Clinical management of psoriasis: principles and practice.

A chronic condition that compromises many patients' quality of life, psoriasis is treatable with a range of agents, either alone or in combination. Clinical management strategies using these therapies can be organized as a stepped-care approach. For mild disease, corticosteroids and other topical therapies (step 1) are often appropriate. When lesions are more pronounced or extensive, phototherapy (step 2) is often the treatment of choice, and topical treatments or the step 3 agent acitretin can be added to enhance or accelerate therapeutic responses. Step 3 agents, which also include cyclosporine and methotrexate, may be contemplated when psoriasis is moderate or severe. Acitretin may cause acute adverse effects, including mucocutaneous effects, which can be avoided by reducing dosage. Methotrexate treatment can lead to bone marrow suppression and hepatotoxicity, and cyclosporine can cause nephrotoxicity. The clinical uses of these agents are illustrated in part through case presentations drawn from the authors' practices, and the supportive role of the National Psoriasis Foundation is reviewed.

Narrow-band UVB: a practical approach.

Narrow-band UVB therapy offers a new and exciting treatment option and area of study in phototherapy. The narrow-band skin type protocol offers a safe and effective treatment plan for those who do not routinely use, or wish to use, minimal erythema dosing to establish starting doses for narrow-band UVB therapy.

UVB therapy: dermatology nursing considerations.

Each patient responds uniquely to phototherapy treatment. Not every patient can tolerate daily treatment. Different areas of the body require different amounts of light in order to clear. Precise documentation of erythema is important for both treatment and legal reasons. A negative response to UVB therapy can be from either ineffective treatment or an adverse reaction to UVB.

Psoralen photochemotherapy.

Psoralens and sunlight have been used by the Egyptians and Indians for hundreds of years for treating vitiligo. The combination of oral psoralens and artificial ultraviolet A (PUVA) therapy was approved for managing severe psoriasis by the Food and Drug Administration in 1982. Since then, PUVA therapy has been an effective modality for treating many cutaneous conditions (psoriasis, atopic dermatitis, vitiligo, and mycosis fungoides). However, proper knowledge and administration of PUVA therapy are vital to treatment success and reducing side effects.

Staff responsibilities for phototherapy administration.

Caring for the phototherapy patient is a multifaceted role; however, the primary nursing responsibility is quality patient education. The opportunities to implement this responsibility are as endless as the disease itself.

Phototherapy equipment.

Treating patients with phototherapy is like dosing patients with medication. The purpose of this continuing education article is to describe various phototherapy equipment and how to conduct safe and efficacious therapy.

Basic principles of photobiology and photochemistry for nurse phototherapists and phototechnicians.

Phototherapy administration requires a team approach to be safe and effective. Implementing the treatment plan requires the knowledge, skills, and expertise of the entire health care team. Understanding the relationship between natural light, artificial light sources, administration of phototherapy, and the short and long-term consequences of the therapy can enhance the experience for the patient and provide an increase in employment satisfaction for the therapist.

Phototherapy: a nursing overview.

Phototherapy can be administered in several settings, but should only be administered by a knowledgeable, trained individual. This article presents an understanding of what this form of treatment is, to whom it is given, and guidelines for safe, effective administration.