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A maintenance protocol for psoriasis plaques cleared by the 308 nm excimer laser.

Abstract

OBJECTIVE

Using the 308 nm excimer laser, to evaluate the effectiveness of tapering the dose frequency on maintaining the clearance of psoriasis plaques after at least 75% clearance of a target plaque was achieved.

METHODS

This prospective case series, conducted at a university-based dermatology practice, enrolled five adults with stable, mild-to-moderate plaque-type psoriasis vulgaris. Patients received 308 nm UVB doses to affected areas. Initial dosing was based on multiples of a pre-determined minimal erythema dose (MED). Delivered fluences were 100, 150, 200, 250, 300 and 350 mJ/cm(2), corresponding to MED levels of 1 through 6. Subsequent doses were based on response to treatment. Induction treatments were scheduled biweekly for a total of 15 treatments. After improvement of disease, tapering began as follows: one treatment per week for 4 weeks, one treatment every other week for 4 weeks, and one final treatment 4 weeks later for a total of seven treatments. The main outcome measure was maintenance of disease improvement as determined by the Psoriasis Area and Severity Index (PASI) score and percentage improvement of target lesion and total body disease during and after the laser therapy taper. A flare was defined as a 25% worsening of the percentage improvement.

RESULTS

All five patients completed the protocol. All patients achieved > or = 75% clearance of target plaques. No flares were noted upon completing the first month of the taper in any patient, either per percentage improvement or per PASI scores. One month after the second month of the taper (total of six treatments), no flares were noted and four out of five patients had no flares per PASI scores. No patients, either at the end of induction or at any interval during the taper, met the definition of a 50% rebound of PASI scores. Adverse effects included erythema, blisters, hyperpigmentation and erosions. All were well tolerated.

CONCLUSION

Our results reaffirm that biweekly UVB laser treatments promote clearance of psoriatic plaques. A tapering of laser treatments may be beneficial in maintaining the level of plaque clearance obtained from biweekly laser treatments. Randomized, prospective trials are needed to establish laser therapy protocols for maintaining the plaque clearance achieved with the 308 nm excimer laser.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.

    ,

    Source

    MeSH

    Adult
    Aged
    Female
    Humans
    Male
    Middle Aged
    Prospective Studies
    Psoriasis
    Radiation Dosage
    Severity of Illness Index
    Treatment Outcome
    Ultraviolet Therapy

    Pub Type(s)

    Evaluation Studies
    Journal Article

    Language

    eng

    PubMed ID

    15204159

    Citation

    Housman, T Salam, et al. "A Maintenance Protocol for Psoriasis Plaques Cleared By the 308 Nm Excimer Laser." The Journal of Dermatological Treatment, vol. 15, no. 2, 2004, pp. 94-7.
    Housman TS, Pearce DJ, Feldman SR. A maintenance protocol for psoriasis plaques cleared by the 308 nm excimer laser. J Dermatolog Treat. 2004;15(2):94-7.
    Housman, T. S., Pearce, D. J., & Feldman, S. R. (2004). A maintenance protocol for psoriasis plaques cleared by the 308 nm excimer laser. The Journal of Dermatological Treatment, 15(2), pp. 94-7.
    Housman TS, Pearce DJ, Feldman SR. A Maintenance Protocol for Psoriasis Plaques Cleared By the 308 Nm Excimer Laser. J Dermatolog Treat. 2004;15(2):94-7. PubMed PMID: 15204159.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - A maintenance protocol for psoriasis plaques cleared by the 308 nm excimer laser. AU - Housman,T Salam, AU - Pearce,D J, AU - Feldman,S R, PY - 2004/6/19/pubmed PY - 2004/7/30/medline PY - 2004/6/19/entrez SP - 94 EP - 7 JF - The Journal of dermatological treatment JO - J Dermatolog Treat VL - 15 IS - 2 N2 - OBJECTIVE: Using the 308 nm excimer laser, to evaluate the effectiveness of tapering the dose frequency on maintaining the clearance of psoriasis plaques after at least 75% clearance of a target plaque was achieved. METHODS: This prospective case series, conducted at a university-based dermatology practice, enrolled five adults with stable, mild-to-moderate plaque-type psoriasis vulgaris. Patients received 308 nm UVB doses to affected areas. Initial dosing was based on multiples of a pre-determined minimal erythema dose (MED). Delivered fluences were 100, 150, 200, 250, 300 and 350 mJ/cm(2), corresponding to MED levels of 1 through 6. Subsequent doses were based on response to treatment. Induction treatments were scheduled biweekly for a total of 15 treatments. After improvement of disease, tapering began as follows: one treatment per week for 4 weeks, one treatment every other week for 4 weeks, and one final treatment 4 weeks later for a total of seven treatments. The main outcome measure was maintenance of disease improvement as determined by the Psoriasis Area and Severity Index (PASI) score and percentage improvement of target lesion and total body disease during and after the laser therapy taper. A flare was defined as a 25% worsening of the percentage improvement. RESULTS: All five patients completed the protocol. All patients achieved > or = 75% clearance of target plaques. No flares were noted upon completing the first month of the taper in any patient, either per percentage improvement or per PASI scores. One month after the second month of the taper (total of six treatments), no flares were noted and four out of five patients had no flares per PASI scores. No patients, either at the end of induction or at any interval during the taper, met the definition of a 50% rebound of PASI scores. Adverse effects included erythema, blisters, hyperpigmentation and erosions. All were well tolerated. CONCLUSION: Our results reaffirm that biweekly UVB laser treatments promote clearance of psoriatic plaques. A tapering of laser treatments may be beneficial in maintaining the level of plaque clearance obtained from biweekly laser treatments. Randomized, prospective trials are needed to establish laser therapy protocols for maintaining the plaque clearance achieved with the 308 nm excimer laser. SN - 0954-6634 UR - https://www.unboundmedicine.com/medline/citation/15204159/A_maintenance_protocol_for_psoriasis_plaques_cleared_by_the_308_nm_excimer_laser_ L2 - http://www.tandfonline.com/doi/full/10.1080/09546630310021947 DB - PRIME DP - Unbound Medicine ER -