A comparison of three times vs. five times weekly narrowband ultraviolet B phototherapy for the treatment of chronic plaque psoriasis

Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Photodermatology Photoimmunology and Photomedicine (Impact Factor: 1.26). 02/2010; 26(1):10-5. DOI: 10.1111/j.1600-0781.2009.00473.x
Source: PubMed


Narrowband ultraviolet B (NB-UVB) phototherapy is an effective treatment for psoriasis.
To compare the effects of three and five times weekly NB-UVB phototherapy in the treatment of chronic plaque psoriasis. Methods: Sixty-five patients with chronic plaque psoriasis were allocated to receive three or five times weekly NB-UVB, starting at low dose.
Among the patients who completed the study, clearance was achieved in 18 out of 23 patients (78%) in the three times weekly group and in 15 out of 22 patients (68%) in the five times weekly group. The difference was not statistically significant (P=0.44). No statistically significant differences were found between the two groups in the number of treatments (P=0.95), cumulative UVB dose (P=0.51), and rate of side-effects. Length of the treatment period was significantly shorter in the five times weekly group (P<0.001). At the end of treatment, the mean psoriasis area and severity index score was lower in the three times weekly group (P=0.02).
We recommend three times weekly NB-UVB for chronic plaque psoriasis; however, the more rapid clearance of psoriasis with five times weekly phototherapy may justify using this method in some patients.

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    • "Although no evidence exists regarding UVB phototherapyinduced skin cancers (Lee et al 2005), UVB radiation is also known to be highly mutagenic (Kappes et al 2006). To the best of our knowledge, attempts to find the optimal dosimetry for psoriasis UVB phototherapy either by clinical experiment (Asawanonda et al 2000; Boztepe et al 2006; Hallaji et al 2010) or by modeling (Diffey 2004) have not yet obtained a conclusive answer on what set of regimen values maximize the therapeutic effect of UVR and minimize its side effects. In this study, agent-based modeling was employed by representing the interaction of epidermal and immune cells during psoriasis as well as their responses under UVR exposure especially the possible induction of precancerous keratinocyte development. "
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    ABSTRACT: Ultraviolet radiation (UVR) is proven to be an effective treatment for psoriasis yet it needs to be carefully controlled since it is a widely known carcinogen. Due to the time-consuming, expensive and hazardous nature of clinical tests on actual patients, the range of possible values for the optimal regimen set has not yet been thoroughly explored. An agent-based model was constructed in order to study the complex role of UVR in psoriasis phototherapy, including possible contribution to the formation of skin cancers. The treatment progression of the simulated psoriasis undergoing UVR phototherapy was monitored weekly and compared with the corresponding clinical data. For model calibration, a single-objective optimization via genetic algorithm was employed that aimed to minimize the discrepancy between the model output and the expected clinical result. After fitting and validation, the model was then subjected to multi-objective evolutionary optimization using Non-dominated Sorting Genetic Algorithm-II (NSGA-II) in order to suggest sets of optimal UVR phototherapy regimen for psoriasis taking into account the safety, clearance time as well as aggressiveness of the therapy. Results show a good model fit against clinical data and gave some plausible sets of dosimetry for UVR phototherapy that maximize its therapeutic efficacy while minimizing the associated skin cancer risk.
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    ABSTRACT: An agent-based model (ABM) was constructed to integrate dermatological data from literature on the interactions of the skin and immune system cells in psoriasis and study the conflicting roles of ultraviolet radiation (UVR) as a disease treatment and as a carcinogenic agent. Backed by clinical judgement from an expert dermatologist and validated with data available from literature, the model was subjected to various experimental scenarios which would be costly or even not feasible under clinical or laboratory settings. Lastly, the model was used to suggest possible therapeutic regimens by subjecting it to multi-objective evolutionary optimization using the Non-dominated Sorting Genetic Algorithm-II (NSGA-II) which is capable of dealing with the apparently conflicting aspects of the system. Results of the ABM-driven evolutionary optimization suggested some alternatives that are well-balanced in terms of the therapeutic and harmful effects even with adjunct treatments such topical corticosteroids or in the presence of certain constraints such as limited time for therapy and decreased patient tolerance to aggressive dosages.
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