PSORİAZİSLİ HASTALARDA DAR BANT UVB İLE RETİNOİD-DAR BANT UVB TEDAVİLERİNİN KARŞILAŞTIRILMASI

Year 2010, Volume: 11 Issue: 2, 25 - 30, 09.11.2010

Neslihan Sendur Meltem Uslu Osman Tuna Göksun Karaman Ekin Savk

Abstract

AMAÇ:Psoriazis vulgaris, kronik seyirli, inflamatuar bir deri hastalığıdır. Hastalık günlük yaşam kalitesiniolumsuz etkileyebildiğinden, etkin ve hızlı biçimde tedavi edilmesi önemlidir. Kombinasyon tedavileri bu amacahizmet edebilmektedir. Bu çalışmada amacımız psoriazis vulgariste dar bant UVB (dbUVB) ve asitretin-dar bantUVB (re-dbUVB) kombinasyon tedavilerinin etkinliklerinin karşılaştırılmasıdır.GEREÇ ve YÖNTEM:Çalışmaya dbUVB ve asitretin kullanımı için kontrendikasyonu olmayan plak tippsoriazis vulgaris hastaları alındı ve hastalar 4 ay süreyle Psoriazis Alan Şiddet İndeksi (PAŞİ) skorları ve tedaviyan etkileri açısından izlendi.BULGULAR:Çalışmaya 17'si erkek, 5'i kadın 22 hasta dahil edildi. Hastaların yaşları 31 ile 61 arasındadeğişmekte olup yaş ortalaması 45.9±15.7 idi. Hastaların 11'i dbUVB, 11'i re-dbUVB tedavileri aldı. Birinci ve 2.ayda re-dbUVB alan grupta PAŞİ'deki azalma (sırasıyla %83.4 (%34.3-%86.4), %89.3 (%85.3-%96.7)), dbUVBalan grubunkinden %29.6 (%27.0-%74.0) %74.4 (%35.9-%88.8)) anlamlı olarak yüksek bulundu (p=0.006,p=0.033). Ancak 3. ve 4. aylarda re-dbUVB grubunda PAŞİ'deki azalma, dbUVB grubundan anlamlı farklılıkgöstermedi. Çalışmamızda psoriazis vulgariste asitretin-dbUVB kombinasyon tedavisi ile, dbUVB tedavisiylekarşılaştırıldığında 4 ay sonunda tedavi etkinliklerinin farklılık göstermediği, ancak ilk 2 ayda alınan yanıtta redbUVB kombinasyonu ile daha iyi sonuç alındığı saptandı. Asitretin ile eklenen yan etkiler hafifti ve hastalartarafından iyi tolere edildi.SONUÇ:Hızlı yanıta ihtiyaç duyulan plak tip psoriazisli hastalarda, kısa sürede iyi yanıt alınması nedeniyle redbUVB kombinasyon tedavisinin verilmesi, dbUVB'ye tercih edilebilir

Keywords

Asitretin, psoriazis, ultraviyole tedavi

Comparison of Narrow Band UVB and Retinoid Narrow Band UVB Therapies in Patients with Psoriasis

Abstract

OBJECTIVE: Psoriasis vulgaris is a chronic, inflammatory skin disease. Since the disease can worsen the quality of life, it is important to give both effective and also rapid acting therapies. Combination therapies could provide such benefits.Aim of this study was to compare the effectiveness of the narrow band UVB (nbUVB) and acitretin and narrow bandUVBcombination therapies (re-nbUVB) in psoriasis vulgaris. MATERIALS and METHODS: Plaque type psoriasis patients who have no contraindication for nbUVB and acitretin use were included to the study and followed up for 4 months for changes in Psoriasis Area and Severity Index (PASI) scores and side effects. RESULTS: Seventeen men and 5 women, a total of 22 patients were included. Age range was between 31 to 61, mean age was 45.9±15.7. Eleven patients received nbUVB and 11 patients received re-nbUVB combination therapy. In the first and the second months, the decrease in PASI in re-nbUVB group {83.4% (34.3%-86.4%), 89.3% (85.3%-96.7%) respectively}were higher than nbUVB group {29.6% (27.0%-74.0%) , 74.4% (35.9%- 88.8%); p=0.006 and p=0.033}. In the 3rd and the 4th months, decreases in PASI in re-nbUVB group were not significantly different than the nbUVB group. Response to acitretin-nbUVB combination therapy and nbUVB therapy were not different at the end of the 4 months of therapy. On the other hand, in first 2 months, re-nbUVB combination was more effective for decreasing PASI scores. Additional side effects of acitretin were minor and well-tolerated by the patients. CONCLUSION: In patients who were in need of rapid response, re-nbUVB combination therapy may be preferred tonbUVBin order to get good results in a short period of time.

Keywords

Acitretin, psoriasis, ultraviolet therapy

References

• 1. Braun-Falco O, Plewing G, Wolff H.H, Burgdorf H.C. Dermatology. 2nd Edition: Springer-Verlag, Berlin, 2000:585-605.
• 2. Odom RB, James WD, Berger TG. Andrew's diseases of the skin. 9th Edition: W.B. Saunders Company, Philadelphia, 2000:217-35.
• 3. Griffiths C, Camp R, Barker JN. Psoriasis. In: Burns T, Breatnach S, Cox N, Griffiths C, editors. Rook's textbook of dermatology, 7th ed. Blackwell publishing, Turin, 2004: 35.1-35.62.
• 4. Christophers E, Mrowietz U. Epidermis: disorders of persistant inflammation, cell kinetics and differentation. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, Fıtzpatrick TB, editors. Dermatology in general medicine. 5th ed. Mc Graw-Hill Inc, NewYork, 1999:495-521.
• 5. Braun-Falco O, Plewing G, Wolff HH, Burgdorf HC. Dermatology, 2nd Edition: Springer-Verlag, Berlin, 2000:1768-72.
• 6. Nazari Ş, Özarmağan G, Erzengin D, Akar U. Psoriasiste PUVA ve darbant UVB tedavilerinin klinik etkinliklerinin karşılaştırılması. Türkderm 2005;39:103-8.
• 7. Zanolli M. Phototherapy treatment of psoriasis today. J AmAcad Dermatol 2003;49:78-86.
• 8. Hönigsmann H. Phototherapy for psoriasis. Clin Exp Dermatol 2001;26:343-50.
• 9. Berneburg M, Röcken M, Benedix F. Phototherapy with narrowband vs broadband UVB. Acta Derm Venereol 2005;85:98-108.
• 10. Lebwohl M, Menter A, Koo J. Case studies in severe psoriasis: A clinical strategy. J Dermatol Treat 2003;14:26-46.
• 11. Lee SC, Koo J.A review of acitretin, a systemic retinoid for the treatment of psoriasis. Expert Opin Pharmacother 2005;10:1725-34.
• 12. Lowe NJ, Prystowsky JH, Bourget T, Edelstein J, Nychay S, Armstrong R. Acitretin plus UVB therapy for psoriasis. Comparisons with placebo plus UVB and acitretin alone. JAmAcad Dermatol 1991;24:591-4.
• 13. Spuls PI, Rozenblit M, Lebwohl M. Retrospective study of the efficacy of narrow band UVB and acitretin. J Dermatol Treat 2003;14:17-20.
• 14. Lebwohl M, Drake L, Menter A, et al. Consensus conference: acitretin in combination with UVB or PUVA in the treatment of psoriasis. J Am Acad Dermatol 2001;45:544-53.
• 15. Ruzicka T, Sommerburg C, Braun-Falco O, et al. Efficiency of acitretin in combination with UV-B in the treatment of severe psoriasis. Arch Dermatol 1990;126:482-6.
• 16. Iest J, Boer J. Combined treatment of psoriasis with acitretin and UVB phototherapy compared with acitretin alone and UVB alone. Br J Dermatol 1989;120:665-70.
• 17. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb AB, Koo JYM, Lebwohl M, Lim HW, Voorhees ASV, Beutner KR, Bhushan R. Guidelines of care for the management of psoriasis and psoriatic arthritis. J Am Acad Dermatol 2009;61:451-85.
• 18. Halverstam CP, Lebwohl M. Nonstandart and off-label therapies for psoriasis. Clin Dermatol 2008;26:546-53.
• 19. Lebwohl M, Menter A, Koo J, Feldman SR Combination therapy to treat moderate to severe psoriasis. JAmAcad Dermatol 2004;50:416-30.
• 20. Fischer T. UV-light treatment of psoriasis. Acta Derm Venereol 1976;56:473-9.
• 21. Walters IB, Burack LH, Coven TR, Gilleaudeau P, Kruger JG. Suberythematogenic narrow-band UVB phototherapy is markedly more effective than conventional UVB in treatment of psoriasis vulgaris. J AmAcad Dermatol 1999;40:893-900.
• 22. Monfrecola G, Baldo A. Retinoids and phototherapy for psoriasis. J Rheumatol Suppl 2009;83:71-2.