Bath PUVA and Saltwater Baths Followed by UV-B Phototherapy as Treatments for Psoriasis

Abstract

To evaluate the efficacy of psoralens dissolved in a warm-water bath followed by exposure to UV-A irradiation (bath PUVA) or saltwater phototherapy (SW UV-B) compared with tap-water phototherapy (TW UV-B) or UV-B irradiation alone in psoriasis.Design: Multisite, prospective, randomized, controlled trial with 4 parallel groups.Setting: Total of 102 dermatologic outpatient clinics.Patients: Total of 1241 patients with stable psoriasis vulgaris and a Psoriasis Area and Severity Index score of 7 or greater.Interventions: Four-times-weekly UV-B, TW UV-B, SW UV-B, or bath-PUVA with baths preceding UV irradiation over a maximum of 8 weeks. The UV dose was adapted to erythemal response.Main Outcome Measures: Incidence of therapeutic success, defined as a reduction of the Psoriasis Area and Severity Index or affected body surface area of 50% or more.Results: Patients who received TW UV-B had a significantly higher incidence of therapeutic success than did patients treated with UV-B alone (60.7% vs 43.3%; PϽ.001; number needed to treat, 5.8; 95% confidence interval [CI], 3.9-10.9). Patients who received SW UV-B or bath PUVA had a significantly higher incidence of therapeutic success than did patients treated with TW UV-B (74.9% vs 60.7%; PϽ.001; number needed to treat, 7.0; 95% CI, 4.6-14.9; and 78.4% vs 60.7%; PϽ.001; number needed to treat, 5.7; 95% CI, 4.0-9.7, respectively). Bath PUVA was not superior to SW UV-B (78.4% vs 74.9%; P=.34). Conclusion:Bath PUVA and SW UV-B are comparably effective treatments in psoriasis and superior to UV-B and TW UV-B.

The Impact of Salt Water Soaks on Biophysical and Molecular Parameters in Psoriatic Epidermis Equivalents

“…Indeed, the aforementioned observations contrast with previous studies showing rather increased UVB-induced erythema reactions after tap water and low-concentration salt water immersions [10,13,14,15]. On the other hand, neither Schiener et al [7] nor Dawe et al [5] observed in their large clinical psoriasis trials an increase in erythemal response to UVB after salt water exposure of different concentrations. Similar results were also reported by Léauté-Labrèze et al [6], who performed the first randomized controlled large-scale trial on BPT.…”

“…Researchers from Germany have recently performed excellent randomized controlled trials demonstrating that BPT is superior to monophototherapy of psoriasis. The first study, involving 1,241 patients, convincingly demonstrated that bathing in salt water before UVB exposure is superior to UVB monotherapy as well as to tap water baths before UVB exposure [7]. The results of the second trial, involving 143 patients, indicated that BPT using low-concentration saline spa water baths followed by conventional UVB phototherapy was superior to conventional UVB monophototherapy at the end of a 6-week treatment course [8].…”

S3 – Guidelines on the treatment of psoriasis vulgaris Update 2011

“…Balneo phototherapy Brockow et al [182,183] (EG B) reported an increased PASI 75 response rate to [204]. On the whole, there is an additive benefit of combining a mineral salt water bath with phototherapy (EL 2).…”

Psoriasistherapie

“…Der gemeinsame Bundesausschuss konnte in der "Dokumentation zum Beratungsverfahren für die Balneophototherapie" keine Überle-genheit der asynchronen gegenüber der synchronen feststellen [16]. Die Behandlungsrichtlinie für die künstliche Photosoletherapie orientiert sich an der Studie des BvDD [24], die zur Aufnahme in den gesetzlichen Gegenstandskatalog geführt hat. Die Behandlungen finden 4-mal wö-chentlich statt, wobei synthetische Salzlö-sungen mit 20-25% zum Einsatz kommen.…”