RESUMO
Patients with psoriasis typically face longterm therapy for their chronic disease. Often, the therapeutic agents that physicians use to treat them may become less effective or may cause safety or toxicity issues. The clinician must then decide the next therapy for his/her patient and assess benefit/risk of the next therapeutic agent or combination. In moving the patient from one therapy to the next, specific characteristics of the transition must be assessed, and how to stop the existing therapy, and introduce the new agent(s). The decision making process must take into account the longterm risks to the patient. This article focuses on the transition for patients with psoriasis being managed with methotrexate and cyclosporine to retinoids, phototherapy, and newer agents.
Assuntos
Psoríase/terapia , Acitretina/uso terapêutico , Ciclosporina/uso terapêutico , Quimioterapia Combinada , Etretinato/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Ceratolíticos/uso terapêutico , Metotrexato/uso terapêutico , Fototerapia/métodos , Proteínas Recombinantes de Fusão/uso terapêutico , Resultado do TratamentoRESUMO
BACKGROUND: In this retrospective analysis the effect of narrowband ultraviolet B treatment in combination with acitretin is reviewed in 40 patients with plaque psoriasis. Narrowband UVB is highly effective for plaque psoriasis, but requires multiple phototherapy treatments, making patient compliance problematic. Oral acitretin is moderately effective as monotherapy, but when combined with ultraviolet B or PUVA, its use has reduced the number of treatments required for clearing, and has resulted in clearing of patients otherwise refractory to these phototherapeutic modalities. There is only sparse data on the combination of acitretin with narrowband UVB. We therefore analyzed data on 40 patients treated with this combination. RESULTS: The majority of patients treated had psoriasis that was refractory to treatment with broadband ultraviolet B, monotherapy with narrowband UVB, monotherapy with acitretin, or the combination of acitretin and broadband UVB. In this difficult-to-treat group of patients, the combination of low dose acitretin (25 mg po daily) and narrowband UVB three times per week resulted in greater than 75% improvement in 29 (72.5%) patients. Only 5 (12.5%) patients had less than 50% improvement. The combination was well tolerated and associated with typical retinoid and narrowband UVB side effects including elevation of serum lipids, burn and cheilitis. CONCLUSION: The combination of acitretin with narrowband UVB results in faster improvement even in more difficult-to-treat patients. In combination the treatments appear to have synergistic effects.