Comparative study of therapeutic efficacy of PUVA, NBUVB and PUVASOL in the treatment of chronic plaque type psoriasis

Akila, R (2013) Comparative study of therapeutic efficacy of PUVA, NBUVB and PUVASOL in the treatment of chronic plaque type psoriasis. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Psoriasis is a common, immunologically mediated inflammatory dermatosis with genetic predisposition, characterized by erythematous scaly plaques involving the scalp and extensors of limbs affecting 0.5 to 1.5% individual’s worldwide. Psoriasis evokes considerable physical, psychological and social morbidity among the affected individuals. This common dermatosis is extremely variable in clinical manifestations by morphology and extent of involvement, ranging from innocuous lesion to widespread life threatening pustular and erythrodermic forms. It can affect any area including palms, soles and genitalia. Several treatment modalities are currently available and many guidelines have been formulated all over the world. The treatment is mainly suppressive aimed at inducing remissions and improving the patient’s quality of life. The treatment is also depends on the patient’s own perceptions of disability occurring due to the disease. Routinely for limited plaque psoriasis coal tar, topical corticosteroids, dithranol, calcipotriol and topical photochemotherapy are administered. For extensive psoriasis UVB, PUVA, PUVASOL, methotrexate, hydroxyurea, acitretin and cyclosporine are preferred. Disease modifying agents such as etanercept, infliximab and other biological may be required in resistant cases. This study was designed to compare the therapeutic efficacy of PUVA, PUVASOL and NBUVB in the treatment of chronic plaque type psoriasis involving more than 20% body surface area. AIM OF THE STUDY: Aim of the study is to evaluate the therapeutic efficacy of: 1. PUVA (Psoralen ultraviolet A therapy), 2. NBUVB (Narrow band ultraviolet B therapy), 3. PUVASOL (Psoralen ultraviolet A solar therapy), in patients with chronic plaque type of psoriasis involving more than 20% of body surface area. MATERIALS AND METHODS: Sixty patients of chronic plaque type psoriasis who attended the psoriasis outpatient clinic at the Department of Dermatology, Rajiv Gandhi Government General Hospital, Chennai were randomly selected from August 2010 to September 2012. The diagnosis of psoriasis was made clinically by morphology of lesions and Auspitz sign. Study Design: Prospective study. Inclusion Criteria: P atients with chronic plaque type of psoriasis involving more than 20% of body surface area. Exclusion Criteria: 1. Photosensitive disorders or history of photo damage. 2. Pregnant and Lactating women. 3. Children < 12 years of age. 4. Previous or family history of malignant melanoma. 5. H/O exposure to inorganic arsenic or ionizing radiation. 6. Women contemplating conception. 7. Pustular, erythrodermic psoriatic patients. All patients were explained about the disease, benefits and side effects of the treatment were discussed with them. Informal written consent was obtained from all patients before initiation of treatment. CONCLUSION: • PUVA therapy is an effective modality of treatment in chronic plaque type psoriasis. • NBUVB therapy has equal efficacy to PUVA therapy in our study. • The mean cumulative dose is almost equal for both PUVA and NBUVB therapy. • However the mean number of exposure is less for PUVA group when compared to NBUVB group. • When PUVA and NBUVB are compared there is no statistically significant difference in mean PASI score reduction at 16 weeks. The percentage of reduction of mean PASI at 16 weeks in PUVA group is 98.9% and in NBUVB group is 97.9%. So both are almost equally effective. But when duration of treatment is taken into account PUVA therapy scores over the NBUVB therapy. • When PUVA and NBUVB therapy are compared with PUVASOL the rate of clearance of lesions in later group is poor. • All the side effects noted in our study were minor and they were treated conservatively. • In conclusion our study has shown that both PUVA and NBUVB groups achieved >75% or complete clearance at end of 16 weeks when compared to PUVASOL group. But PUVA group achieved faster clearance with less number of exposures as compared to NBUVB group.

Item Type: Thesis (Masters)
Uncontrolled Keywords: therapeutic efficacy ; Psoralen Ultra Violet A (PUVA) ; Narrow Band Ultra Violet B (NBUVB) ; Psoralen Ultra Violet Solar Therapy (PUVASOL) ; chronic plaque type psoriasis ; Comparative study.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Punitha K
Date Deposited: 21 Jun 2018 14:22
Last Modified: 23 Jun 2018 02:05

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