8-MOP PUVA for psoriasis: a comparison of a minimal phototoxic dose-based regimen with a skin-type approach.

Two ultraviolet A (UVA) regimens for oral 8-methoxypsoralen (8-MOP) photochemotherapy (PUVA) for moderate/severe chronic plaque psoriasis using a half body study technique were compared. Each patient received both regimens. A higher-dose regimen based on minimal phototoxic dose (MPD) with percentage incremental increases was given to one-half of the body. The other half received a lower dose regimen based on skin type with fixed incremental UVA increases. Patients were treated twice weekly. Symmetrical plaques were scored to determine the rate of resolution with each regimen. In addition, the number of treatments, cumulative UVA dose and number of days in treatment to achieve overall clearance were recorded. Patients were reviewed monthly for 1 year to record remission data. Thirty-three patients completed the study. Both regimens were effective and well tolerated. With the MPD-based approach, the number of exposures was significantly less for patients with skin types I and II but not III. Although the cumulative UVA dose was higher with the MPD regimen for all skin types studied, the reduced number of exposures required for clearance for skin types I and II but not III, combined with the security of individualized MPD testing, has practical attractions. MPD testing also identified five patients who required an increased psoralen dose and six patients who required a reduction of the initial UVA dose with the skin type regimen. Forty-two percent were still clear 1 year after treatment and there was no significant difference in the number of days in remission between the regimens for those whose psoriasis had recurred. The reduction in the number of exposures required for clearance with the MPD-based regimen may be safer and more cost effective in the long term.

A trial of accelerated PUVA in psoriasis.

Ten psoriatic patients were treated with an accelerated PUVA regimen. Nine patients cleared in an average of 13.7 treatments (range 4-24) after an average total UVA dose of 83 J/cm2 (range 18-186). One patient had to withdraw due to pruritus and burning and six others had burning problems. The high incidence of burning may limit the routine use of this irradiation regimen.

A comparison of the efficacy and relapse rates of narrowband UVB (TL-01) monotherapy vs. etretinate (re-TL-01) vs. etretinate-PUVA (re-PUVA) in the treatment of psoriasis patients.

Forty-five patients with extensive chronic plaque or guttate psoriasis were treated with either narrowband (TL-01) phototherapy, etretinate TL-01 combination therapy (re-TL-01) or etretinate and PUVA (re-PUVA) (15 patients in each group). Re-PUVA was the most effective therapy with 100% satisfactory clearance rate. TL-01 monotherapy had an 80% success rate; the relapse rate compared favourably with re-PUVA (50% in remission after 6 months). In the etretinate-TL-01 group, there was a 93% success rate and a one-third reduction in the total irradiation dose (8.0 J/cm2 vs. 12.7 J/cm2) but the relapse rate was higher, only 33% remaining in remission after 6 months.

A case of hepatitis related to etretinate therapy and hepatitis B vaccine.

The case of a 41-year-old male patient is described who developed acute reversible hepatitis related to etretinate therapy. During the course of etretinate he received 2 doses of hepatitis B vaccine; this and his HLA typing A1, A2, Bw57, Cw6 may have predisposed him to develop this reaction.

311 nm UVB phototherapy--an effective treatment for psoriasis.

Fifty two psoriatic patients were treated with a new experimental fluorescent lamp (Philips TL-01) emitting a narrow band at 311 +/- 2 nm (UVB) which had the advantage of a reduction in burning and carcinogenic wavelengths when compared with conventional broad band UVB therapy. Results of the '311' treated group when compared with broad band UVB therapy revealed a similar percentage of patients achieving a satisfactory response with fewer burning episodes and an increase in duration of remission.

Sister chromatid exchange and chromosome aberration rates in a group of psoriatics before and after a course of PUVA treatment.

Blood was cultured and chromosome preparations were examined for sister chromatid exchanges and chromosome aberrations in eighteen patients receiving photochemotherapy with 8-MOP and UV-A for the treatment of psoriasis, both before starting treatment and again 6 months later. The UV-A was administered both by means of low output (irradiance: 1.1--2.25 mW/cm2) and high output (irradiance: 6.1--7.6 mW/cm2) UV-A radiation cubicles. Irrespective of the intensity of irradiation or the total dose of UV-A administered there was no evidence of chromosome damage in lymphocytes following treatment.

HLA antigens in a Scottish psoriatic population.

Sixty-one patients in the Dundee area suffering from psoriasis were typed for HLA-A and HLA-B antigens. On the basis of the typing results, the patients were divided into three groups, and studied with respect to sex, age of onset and familial incidence of the disease. The frequency of HLA-A1 appeared to be increased and HLA-B7 decreased but HLA-B13 and HLA-B17 were highly significantly increased (P less than 10(-6) and P less than 10(-10) respectively) in the psoriatic group compared to 204 controls. Of particular interest was a highly significant association of HLA-A1 with HLA-B17 in psoriatic patients. Family studies showed HLA-B17 to be a useful genetic marker for psoriasis in the families of B17 positive patients. Considerations of age of onset, familial incidence and typing data suggest that there is heterogeneity of genetic susceptibility to psoriasis and that one probable mechanism is the dominant inheritance of a "disease allele" in linkage disequilibrium with the allele coding for HLA-B17.

Photochemotherapy in the treatment of psoriasis.

This article describes the satisfactory clinical improvement obtained in the majority of a group of 72 patients with psoriasis of various types as a result of the oral and/or topical administration of 8-methoxypsoralen followed by long wavelength ultraviolet irradiation. The irradiation source used was that of conventional longwave UV fluorescent tubes mounted in a specially constructed cubicle. Until such time as the long term effect of this form of photochemotherapy on the cell has been evaluated and the most appropriate regime worked out, it would seem to be important to restrict the amount of irradiation used to that required to produce acceptable maintained clinical improvement.

A correlative study of duodenal aspirate and faeces examination in giardiasis, before and after treatment with metronidazole.

In a study of 95 patients with giardiasis it was shown that examination of duodenal aspirates for Giardia Lamblia can supplement but not replace examination of faeces in the detection and follow-up of cases. The chances of finding trophozoites in duodenal aspirate is greater in those with trophozoites in the faeces than in cyst passers. Patients were treated with metronidazole in either conventional dosage (400 mg.t.d.s. for 7 days) or with a single 'hammer dose' of 2400 mg. Results showed that the parasites may persist in the duodenum and faeces after conventional therapy, though the incidence was not very high; and it is suggested that a single large dose of metronidazole may be equally if not more effective than divided doses spread over a few days.