308nm excimer laser phototherapy of psoriasis: Monotherapy versus combination with Calcipotriol therapy

Abstract

Abstract Objective Aim of the present investigation was to prove whether a combination therapy using 308 nm excimer laser phototherapy and topical Calcipotriol application is more effective than a monotherapy to treat stable plaque psoriasis. Material and methods In a one center open trial, 36 patients (21 men, 15 women) with stable, moderate to severe, plaque-type psoriasis vulgaris received 308 nm UVB dose of 200–1200 mJ/cm 2 to affected areas, delivered by an 308 nm XTRAC™ XeCl excimer laser (PhotoMedex, Radnor, PA, USA). One side of either, back, leg or arm was additionally treated with Calcipotriol ointment twice daily, starting 0–7 days before the treatment with the 308 nm laser. The other side was treated with the 308 nm laser and Vaseline only. To evaluate the efficiency of both therapy concepts, a modified Psoriasis Area and Severity Index (PASI) score was calculated, which was initially found to be 31 per side on average. Results Clearing of infiltration, erythema and scales was achieved at 25% after 2 sessions for the excimer laser treated side without Calcipotriol, and 40% in the Calcipotriol plus excimer laser treated side. Discussion With the 308 nm excimer laser (FDA approved), higher doses of UVB can be administered to the psoriatic plaques while sparing the non-affected skin. Plaques clear faster in fewer sessions at a lower cumulative dose. The combination of 308 nm excimer laser phototherapy with Calcipotriol improves the reduction of infiltration and scales of psoriatic plaques considerably. Compared to narrow-band UVB monotherapy, the narrow-band UVB plus Calcipotriol treatment needed fewer sessions of excimer laser treatment, fewer days to achieve a reduction of the PASI parameter and a lower cumulative dosage.