PUVA ( UVA) and Narrow-band UVB light therapy are both very effective for the treatment of psoriasis.There are multiple available treatments for psoriasis inlcuding PUVA, which uses a special pill (psoralen) plus UVA light to treat affected skin. Those wishing to initiate PUVA may also want to consider the option of narrow-band UVB therapy which would not require inernal drugs or chemicals.
The Skin Center physicians are trained in psoriasis light therapy with PUVA and UVB. Light is usually started 2-3 times/ week and gradually adjusted to accommodate skin clearing.
Both PUVA and Narrow-band UVB light treatments are continued until psoriasis clears or almost clears, followed by tapering maintenance treatments. The goals of therapy are to establish and maintain control over psoriatic flares, and to balance the risks and benefits of PUVA narrow-band UVB treatment.
Narrow-band ultraviolet B (NB-UVB) was newly introdcued and became available in the United States in 1996. NB-UVB emits a wavelength between 311-313 nm, which is most phototherapeutic for the clearance of psoriasis. NB-UVB has been shown to be more effective than broad-band ultraviolet B (BB-UVB)and almost as effective as PUVA for the treatment of psoriasis, but with a shorter remission time, and possibly with a lower risk of skin cancer.
Dr. Alai | Dermatologist in Orange County
Department of Dermatology, Gaziosmanpasa University School of Medicine, Tokat, Turkey. firstname.lastname@example.org
Hand eczema is a chronic skin disorder characterized by a poor response to conventional therapies. Although local PUVA has been proven to be effective in the treatment of chronic hand eczema, little is known about the efficacy and safety of local narrowband UVB (TL-01) for this condition. The aim of our study was to compare the efficacy and safety of local narrowband UVB phototherapy with paint-PUVA in patients with chronic hand eczema of dry and dyshidrotic types unresponsive to conventional therapies.
Fifteen patients (nine men and six women) with chronic hand eczema of dry and dyshidrotic types was included in this prospective, comparative study based on a left to right comparison pattern. The treatments were administered with local narrowband UVB irradiation on one hand and local paint-PUVA using 0.1% 8-methoxypsoralen gel on the other hand three times a week over a 9-week period. The NB-UVB irradiation was administered using a local NB-UVB system equipped with TL-01 lamps. The initial dose was 150 mJ/cm(2) for each patient. An increasing percentile dose schedule based on an increase of 20% was used in every session, until a final dose of 2000 mJ/cm(2) was reached. Evaluation of clinical scores was carried out every 3 weeks during the treatment period.
Twelve of the 15 recruited patients completed the study. There was a statistically significant decrease in the mean clinical score at the third, sixth and nineth week in both groups. The difference in clinical response between the two treatment modalities was not statistically significant at the end of the 9-week treatment period. In the narrowband UVB-treated side, the tolerance of all the patients to the treatment was good all patients well-tolerated the treatment with the exception of mild xerosis that responded to topical emollients.
Local narrowband UVB phototherapy regimen is as effective as paint-PUVA therapy in patients with chronic hand eczema of dry and dyshidrotic types.
PUVA vs Narrowband UVB: General considerations
Narrow-spectrum UVB phototherapy offers a good alternative to PUVA therapy since concomitant psoralen is not required, but there are few immediate adverse effects, there is less risk of drug-induced photosensitisation, and there is no need for skin or ocular photoprotection after sessions. We recommend this approach as the first-line phototherapy (level of proof: A) in children and adolescents, and in adults with extensive moderate psoriasis involving small superficial plaques. It may also be used in pregnant or breastfeeding women and in patients with renal or hepatic insufficiency. In addition, it is preferable for HIV-positive subjects (level of proof: C). However, PUVA therapy is preferable as first-line treatment in extensive severe psoriasis involving large thick plaques (level of proof: A) and in adults of phototypes IV to VI (level of proof: B); it should also be contemplated for psoriasis refractory to UVB TL01 (level of proof: B).