Is it Useful to Calculate Minimal Erythema Dose Before Narrowband UV-B Phototherapy? / ¿Es útil la determinación de la dosis eritematógena mínima previa a la fototerapia ultravioleta B de banda estrecha?

INTRODUCTION AND OBJECTIVES: The starting dose for narrowband UV-B phototherapy is determined by a patient's skin phototype or minimal erythema dose (MED). Calculation of MED identifies patients with unsuspected photosensitivity. The aim of this study was to investigate the influence of factors such as concomitant use of photosensitizing agents, diagnosis, and combination with acitretin in patients with psoriasis on the frequency and severity of adverse effects in patients with a low MED to narrowband UV-B phototherapy. MATERIAL AND METHODS: We undertook a retrospective observational cohort study between February 1, 2009 and March 31, 2015. MED values were classified as normal or low. RESULTS: In total, 302 patients with different skin conditions started narrowband UV-B phototherapy at a dose determined by their MED. No differences were found between patients with a low MED and those with a normal MED for number of drugs taken (P=.071) or use of photosensitizing agents (P=0.806). Following adjustment for age, sex, and phototype, the multivariate analysis showed that psoriasis exerted a protective effect against a low MED (OR=0.31 [95% CI, 0.16-0.58]). No significant risk of erythema or pruritus was detected in patients with a low MED (OR=1.68; 95% CI, 0.91-3.29 and OR=2.04; 95% CI, 0.99-4.22, respectively). CONCLUSIONS: Psoriasis protects against a low MED. Although erythema and pruritus were more common in patients with a low MED, the differences were not significant.

[Therapeutic effectiveness of psoralen-UV-A bath therapy in psoriasis]. / Eficacia terapéutica del baño-PUVA en psoriasis.

INTRODUCTION: The use of psoralen baths with long-wave UV radiation, known as PUVA bath therapy, is useful in the treatment of psoriasis. The therapy is not associated with systemic adverse effects and the dose of UV-A radiation administered is lower. The objectives of this study aimed to identify the variables that influence the effectiveness of PUVA bath therapy and the duration of remission, as well as to determine factors that predict relapse. It also aimed to assess the effectiveness of a protocol using the minimal phototoxic dose and to compare two concentrations of 8-methoxypsoralen. PATIENTS AND METHODS: Two hundred nine patients with moderate-severe plaque psoriasis attended between 1994 and 2000 were included in the study. The characteristics and therapeutic outcomes of the sample were recorded. Survival curves were plotted for the disease-free interval after a good response to treatment. A proportional hazard model was used to assess the factors that influence the duration of remission. RESULTS: Therapeutic outcomes were better in patients with greater photosensitivity (p = 0.03). Application of the minimal phototoxic dose protocol was not associated with greater phototoxicity during treatment. The median duration of remission was 7 months. Those patients who had previously undergone oral PUVA therapy and those who did not achieve a substantial reduction in the psoriasis area and severity index (PASI) score were at greater risk of relapse. CONCLUSIONS: A lower final PASI extended the lesion-free period.

[Consensus document on bath-PUVA therapy. The Spanish Photobiology Group of the Spanish Academy of Dermatology and Venereology]. / Documento de consenso sobre la modalidad terapéutica del baño-PUVA. Grupo Español de Fotobiología de la Academia Española de Dermatología and Venereología.

Bath PUVA is a variant of phototherapy as efficacious as oral PUVA therapy that avoids many of the adverse effects associated to this treatment. Nevertheless, the special features and the specialized equipment required for its employment have limited its application in the dermatologic clinics of our country. Following the trend initiated after the publication of the consensus document on oral PUVA therapy and narrow band (NB) UVB therapy, the Spanish Photobiology Group from the Spanish Academy of Dermatology and Venereology has developed a therapeutic guideline for bath PUVA therapy based on the literature review and the experience of its members. The document aims to be a practical reference guide for those dermatological centres that include phototherapy among their services. It reviews the concept and indications of this type of treatment and proposes recommendations concerning therapeutic procedures, drug associations of interest and prophylaxis and management of adverse effects.

Documento de consenso sobre la modalidad terapéutica del baño-PUVA / Consensus document on bath-PUVA therapy

El baño-PUVA se reconoce como una variante de fototerapia tan eficaz como la terapia PUVA oral, pero que permite evitar buena parte de los efectos adversos asociados a este tratamiento. Sin embargo, las particularidades de su empleo y la necesidad de utillaje especializado han limitado su uso en los centros dermatológicos de nuestro país. En continuidad con la línea iniciada tras la publicación del documento de consenso de la terapia PUVA oral y la terapia UVB de banda estrecha (BE), el Grupo Español de Fotobiología (GEF) de la Academia Española de Dermatología y Venereología (AEDV), ha llevado a cabo la elaboración, a través de la revisión de la literatura al respecto y la experiencia propia de sus miembros, de una guía terapéutica del baño-PUVA. El documento pretende ser una guía práctica de referencia para aquellos centros dermatológicos que incluyan la fototerapia entre sus prestaciones. En él se revisan el concepto y las indicaciones de esta forma de tratamiento y se proponen recomendaciones referidas a los procedimientos terapéuticos, las asociaciones farmacológicas de interés, la prevención y el manejo de los efectos secundarios

Bath PUVA is a variant of phototherapy as efficacious as oral PUVA therapy that avoids many of the adverse effects associated to this treatment. Nevertheless, the special features and the specialized equipment required for its employment have limited its application in the dermatologic clinics of our country. Following the trend initiated after the publication of the consensus document on oral PUVA therapy and narrow band (NB) UVB therapy, the Spanish Photobiology Group from the Spanish Academy of Dermatology and Venereology has developed a therapeutic guideline for bath PUVA therapy based on the literature review and the experience of its members. The document aims to be a practical reference guide for those dermatological centres that include phototherapy among their services. It reviews the concept and indications of this type of treatment and proposes recommendations concerning therapeutic procedures, drug associations of interest and prophylaxis and management of adverse effects