MTÜ Psoriaasihaigete Toetamise Ühing "Psoriaasikeskus"
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Narrowband UVB Is Advantageous for Psoriasis
WASHINGTON — Narrowband UVB phototherapy and UV excimer laser treatment offer several advantages over other psoriasis phototherapies, Dr. Jeffrey S. Dover said at the annual meeting of the American Academy of Dermatology.
The availability of narrowband UVB, also known as TL-01 light sources, "has changed the way we use phototherapy to treat psoriasis," said Dr. Dover of SkinCare Physicians of Chestnut Hill (Mass.).
These light sources are in the 310- to 315-nm range, matching the "action spectrum" for psoriasis, which responds 10-100 times better to wavelengths in this spectrum than it does to any other wavelengths in the UVB range.
Historically, broadband UVB (in the 270- to 350-nm range) was the phototreatment of choice for psoriasis, even though much of that wavelength is "totally unnecessary for clearing psoriasis," he said.
Mounting evidence now shows that narrowband UVB is significantly more effective than broadband in treating psoriasis, and requires less erythema for clearance, Dr. Dover said.
Moreover, this modality is at least as effective as PUVA, and is not associated with the gastrointestinal side effects of PUVA medications; nor is any eye protection required after treatment, he continued. However, these light sources, developed in the 1980s and "nearly ubiquitous" in Europe and other parts of the world, are not widely used in the United States, largely due to the cost of replacing the older units, he said. Unfortunately, narrowband bulbs cannot be put in the older broadband units.
Dr. Dover described UV excimer laser phototherapy as one of the "hottest topics" in dermatology now. Over the past year, this treatment has become commercially available in the United States, with Food and Drug Administration approval of the PhotoMedex excimer laser 308 nm.
Even though lasers are more expensive, make more heat, and tend to break more frequently than bulb sources of narrowband UVB radiation, they have distinct advantages for treating psoriasis, he said.
The excimer laser can aim the UVB rays specifically at psoriatic plaques, sparing surrounding tissue and making it possible to deliver much higher doses than possible with other light sources, he said.
As a result, plaques clear after as little as one treatment in some patients, which has never been achieved before, he said. On average, patients clear after 6-8 excimer laser treatments. Other advantages include fewer side effects and less carcinogenicity, since the light only shines on the psoriatic plaques, said Dr. Dover, also of Beth Israel Deaconess Medical Center, Boston, and Dartmouth Medical School, Hanover, N.H.
On the downside: Total body psoriasis requires a broader light source, so it cannot be treated with the excimer laser.
In a multicenter study of the UV excimer laser for psoriasis, 72% of 80 patients completing the trial experienced at least 75% clearing after an average of six to eight treatments, Dr. Dover said. And 84% of the patients had at least 75% clearing after 10 treatments, "which is something you never can achieve" with PUVA or broadband UVB therapy, or even with narrowband UVB light therapy, he observed.
The unresolved question is how long people will remain clear after treatment. There are no long-term data available, although it appears that these patients remain clear for as long as those treated with PUVA or UVB phototherapy, he said.
PhotoMedex is also developing the same laser contained in a comb for scalp psoriasis, where the laser light comes out of the spicules of the comb, making it possible to deliver the light directly to the scalp, said Dr. Dover, who reported having no relationship with PhotoMedexor or with manufacturers of the TL-01 lights.
Skin and Allergy News , May 2001, vol 32, nr.5
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