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Phototherapy using narrowband ultraviolet B and psoralen plus ultraviolet A is beneficial in steroid‐dependent antihistamine‐refractory chronic urticaria: a randomized, prospective observer‐blinded comparative study
Author(s) -
Bishnoi A.,
Parsad D.,
Vinay K.,
Kumaran M.S.
Publication year - 2017
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.14778
Subject(s) - antihistamine , medicine , psoralen , ultraviolet a , refractory (planetary science) , dermatology , ultraviolet b , randomized controlled trial , pharmacology , chemistry , dna , physics , astrobiology , biochemistry
Summary Background Literature on the efficacy of phototherapy in steroid‐dependent antihistamine‐refractory chronic urticaria ( CRU ) is limited. Objectives To assess and compare the efficacy of psoralen plus ultraviolet A ( PUVA ) and narrowband ultraviolet B ( NB ‐ UVB ) in steroid‐dependent CRU . Methods In this randomized, prospective observer‐blinded comparative study, 50 patients with steroid‐dependent CRU (6 months of spontaneous urticaria with no response after 3 consecutive months of antihistamines and steroid dependence) were administered either PUVA (group A) or NB ‐ UVB (group B) for 90 days, with a post‐treatment follow‐up of 90 days. The treatment efficacy was assessed using the average urticaria activity score 7 ( aUAS 7) and outcome scoring scale ( OSS ) every 2 weeks. Results The mean values of aUAS 7 progressively decreased from 4·9 ± 0·8 and 5·0 ± 0·7 at baseline to 1·9 ± 0·7 and 1·4 ± 0·7 in groups A and B, respectively, by day 90. This further decreased to 1·5 ± 0·8 and 1·4 ± 1·0 at day 180 in both groups. The values of OSS progressively increased from baseline (1·6 ± 0·5 in group A and 1·3 ± 0·5 in group B) to 3·9 ± 0·3 and 4·0 ± 0·3 in groups A and B, respectively, by day 90, and 3·9 ± 0·5 and 4·0 ± 0·6 by day 180. NB ‐ UVB fared statistically better than PUVA at different time points. Adverse events encountered were minimal and did not warrant treatment discontinuation. Conclusions Phototherapy, especially NB ‐ UVB , is an effective, safe and affordable therapeutic modality for steroid‐dependent CRU and should be tried prior to third‐line treatment options such as omalizumab, ciclosporin and other immunosuppressants.