[Phototherapy in the era of biologicals]

The development of biologicals had led to a dramatic change in the therapy of psoriasis, making necessary a re-evaluation of conventional therapeutic strategies. Four parameters must be evaluated: efficacy, economic burden, side effects and practicability. As for efficacy, according to published meta-analyses Infliximab reaches the efficiency of PUVA therapy, whereas the other biologicals, although being very effective, are inferior. Biologicals have a clear advantage in treating psoriatic arthritis. All published pharmacoeconomic studies demonstrate a significant advantage of phototherapy over biologicals. Severe and atypical (masked) infections, demyelinizing diseases, possible induction of lymphomas (not definitely established), and autoimmune phenomena are troublesome and feared side effects of biologicals. The risk of photocarcinogenesis after long-term use is the most significant side effect of phototherapy. However, considering the experience of 5 decades of good controlled clinical evaluation of phototherapy, this option has to be considered as safer than Biologicals. Looking at practicability, biologicals have undoubtedly a significant advantage compared to phototherapy.