Comparison of Local Bath-PUVA with Steroid Treatment in Palmoplantar Pustular Psoriasis and Dyshidrotic Eczema / 대한피부과학회지

BACKGROUND: Local bath-PUVA(LB-PUVA) therapy has been recently tried for the treatment of palmoplantar pustular psoriasis and chronic eczema with successful results. However it has not been reported that the effectiveness of LB-PUVA was compared with that of steroid treatment which is the most available treatment. OBJECTIVES: The purpose of this study was to assess the effectiveness, symptom-free interval, recurrence rate and side effects of local bath-PUVA(LB-PUVA) therapy in palmoplantar pustular psoriasis and dyshidrotic eczema which had been resistant to conventional treatments and to compare these results with those of the steroid treatment. METHODS: Twenty four patients with palmoplantar pustular psoriasis, dyshidrotic eczema and palmoplantar keratoderma were treated with local bath-PUVA and the control group of twenty patients with systemic and topical steroid. 1. Local bath-PUVA therapy After a 15-minute bath in 1mg/L of methoxsalen solution(0.0001%), the palms or soles or both were exposed immediately to UVA radiation by UV/PUVA200. The initial standard dose was 1.5 J/cm2, and the patients were treated three times a week. 2. Systemic and topical steroid therapy The patients treated with 10-15mg of oral prednisolone once a day and high-potency steroid(Dermovate ointment) to the lesion topically for 4-8 weeks. The efficacy, symptom-free interval and side effects were assessed for 6-12 months after termination of the treatments. RESULTS: The following results were obtained from this study. 1. In the objective study, severity scores before and after treatment significantly differed in palmoplantar pustular psoriasis treated with local bath-PUVA (p<0.001). 2. In the subjective study, steroid treatment was more effective than LB-PUVA treatment for dyshidrotic eczema and palmoplantar pustular psoriasis. 3. Remission period was significantly longer (mean 9.1+/-2.8 months vs. 5.2+/-3.1 months) and recurrence rate, lower (26.7% vs. 68.9%) after LB-PUVA treatment than after steroid treatment in palmoplantar pustular psorisis and dyshidrotic eczema. 4. One patient with palmoplantar keratoderma was effectively treated by LB-PUVA. CONCLUSION: Local bath-PUVA therapy can be used as an effective and safe treatment method of palmoplantar pustular psoriasis and possibly palmoplantar keratoderma.

Bath-8-MOP-UVA Therapy for Psoriasis / 대한피부과학회지

BACKGROUND: An alternative approach to oral PUVA therapy for psoriasis, psoralen bath plus UVA therapy(bath PUVA therapy) that avoids the adverse effects associated with oral PUVA therapy has increasingly been used during recent years. OBJECTIVE: This study was performed to evaluate the efficacy and safety of bath-8-MOP-UVA therapy in the treatment of psoriasis. METHODS: Twenty patients were enrolled in this study after determination of the minimal phototoxic doses(MPD). We evaluated the total treatment number, duration, final UVA dose and total cumulative UVA dose of bath-8-MOP-UVA therapy to reach grade 4 response and categorized each patient into clearing, improvement, or failure groups based on the therapeutic efficacy. We measured the PASI score at two week intervals. Blood samples were obtained from all twenty patients 2 hours after bath-8-MOP and plasma levels of 8-MOP were quantified by a reverse phase high performance liquid chromatography. RESULTS: The following results were obtained from this study. 1. Phototoxicity testing with bath-8-MOP-UVA elicited mean MPD value of 3.5+/-1.3J/cm2. 2. The mean PASI score at 10 weeks was significantly decreased to 5.8+/-1.3 from baseline PASI score 20.1+/-4.3. 3. Among 20 patients, clearing was shown in 13 patients(65%), 6 patients(30%) were improved and 1 patients(5%) showed failure. 4. In clearing and improvement groups, the mean treatment number, duration, final dose of UVA and total cumulative UVA dose reaching grade 4 were 19.3+/-5.4, 49.9+/-13.5days, 5.2+/-1.3J/cm2 and 68.6+/-30.1J/cm2, respectively. 5. Five patients experienced side-effects. Two patients had intense tan, one withdrawing because of it and the other continued treatment. Three had pruritus that was controlled on oral antihistamines. Phototoxic or other classic adverse effects of oral PUVA therapy, such as nausea, vomiting and headaches, were not observed in any of our 20 patients. 6. All twenty patients had an undetectable plasma 8-MOP level. The lower limit of detection level was 20ng/ml. CONCLUSION: Bath-8-MOP-UVA therapy for psoriasis is a very effective and safe alternative to oral PUVA therapy.