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Paired comparison of bathwater versus oral delivery of 8‐methoxypsoralen in psoralen plus ultraviolet A therapy for chronic palmoplantar psoriasis
Author(s) -
Hofer A.,
FinkPuches R.,
Kerl H.,
Quehenberger F.,
Wolf P.
Publication year - 2006
Publication title -
photodermatology, photoimmunology and photomedicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.736
H-Index - 60
eISSN - 1600-0781
pISSN - 0905-4383
DOI - 10.1111/j.1600-0781.2006.00196.x
Subject(s) - psoralen , medicine , puva therapy , psoriasis , dermatology , erythema , methoxsalen , dna , genetics , biology
Background: Both bath psoralen plus ultraviolet A (PUVA) and oral PUVA with 8‐methoxypsoralen (8‐MOP) have been successfully used for the treatment of recalcitrant palmoplantar psoriasis. This trial was designed to assess the efficacy and side effects of the different treatment modalities in a randomized half‐side comparison. Methods: Eight patients with moderate‐to‐severe psoriasis on soles ( n =6) and/or palms ( n =8) were randomly assigned to receive bath PUVA treatment on one side and oral PUVA on the other. Initial treatment dose was 50% of the minimal phototoxic dose evaluated for bath PUVA and oral PUVA. Treatment was given three times a week for 4 weeks. Before treatment and every week a severity index (SI) was assessed by summing the scores of erythema, infiltration, scaling and vesicles evaluated on a scale from 0 to 4. After 4 weeks of treatment the half‐side trial was finished and the treatment was continued on both sides with the more effective treatment regimen. Results: Both bath PUVA and oral PUVA achieved a reduction of the mean initial SI from 5.9 (95% confidence intervals (CI) 4.5–8.0) to 3.3 (1.8–6.0) (44% SI reduction, P <0.005, Student's paired t ‐test) and 6.0 (5.0–7.8) to 2.9 (1.8–4.0) (52% SI reduction; P <0.005), respectively. The statistical comparison of the entire 4‐week study period revealed a significant better effect in lesions treated with oral PUVA compared with bath PUVA ( P =0.033). However, at 4 weeks, there was no significant difference between the achieved SI reduction of oral PUVA and bath PUVA. Systemic side effects (nausea and/or dizziness) were only observed after oral PUVA. Conclusion: This study gives evidence that in the first 4 treatment weeks oral PUVA is slightly more effective than bath PUVA but the former has more systemic side effects.