Localized Psoriasis Research Articles

308-nm excimer laser versus nontargeted phototherapy for localized psoriasis: A review

308-nm excimer laser versus nontargeted phototherapy for localized psoriasis: A review

Targeted phototherapy of plaque-type psoriasis using ultraviolet B-light-emitting diodes

One of the major technological breakthroughs in the last decade is represented by the diversified medical applications of light-emitting diodes (LEDs). LEDs emitting in the ultraviolet (UV) B spectrum might serve as a more convenient alternative for targeted delivery of phototherapy in inflammatory skin diseases such as psoriasis. We investigated the efficacy and safety of a new UVB-LED phototherapeutic device in chronic plaque-type psoriasis. Twenty patients with stable plaque-type psoriasis were enrolled into a prospective, right-left comparative, open study. Symmetrical lesions located on extremities or trunk were chosen; one lesion was treated with the study device, whereas the other lesion served as an untreated control. Two treatment regimens were used in the study, one with an aggressive dose escalation similar to those used for outpatient treatment and one with slow increase in dose, similar to those used for treatment at home. Patients in both groups responded rapidly to the UVB-LED therapy. Early disease resolution was observed in 11 patients (seven in the first group and four in the second group). Overall improvement at end of therapy was 93% in the high-dose group and 84% in the low-dose group. Four patients from the high-dose group and five from the low-dose group were still in remission at the 6-month follow-up visit. These results suggest that this innovative UVB-LED device is effective in the treatment of localized psoriasis and may be useful in other UV-responsive skin diseases.

LCD solution extends the clinical benefit of acute clobetasol propionate treatment in moderate to severe localized psoriasis: Results from a pilot study

LCD solution extends the clinical benefit of acute clobetasol propionate treatment in moderate to severe localized psoriasis: Results from a pilot study

Juvenile localized annular pustular psoriasis developing severe exacerbation after topical indomethacin application

Juvenile localized annular pustular psoriasis developing severe exacerbation after topical indomethacin application

308 nm excimer laser in the treatment of psoriasis

It has been shown that the 308nm excimer laser iS markedly effective for the treatment of psoriasis with long-term remission,and is particularly effective for localized psoriasis via targeting on local lesions.Clinical trials are schemed either by psoriasis area and severity index(PASI)score or by the skin types of patients.The efficacy iS evaluated on the basis of PASI changes as well as medical record of patients.The review mainly summarizes the mechanism,clinical application,clinical trial scheme and efficacy evaluation of 308nm excimer laser in the treatment of psoriasis. Key words: Psoriasis; Excimer laser; Treatment outeome

Topical 8‐methoxypsoralen enhances the therapeutic results of targeted narrowband ultraviolet B phototherapy for plaque‐type psoriasis

Targeted broadband ultraviolet B (UVB) phototherapy as well as 308-nm excimer laser have been reported to significantly improve or clear localized psoriatic plaques within 5 to 10 treatments when medium fluences [i.e. 4-6 multiples of minimal erythema doses (MED)] were used. Our study was conducted to determine the effects of different concentrations of topical 8-methoxypsoralen (8-MOP) cream when used in combination with targeted UV phototherapy with regard to number of treatments and cumulative UV doses to clear localized psoriasis. Ten evaluable patients with stable plaque-type psoriasis completed the study. Three different concentrations of 8-MOP creams (0.001%, 0.01% and 0.1%) were applied prior to irradiation with 4 MEDs of targeted narrowband UVB (NB-UVB), whereas 0.001% 8-MOP cream was used in conjunction with 5 J/cm(2) UVA. All irradiations took place once weekly for 12 weeks. Psoriasis severity index (PSI) score was used to evaluate the efficacy of the treatment. With area-under-the-curve analysis, 0.1% 8-MOP/NB-UVB was superior to other modalities in reducing the PSI scores. The number of treatments and cumulative NB-UVB doses necessary to achieve PSI-95, a 95% reduction in the scores, was also lower in the 0.1% 8-MOP/NB-UVB group, although the differences were not statistically significant. We conclude that topical 8-MOP cream enhances the therapeutic effects of targeted NB-UVB phototherapy without significantly increasing the short-term adverse effects.

Treatment of localized persistent plaque psoriasis with 308 nm monochromatic excimer light (308 nm MEL) and a new formulation of an occlusive dressing containing betamethasone valerate 0.1%

Treatment of localized persistent plaque psoriasis with 308 nm monochromatic excimer light (308 nm MEL) and a new formulation of an occlusive dressing containing betamethasone valerate 0.1%

Niosomal methotrexate gel in the treatment of localized psoriasis: Phase I and phase II studies

Efficacy of topical methotrexate in psoriasis is limited by its penetration. The study involved the preparation of niosomal methotrexate in chitosan gel and to test the same for irritation and sensitization on healthy human volunteers followed by assessing the efficacy of the gel through double-blind placebo-controlled study on psoriasis patients and also comparing its efficacy with a marketed methotrexate gel. The methotrexate niosomes were prepared by lipid layer hydration method. The characterized niosomes were incorporated in chitosan gel. The gels were tested on 10 human volunteers to check for irritation and skin sensitivity by human repeated insult patch test (HRIPT). The formulations were assessed for efficacy by double-blind placebo-controlled study in 10 psoriasis patients for each formulation. The efficacy was calculated by psoriasis area and severity index scoring method. The global score was used to assess the progress of the disease. The HRIPT test did not produce any significant irritation or sensitization on healthy human volunteers. The placebo and marketed gels were compared with niosomal methotrexate gel. At Week 12, with niosomal methotrexate gel, there was reduction in total score from 6.2378+/-1.4857 to 2.0023+/-0.1371. These results suggest that niosomal methotrexate gel is more efficacious than placebo and marketed methotrexate gel.

8‐methoxypsoralen cream plus targeted narrowband ultraviolet B for psoriasis

Targeted ultraviolet (UV) phototherapy is a recent addition to the therapeutic armamentarium for the treatment of localized psoriasis. Topical psoralens enhance the therapeutic effects of UV-based treatment for various dermatoses, but have never been used in conjunction with targeted UVB. To compare the efficacy of targeted narrowband UVB phototherapy (NB-UVB) alone with that of the combination of 0.1% 8-methoxypsoralen cream and targeted NB-UVB phototherapy (8-MOP/NB-UVB) for the treatment of plaque-type psoriasis. Two areas within the same lesion of stable psoriasis were randomized to receive either targeted NB-UVB alone or 8-MOP/NB-UVB. Fluences of UVB delivered were held constant at four minimal erythema doses. The treatments were continued until lesions cleared or 12 treatments. Follow-ups were done until lesional scores returned to 50% of the baseline values. Ten patients completed this study. Four lesions were cleared by 8-MOP/NB-UVB while three were cleared by NB-UVB alone. The improvement in disease activity as reflected by psoriasis severity index score during treatment was statistically significantly better in the combination group (P=0.005). Mean remission time of lesions which were cleared by 8-MOP/NB-UVB was 8 weeks while that for lesions that were cleared by NB-UVB alone was 4.67 weeks. We concluded that addition of 0.1% 8-MOP cream to targeted narrowband UVB significantly enhances the therapeutic effects of the light treatment without increasing the incidence of adverse effects.

New topical immunological treatments for psoriasis

AbstractTopical treatments for psoriasis have been used for a very long time. They were designed to reduce epidermal proliferation and hyperkeratosis. Recent pathophysiological data have led to the use of many immunological therapies, initially systemically in severe forms and, in recent years, topically. Calcineurin inhibitors are now a well‐established treatment for atopic dermatitis and have also been evaluated in psoriasis. The first trials of tacrolimus (Protopic®, Astellas) and pimecrolimus (Elidel®, Novartis) failed to demonstrate any positive results on plaque‐type psoriasis, but several studies showed a definite efficacy on facial and intertriginous psoriasis. Calcineurin inhibitors do not induce skin atrophy and are therefore particularly useful in sites in which the skin is thinner (face, intertriginous areas). A third substance, sirolimus (Rapamune®, Wyeth), has recently been tested topically in psoriasis. A recent study demonstrated that topical sirolimus crosses the cutaneous barrier and is effective on psoriasis lesions. These studies therefore show an indisputable efficacy of calcineurin inhibitors and sirolimus in the treatment of localized psoriasis. The major advantage is the absence of skin atrophy. However, large‐scale efficacy and safety studies must be conducted in this indication.

Targeted UV-B Phototherapy for Plaque-type Psoriasis

To determine whether targeted UV-B phototherapy is efficacious and safe in the treatment of localized psoriasis and whether there is a dose-response relationship. Randomized, evaluator-blind, controlled study. Dermatology clinic in a large university-based hospital in Bangkok, Thailand. Fourteen patients with stable, localized, plaque-type psoriasis. Patients were randomized to receive different fluences of targeted UV-B phototherapy 3 times weekly based on predetermined minimal erythema doses (MEDs). Treatment fluences were constant throughout the study period of 4 weeks. Follow-up was carried out until lesions returned to original state. Modified psoriasis area and severity index. All fluences of UV-B produced some clinical improvement and were very well tolerated. Fluences ranging from 1 to 6 multiples of MEDs resulted in clearance of lesions in some patients with 6 MEDs producing clearance in 77% of patients. The number of treatments required to clear psoriatic lesions when 2 to 6 MEDs were used was 5.0 to 6.1 treatments. The only adverse events observed were erythema, which was asymptomatic in most subjects, and hyperpigmentation. Incoherent, targeted UV-B phototherapy is a safe and efficacious treatment modality for localized psoriasis. Its value in other UV-B responsive conditions should be further investigated.

Comparison of the Efficacy and Safety of the 308 nm Excimer Laser for the Treatment of Localized Psoriasis in Adults and in Children: A Pilot Study

The 308-nm excimer laser has been shown to be safe and efficacious in the treatment of localized mild-to-moderate plaque-type psoriasis in adults. However, the laser's safety and efficacy has not yet been demonstrated in children. Four of seven children with a mean age of 11.0 years and 12 of 18 adults with a mean age of 48.8 years completed the full protocol. The most common reason for incompletion was noncompliance unrelated to side effects. Both the children (p=0.0200) and the adult groups (p=0.0009) yielded a significant decrease in psoriatic severity scores of their respective target lesions. The children group had a greater reduction (p=0.008) from a mean baseline target (PSS) of 5.75+/-1.71 to final of 0.50+/-0.58 (91.3% reduction) as compared to the adult treatment group from a mean baseline psoriatic severity score of 5.00+/-1.15 to final of 1.92+/-1.11 (61.6% reduction). However, there was no statistical difference between the mean total treatments required to achieve this result (p=0.112). Side effects were common, albeit minor and well tolerated. In conclusion, the 308 nm excimer laser appears to be a safe and effective treatment for localized psoriasis in children as well as in adults.

A multicenter study of calcipotriene ointment 0.005% and clobetasol propionate foam 0.05% in the sequential treatment of localized plaque-type psoriasis

A multicenter study of calcipotriene ointment 0.005% and clobetasol propionate foam 0.05% in the sequential treatment of localized plaque-type psoriasis

Topical aminolaevulinic acid-based photodynamic therapy as a treatment option for psoriasis? Results of a randomized, observer-blinded study

Topical aminolaevulinic acid-based photodynamic therapy (ALA-PDT) has recently been tried in small open studies for several inflammatory dermatoses including psoriasis. The purpose of this randomized, within patient comparison study was to investigate whether topical ALA-based PDT using a range of light doses can induce a satisfactory response in localized psoriasis. Twenty-nine patients with chronic plaque type psoriasis were enrolled in the study. After keratolytic pretreatment three psoriatic plaques in each patient were randomly allocated to PDT with 1% ALA and a light dose of 5 J cm(-2), 10 J cm(-2) or 20 J cm(-2), respectively. Treatment was performed twice weekly until complete clearance or for a maximum of 12 irradiations. As a measure of clinical response the psoriasis severity index (PSI) of the three target plaques was assessed separately by an observer blinded to the treatment at baseline, before each PDT treatment and 3-4 days after the last irradiation. Eight patients withdrew prematurely from the study. Keratolytic pretreatment alone reduced the baseline PSI in all three dose groups by about 25%. Subsequent PDT with 20 J cm(-2) resulted in a final reduction of PSI by 59%, PDT with the lower doses of 10 J cm(-2) and 5 J cm(-2) decreased the baseline PSI by 46% and 49%, respectively. The difference in clinical efficacy between 20 J cm(-2) and 10 J cm(-2) or 5 J cm(-2) was statistically significant (P = 0.003; P = 0.02), whereas no difference was found between 10 J cm(-2) and 5 J cm(-2) (P = 0.4). All patients reported some degree of PDT-induced stinging or burning during irradiation. The unsatisfactory clinical response and frequent occurrence of pain during and after irradiation renders topical ALA-based PDT an inadequate treatment option for psoriasis.

Non-laser targeted UV treatment for localized psoriasis

Non-laser targeted UV treatment for localized psoriasis

Photometric and clinical assessment of localized UVB phototherapy systems for the high‐dosage treatment of stable plaque psoriasis

BACKGROUND: Ultraviolet‐B (UVB) light sources are widely used for the safe and effective treatment of inflammatory skin conditions. The recent commercial introduction of fiber‐coupled UVB phototherapy systems facilitates the selective exposure and treatment of localized psoriasis plaques while permitting the safe use of high‐dosage treatments.OBJECTIVE: In this study, the performance characteristics and clinical outcome of psoriasis treatments were assessed when using two technologically distinct sources of high‐intensity, fiber‐optically delivered therapeutic UVB.METHODS: A pulsed, monochromatic 308 nm excimer laser and a continuous‐wave, incoherent UVB light source were compared using photosensitive recording papers, images captured with a CCD camera, and on the healthy and lesional skin of ten psoriasis patients.RESULTS: Beam profile analyses and minimal erythema dose (MED) test spots revealed distinct energy distribution patterns from the two devices. The Guassian‐type laser beam energy distribution complicated MED determinations, whereas skin exposed to light from the incoherent UVB system developed a more uniform erythema. Both systems cleared the treated psoriasis plaques equivalently, requiring no more than two to five weeks of high‐dose treatments.CONCLUSION: When used at equally erythemogenic high doses, both systems produced rapid plaque clearance with minimal side effects. Unlike conventional phototherapy, localized UVB minimizes exposure to the healthy skin, making it suitable for patients with mild to moderate psoriasis, individuals with recalcitrant plaques and for the successful treatment of lesions occurring on most body sites.

Psoriasis and Pregnancy

Background:Women comprise half of all psoriasis patients and because the majority of psoriasis cases present before age 40 the disease affects women who may become pregnant. Information regarding the heritability of psoriasis can be used in counseling patients who inquire about the potential risk to their children. Patients with psoriasis who become pregnant will likely notice an associated improvement of their symptoms if any change is noted at all.Objective:Because of potential fetal effects, the treatment of chronic psoriasis in pregnancy involves prudent consideration of whether the severity of the disease warrants treatment and selection of the safest treatments available.Conclusion:Topical corticosteroids and topical calcipotriene as well as topical anthralin and topical tacrolimus appear to be safe choices for control of localized psoriasis in pregnancy. UVB is the safest treatment for extensive psoriasis during pregnancy, particularly when topical application of other agents is not practical. Short-term use of cyclosporine during pregnancy is probably the safest option for management of severe psoriasis that has not responded to topical or UVB treatment.

Psoriasis and pregnancy.

Women comprise half of all psoriasis patients and because the majority of psoriasis cases present before age 40 the disease affects women who may become pregnant. Information regarding the heritability of psoriasis can be used in counseling patients who inquire about the potential risk to their children. Patients with psoriasis who become pregnant will likely notice an associated improvement of their symptoms if any change is noted at all. Because of potential fetal effects, the treatment of chronic psoriasis in pregnancy involves prudent consideration of whether the severity of the disease warrants treatment and selection of the safest treatments available. Topical corticosteroids and topical calcipotriene as well as topical anthralin and topical tacrolimus appear to be safe choices for control of localized psoriasis in pregnancy. UVB is the safest treatment for extensive psoriasis during pregnancy, particularly when topical application of other agents is not practical. Short-term use of cyclosporine during pregnancy is probably the safest option for management of severe psoriasis that has not responded to topical or UVB treatment.

Follow-up survey of 308-nm laser treatment of psoriasis.

UVB treatment with a 308-nm excimer laser is a new treatment modality for localized psoriasis. The purpose of this study is to assess patients' impressions and satisfaction with 308-nm laser treatment of mild to moderate psoriasis. Telephone survey data were obtained from patients after participation in a case series study of 124 patients with mild to moderate psoriasis treated with 308-nm UVB laser treatment for a target plaque and other lesions. The survey included information on changes in the target plaque, remission time, changes in other areas of psoriasis, satisfaction with the result, side effects of treatment, and efficacy relative to other treatments. Patients (55% of total) reported overall satisfaction with the treatments, and 63% of patients thought they needed additional laser treatments, including for maintenance. Subjects (25%) reported that the laser treatments were better than any other treatment they had tried. Adverse effects were mild and had either disappeared or were significantly decreased in 86% of patients. Self reported length of remission compared favorably to those for other therapies for localized disease. UVB laser treatments provide a well-tolerated means to clear psoriasis plaques. The treatment provides a high level of patient satisfaction.

022 308 excimer laser treatment of psoriasis

The excimer 308 nm laser has recently been FDA‐approved in the United States for the treatment of psoriasis. Our center was the first to study this device systematically for this indication. Investigations to date have included an initial dose‐response study, a high‐dose as well as a medium‐dose one. Collectively, these results were analyzed and remission periods were reviewed. The rapidity of clearing as well as the severity of side‐effects showed a clear dose‐response relationship. Even thick plaques responded. The treatment process itself is quick and painless, allowing the operator to cover a palm‐sized area in just a minute. The laser is easy to use and there are no disfiguring purpura. By selectively focusing on lesional skin, overall cutaneous ultraviolet burden is minimized. Localized tanning is another side‐effect to be anticipated. Obviously, blistering doses show limited applicability as the sole treatment for extensive disease. Moreover, the long‐term risks associated with blistering directly on plaques of psoriasis themselves, while not clearly established, seem unlikely to be favorable. On the other hand, sub‐blistering doses appear to be extremely well‐tolerated. Wound care, except in the cases of blistering doses, is minimal. In short, the 308 nm excimer laser offers a novel targeted treatment modality for localized psoriasis, even when the plaques are quite thick.