Photochemotherapy For Widespread Psoriasis

Abstract

Forty live psoriatics (40 chronic plaque, 5 stable erythrodermic) were treated with PUVA therapy. The psoriasis area and severity index (PASI) was used for evaluation. The average pretreatment PASI score was 14.6 (range 7.4-35.4) in chronic plaque psoriasis and 39.9 (22.3-52.2) in psoriatic erythroderma. Patients were given oral 8-methoxypsoralen (0.6mg/kg), thrice a week with initial UVA exposure of 3 joulrd/cm2 and increments of 1 joulrd/cm2 every week till complete clearance or up to 12 weeks whichever was earlier. After clearing, patients were put on maintenance therapy. The average response at the end of 8 weeks was 84.5% reduction in PASI score in chronic plaque and 86.5% in erythroderma. Patients received a cumulative dose of 186 and 165 joules/cm2 respectively. Based on the time required for clearance, patients could be divided into rapid responders (4 weeks, 14 cases), average responders (8 weeks, 21 cases), slow responders (12 weeks, 5 cases) and non-responders (5 cases). One patient of chronic plaque type developed pustular psoriasis. No other serious side effect was observed. Hence, systemic photochemotherapy is effective in inducing long-lasting remissions in plaque and even stable erythrodermic psoriasis. More than 70% cases were maintained in remission at 6 months, 58% at 1 year and 32% at 2 years.