Ultraviolet B 308-nm excimer laser treatment of psoriasis: a new phototherapeutic approach
Ultraviolet B 308-nm excimer laser treatment of psoriasis: a new phototherapeutic approach
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DOI：
10.1111/j.1365-2133.2003.05709.x
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发表时间：
2003-12-01
影响因子：
10.3
通讯作者：
Ockenfels, HM
中科院分区：
文献类型：
--
作者：
Gerber, W;Arheilger, B;Ockenfels, HM
背景准分子激光衍生的308 nm紫外线（UV）B疗法是通过光疗治疗银屑病的新替代方案。一些研究表明，病灶内光疗技术治疗银屑病的有效性。然而，迄今为止还没有关于累积剂量的信息，对一个更大的组的患者和治疗优化的治疗strategies.Objectives一百二十银屑病患者进行了治疗，根据标准协议，以定义的有效性。我们的目的是开发新的参数，并确定是否有效，可以提高和治疗暴露，累积UVB剂量和不良反应是否可以minimized.Methods最初，准分子激光治疗银屑病的有效性进行了评估，在一个开放的前瞻性研究，根据标准协议。这包括120名患有慢性斑块状银屑病的成年患者（67名女性/53名男性），< 20%累及体表。初始剂量基于预定最小红斑剂量（MED）的三倍。患者在前3周每周治疗两次，然后每周治疗一次，直至清除。主要参数为初始起始剂量、银屑病面积和严重程度指数（PASI）、所需治疗次数、治疗时间和清除银屑病斑块所需的累积剂量。此后，43例患者作为第二个可比组接受治疗。治疗开始于起始剂量，定义为MED-I。MED-I定义为UVB 308 nm剂量，24 h后引起红斑明显增加。此外，通过20 MHz超声测量斑块的表皮厚度，并与MED-I相关联。结果在符合标准方案的患者中，65.7%的患者在最多10次治疗后至少90%清除;在13次治疗后，更多的患者（85.3%）显示PASI改善大于或等于90%，而14.7%的患者仅具有小于或等于50%的PASI改善。累积UVB剂量为11.25 +/- 4.21 J cm（-2），平均治疗时间为7.2周。采用MED-I起始剂量单独治疗的患者显示出几乎相同的清除率（83.7%），但在7.07 +/- 2.15次治疗中清除，累积剂量为6.25 +/- 4.02 J cm（-2）。结论我们的大多数患者从激光衍生的308 nm UVB治疗中获益匪浅，该治疗比传统光疗更快地清除皮肤病变。由于这种疗法仅针对受累皮肤，因此斑块的厚度和个体MED-I应确定初始剂量，从而增加治疗的有效性。我们建议，光疗法保留未涉及的皮肤将成为未来的主导。
Background Excimer laser-derived 308-nm ultraviolet (UV) B therapy is a new alternative for treating psoriasis by phototherapy. Some studies have been made showing the effectiveness of intralesional phototherapy technology in treating psoriasis. However, there has been no information available so far with regard to the cumulative dosage on a larger group of patients and on therapy optimized treatment strategies.Objectives One hundred and twenty psoriatic patients were treated according to standard protocol to define the effectiveness. Our aim was to develop new parameters and determine whether effectiveness could be improved and whether treatment exposure, the cumulative UVB dose and adverse effects could be minimized.Methods Initially, the excimer laser's effectiveness in treating psoriasis was evaluated in an open prospective study according to standard protocol. This included 120 adult patients (67 female/53 male) with chronic plaque psoriasis and < 20% involved body surface. The initial dose was based on three multiples of a predetermined minimal erythema dose (MED). Patients were treated twice a week for the first 3 weeks, then once a week until clearance was achieved. The main parameters were the initial starting dose, psoriasis area and severity index (PASI), the number of treatments needed, the time in treatment and the cumulative dose needed to clear psoriatic plaques. Thereafter, 43 patients were treated as a second comparable group. Therapy began with a starter dose, defined as MED-I. MED-I was defined as a UVB 308-nm dose which provoked a visible increase in erythema after 24 h. In addition, the epidermal thickness of the plaques was measured on an individual basis by 20-MHz ultrasound and correlated to the MED-I.Results Of the patients who met the standard protocol, 65.7% were at least 90% clear after a maximum of 10 treatments; an even greater number (85.3%) showed a greater than or equal to 90% improvement in PASI after 13 sessions, while 14.7% of patients had only a less than or equal to 50% PASI improvement. The cumulative UVB dose was 11.25 +/- 4.21 J cm(-2) and the average treatment time was 7.2 weeks. Patients treated individually with the MED-I starter dose showed nearly identical rates of clearance (83.7%), but were clear in 7.07 +/- 2.15 sessions with a cumulative dose of 6.25 +/- 4.02 J cm(-2).Conclusions The majority of our patients benefited greatly from laser-derived 308-nm UVB therapy, which cleared skin lesions faster than conventional phototherapy. As this therapy targets only the involved skin, the thickness of the plaques and individual MED-I should determine the initial dose, thus increasing the effectiveness of the therapy. We propose that light therapy sparing uninvolved skin will become predominant in the future.