Psoriasis phototherapy experience from a Lisbon unit: a still valid therapeutic approach in the 21st century

During the last half of the 20th century, the use of UVB therapy and photochemotherapy (PUVA), were one of the mainstays of treatment for psoriasis. However, accompanying to the advent of the most recent era of psoriasis, with targeted biologic therapy has been a decline in the frequency of phototherapy. This does not diminish its known clinical effects.

To perform a retrospective analysis of demographic, clinical and therapeutic variables of psoriatic patients treated with phototherapy in the last 10 years, when biological therapies become available. Also, review some of the published phototherapy and biological therapy data in psoriasis.

Psoriatic patients were treated between 1st January 2000 and 31st December 2010 in a Lisbon Phototherapeutic unit. Psoriatic arthritis patients were excluded. Regimes used included PUVA (systemic or topical), Re PUVA, UVAB (broad band) or combined options.

During this period, 211 patients were treated with phototherapy; 40% (85/211) UVAB, 31% (64/211) topical PUVA, 23% (49/211) systemic PUVA and 6% (13/211) Re PUVA. Mean follow-up period was 18 months (Min 1; Max 120). The average age was 45 years old (mean 44.80; Min 10; Max 80; SD 16.31), 54% (114/211) of patients were female and 46% (97/211) were male. Of all 211 psoriasis patients, 54% (144/211) had plaque psoriasis diagnosis, 31% (66/211) palmoplantar psoriasis and 15% (41/211) guttate psoriasis. Regardless the phototherapy modality used, substantial BSA improvements were achieved in all psoriasis groups.

Current advancements in therapeutics enjoyed today include the advent of the biologics and other immunomodulating systemic agents. However, attending to the responses achieved, and considering other variables like well-known side effects and cost, photo(chemo)therapy will remain an essential method of treatment for psoriasis vulgaris in the 21st century.