest Dermatol 1995;105:285–290.
32.
Pasker-de Jong PCM, Wielink G, van der Valk PGM, van der Wilt GJ: Treatment with UV-B for psoriasis and nonmelanoma skin cancer. Arch Dermatol 1999;135:834–840.
33.
Stern RS, Laird N: The carcinogenic risk of treatments for severe psoriasis. Photochemotherapy Follow-up Study. Cancer 1994;73:2759–2764.
34.
Slaper H, Schothorst AA, van der Leun JC: Risk evaluation of UVB therapy for psoriasis: Comparison of calculated risk for UVB therapy and observed risk in PUVA-treated patients. Photodermatology 1986;3:271–283.
35.
Shephard SE, Panizzon RG: Carcinogenic risk of bath PUVA in comparison to oral PUVA therapy. Dermatology 1999;199:106–112.
36.
Stern RS: Genital tumors among men with psoriasis exposed to psoralens and ultraviolet A radiation (PUVA) and ultraviolet B radiation. N Engl J Med 1990;322:1093–1097.
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