Psoriasis Treatment: Light Therapy

Light therapy (phototherapy) is given under the supervision of a physician. It is available in dermatologists’ offices, psoriasis day-care centers, phototherapy clinics and some hospitals.

UVB:

Ultraviolet B (UVB) light waves have wavelength’s ranging between 290-320 nm. It is the wavelength in sunlight, which is responsible for most of the sunburns. Sometimes tar, anthralin, calcipotriol/calcipotriene, or tazarotene topical therapy is also used in conjunction with UVB phototherapy. In 1925, Goeckerman used tar in addition to UVB. The Ingram method refers to tar baths, topical anthralin and UVB.

UVB is given to the whole body in a cabinet, or to localized areas with a small portable unit. Most UVB given is broadband UVB. Narrow band UVB, which has a wavelength of 311 nm, is available in certain centers. Some patients may do better with narrow band UVB, but the risk of a sunburn reaction may be greater.

The eyes need to be protected with special glasses during UVB treatment in order to prevent eye damage. Although treatment is often limited to 2-4 weeks, long-term treatment might be associated with aging of the skin and potentially an increase in skin cancer. UVB treatment is usually given 3 to 5 times a week, then less frequently as the skin improves. Long remissions may occur after UVB phototherapy.

PUVA:

PUVA stands for Psoralen (a medication that sensitizes your skin to ultraviolet A light waves) + UVA (ultraviolet A, with a wavelength range of 320-400 nm). The psoralen may be taken internally as a pill or applied to the skin (in bath water or as a cream, ointment or lotion). After a set time after the psoralen has been taken or applied, the skin is exposed to ultraviolet A radiation in a cabinet or with a small portable unit.

You must wear protective eye glasses as soon as you take the psoralen pill, during treatment (for both the internal and topical PUVA treatments), and for one day after your treatment, in order to prevent eye damage. Other potential side-effects include itching and dryness of the skin, a sunburn reaction, freckling, aging of the skin and skin cancer. The pill often causes an upset stomach. You can minimize nausea by taking the psoralen pill with food. PUVA therapy is usually given initially 2 to 3 times a week, then less frequently as the skin improves. It takes about 25 treatments over a 2-3 month period before clearing takes place. Long remissions may occur after PUVA therapy.

Re-PUVA:

Re-PUVA refers to treatment with a retinoid (for example, Acitretin) and PUVA. The retinoid is usually started a couple of weeks before the PUVA. The total dose and number of PUVA treatments may be less if treatment with a retinoid is also given.

Laser:

Laser light treatment has been used for localized resistant patches with some success. However, it is still considered experimental. The laser used is the 308nm Eximer® laser which gives a quick response. Since the light beam is relatively small, it is not a practical treatment option for generalized disease.

Dovobet®

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INTRODUCTION
Dovobet (50 micrograms/gram calcipotriol and 0.5 milligrams/gram betamethasone dipropionate) is a topical ointment approved for use in Canada to treat plaque psoriasis. Dovobet has become the topical therapy of choice for many patients with plaque type psoriasis not involving the face or skin folds... | Read more ...

CLININCAL EXPERIENCE
More than six international studies involving over 6,000 patients have shown reductions in the PASI (Psoriasis Area and Severity Index) of approximately 40% after one week of treatment and 70% after four weeks... | Read more ...

INDICATIONS
Used to treat chronic plaque psoriasis that covers less than 30% of the body surface (see following slides for clarification). Dovobet is not often used to treat the scalp because the sticky base does not allow for easy application or removal... | Read more ...

PATIENT PROFILE
Patients with chronic plaque psoriasis that covers less than 30% of the body surface. In some cases, a patient could use it on a greater BSA if he/she wanted to as long as the use/week is 100 g per week or less... | Read more ...

DOSING
Dovobet should be applied to the affected area once daily for four weeks. Several studies have shown that there are no statistically significant differences between applying the ointment once daily or twice daily... | Read more ...

EFFICACY
Six international studies involving more than 6,000 patients using Dovobet to treat psoriasis have shown PASI reductions of approximately 40% after one week of treatment and 70% after four weeks. Additional studies have shown that Dovobet has superior... | Read more ...

COMPLIANCE
Compliance is aided by the convenience of the once daily dosing of Dovobet. Compliance is also less of a problem than with most products due to the rapid onset of action. Significant improvement is usually seen within the first week... | Read more ...

SIDE EFFECTS, SAFETY AND RISKS
Because Dovobet is a combination drug, the frequency of side effects reported is less than would be expected if using each compound on its own: for example, the anti-inflammatory action of the corticosteroid (betamethasone dipropionate) minimizes the irritation often reported when using calcipotriol alone... | Read more ...

COST OF TREATMENT
It is probably the single most effective topical therapy available for psoriasis, so patients are generally prepared to pay for this. It is somewhat more expensive than the equivalent potent topical steroid, but the rapid and significant improvement in quality of life... | Read more ...

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