COMPARISON OF PSORALEN ULTRAVIOLET A (PUVA) PHOTOCHEMOTHERAPY PLUS TOPICAL CORTICOSTEROIDS WITH PUVA PLUS BLAND EMOLLIENTS IN THE TREATMENT OF PSORIASIS

Raheel Tahir, Ghulam Mujtaba

Abstract


Background: Psoralen Ultraviolet A (PUVA) therapy is a well-established treatment of psoriasis. The objective of the study was to compare the clinical improvement in psoriasis with PUVA photochemotherapy + topical corticosteroids and PUVA + bland emollients. Methods: Forty patients with chronic plaque type of psoriasis were divided into two equal groups each having 20 patients. PUVA therapy was given thrice weekly. In addition, patients of group-A were allowed to apply topical betamethasone 17-valerate 0.1% diluted 1 into 2 parts with plain vaseline twice daily. Patients of group-B were allowed to apply only plain vaseline over lesions twice daily. Clinical improvement in lesions was observed by decrease in the severity of erythema, scaling and plaque elevation. Results: Clearance of psoriasis was achieved in 95% of the patients treated with PUVA plus topical corticosteroids while clearance was achieved in 80% of patients treated with PUVA plus bland emollients (P=0.0758). Median numbers of exposures for group-A were 16 & for group-B were 17.5 (p= 0.1029). Similarly, median cumulative dose in group-A was 64.5 J/cm2 & in group-B was 70.7 J/cm2 (p= 0.372). Conclusion: There is no significant difference in clinical improvement in psoriasis treated either by PUVA plus topical steroids or PUVA plus bland emollients.

Key Words: Psoriasis, PUVA therapy, Betamethasone 17-valerate, Emollients

 

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References


Hirji S, Kanji A. Use of cyclosporine-A in the treatment of acute generalized pustular psoriasis. J Pakistan Assoc Derma 2000; 11: 48-53.

Christophers E, Mrowietz U. Psoriasis. In: Fitzpatrick TB, Eisen A, Wolff K, Freedberg IM, Austen KF. Dermatology in general medicine. New York: Mcgraw Hill, 1999: 495-521.

Lebwohh M, Sheren D, Washenik K, Krueger GG, Menter A, Koo J et al. A randomized, double blind, placebo controlled study of clobetasol propionate 0.05% foam in the treatment of non-scalp psoriasis. Int J Dermatol 2002; 41: 269-74.

Pierard GE, Pierard-Franchimont C, Mosbah TB, Estrada JA. Adverse effects of topical corticosteroids. Acta Derm Venereol (Stockh) 1989; 69 (Suppl 151): 26-30.

Abma EM, Blanken R, De Heide LJ. Cushing’s syndrome caused by topical steroid therapy for psoriasis. Neth J Med 2002; 60: 148-50.

Du Vivier A, Stoughton RB. Tachyphylaxis to the action of topically applied corticosteroids. Arch Dermatol 1975; 111: 581-3.

Liem WH. McCullough JL, Weinstein GD. Effectiveness of topical therapy for psoriasis: results of a national survey. Cutis 1995; 55: 306-10.

Mujtaba G, Khalid M. PUVA therapy for psoriasis. Ann King Edward Med Coll 1999; 5: 78-9.

Alge C, Baxter RM, Doyle ME, Moor AC, Brissette JL, Ortel B. PUVA down regulates whn expression in primary mouse keratinocytes. J Photochem Photobiol 2001; 64: 75-81.

Khurshid K, Haroon TS. Photochemotherapy in dermatology. J Coll Physicians Surg Pak 2000; 10:153-4.

Stern RS. The risk of melanoma in association with long term exposure to PUVA. J Am Acad Dermatol 2001; 44: 755-61.

Feldmann SR, Garton R, Averett W, Vallee J, Balkrishnan R. Strategy of manage the treatment of severe psoriasis: considerations of efficacy, safety and cost. Expert Opin Pharmacother 2003;4:1525-33.

Tzaneva S, Henigsmann H, Tanew A, Seeber A. A comparison of psoralen plus ultraviolet A (PUVA) monotherapy, tacalcitol plus PUVA and tazarotene plus PUVA in patients with chronic plaque type psoriasis. Br J Dermatol 2002; 147(4): 748-53.

Boyuat A, Erdi H, Birol A, Guvgey E. Interaction of commonly used emollients with photochemotherapy. Photodermatol Photoimmunol Photomed 2000; 16: 156-60.

Epstein JH, Farber EM, Nall L. Current status of oral PUVA therapy for psoriasis. J Am Acad Dermatol 1979;1:106-17.

Anderson TF, Waldinger TP, Voorhees JJ. UV-B phototherapy: an overview. Arch Dermatol 1984;120:1502-7.

Meola T, Soter NA, Lim HW. Are topical corticosteroids useful adjunctive therapy for the treatment of psoriasis with UV radiation? Arch Dermatol 1991;127:1708-13.

Dower JS. Are topical corticosteroids useful in phototherapy for psoriasis? J Am Acad Dermatol 1989; 20: 748-51.

Levine MJ, Parrish JA. The effect of topical fluocinonide ointment on phototherapy of psoriasis. J Invest Dermatol 1989; 157: 78-82.

Kostovic K, Situm M, Nola I. Phototherapy (UVB) and photochemotherapy (PUVA) for psoriasis. Acta Clin Croat 2002; 41: 103-12.


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