This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (3)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Randomized Controlled Trial  • Prognosis/ Outcomes  • Psoriasis  • Phototherapy  • Alert me on articles by topic

A Randomized Controlled Trial

Ralf Schiener, MD; Thomas Brockow, MD; Annegret Franke, PhD; Bernd Salzer, MD; Ralf U. Peter, MD; Karl L. Resch, MD

Arch Dermatol. 2007;143(5):586-596.

Objective  To evaluate the efficacy of psoralens dissolved in a warm-water bath followed by exposure to UV-A irradiation (bath PUVA) or saltwater phototherapy (SW UV-B) compared with tap-water phototherapy (TW UV-B) or UV-B irradiation alone in psoriasis.

Design  Multisite, prospective, randomized, controlled trial with 4 parallel groups.

Setting  Total of 102 dermatologic outpatient clinics.

Patients  Total of 1241 patients with stable psoriasis vulgaris and a Psoriasis Area and Severity Index score of 7 or greater.

Interventions  Four-times-weekly UV-B, TW UV-B, SW UV-B, or bath-PUVA with baths preceding UV irradiation over a maximum of 8 weeks. The UV dose was adapted to erythemal response.

Main Outcome Measures  Incidence of therapeutic success, defined as a reduction of the Psoriasis Area and Severity Index or affected body surface area of 50% or more.

Results  Patients who received TW UV-B had a significantly higher incidence of therapeutic success than did patients treated with UV-B alone (60.7% vs 43.3%; P<.001; number needed to treat, 5.8; 95% confidence interval [CI], 3.9-10.9). Patients who received SW UV-B or bath PUVA had a significantly higher incidence of therapeutic success than did patients treated with TW UV-B (74.9% vs 60.7%; P<.001; number needed to treat, 7.0; 95% CI, 4.6-14.9; and 78.4% vs 60.7%; P<.001; number needed to treat, 5.7; 95% CI, 4.0-9.7, respectively). Bath PUVA was not superior to SW UV-B (78.4% vs 74.9%; P = .34).

Conclusion  Bath PUVA and SW UV-B are comparably effective treatments in psoriasis and superior to UV-B and TW UV-B.

Author Affiliations: Department of Dermatology, University of Ulm, Ulm, Germany (Drs Schiener and Peter); Spa Medicine Research Institute, Bad Elster, Germany (Drs Brockow, Franke, and Resch); and Dermatologic Outpatient Clinic Dr Salzer and Dr Arnold, Heilbronn, Germany (Dr Salzer). Dr Schiener is now with the Dermatologic Outpatient Clinic Dr Schiener, Würzburg, Germany. Dr Peter is now with the Hospital and Clinic for Vascular Surgery and Dermatology, Ulm-Blaustein, Germany.

RELATED ARTICLE

Balneophototherapy for Psoriasis Using Saltwater Baths and UV-B Irradiation, Revisited
Thilo Gambichler
Arch Dermatol. 2007;143(5):647-649.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Balneophototherapy for Psoriasis Using Saltwater Baths and UV-B Irradiation, Revisited
Gambichler
Arch Dermatol 2007;143:647-649.
FULL TEXT