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Remissions of psoriasis with excimer laser treatment

  • Author(s): Feldman, Steven R.
  • et al.
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Remissions of psoriasis with excimer laser treatment
Steven R. Feldman
Dermatology Online Journal 8(2): 23

From the Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina

The 308-nm excimer laser offers a new, effective approach to treat localized psoriasis.[1] Because only the psoriasis plaques are treated, high initial UVB doses can be given, and lesions improve in fewer treatments with the excimer laser when compared with standard UVB phototherapy. A key advantage of phototherapy over other therapies is its remittive quality.[2,3,4] After clearing of the plaques, the lesions may remain clear without further therapy for a long period.[5] The initial report of the efficacy of the excimer laser did not address whether this therapy is associated with remissions of the disease.

Information on the remission rates associated with the excimer laser treatment can be obtained from a follow up survey of subjects who had participated in the multicenter trial.[6] Complete data were obtained on 51 subjects who had obtained at least 75% improvement in the lesions with 308 nm excimer laser treatment. The median remission time was 8.7 weeks. 24% did not report worsening of the disease in from 33 to 48 weeks of follow up. True mean remission rates cannot be calculated because of truncated data (we do not know when those who did not relapse would have relapsed), however using the length of the follow up period for those who did not flare allows one to calculate a lower bound estimate for the mean relapse free period of 16 weeks (Table 1).

Table 1. Comparison of UVB laser relapse rate to published relapse rates of psoriasis therapies[5]
TreatmentLength of remission
UVB laser 16 weeks
Fluocinonide cream 12 weeks
Betamethasone dipropionate ointment 12 weeks
Calcipotriene 6 weeks
Tazarotene 0.1% gel 12 weeks
Etretinate 8 weeks
Cyclosporine 6 weeks
Methotrexate 10 weeks

A review of remission times associated with psoriasis therapies described the difficulties comparing remission times and rates across treatments.[5] Differences between study populations, definitions of remission and relapse, and reporting methods make clear comparisons quite difficult. Moreover, relapse-free periods in clinical practice may differ from those reported in trials because of additional differences in treatment protocol and use of combination regimens and maintenance therapy. Despite these limitations, 308 nm excimer laser treatments appear to offer relapse-free periods for localized psoriasis that are comparable or better than that offered by standard topical therapy regimens. Further data are needed to determine how the excimer laser remission rate may be maximized in order to provide patients good long-term control of their disease.

Dr. Feldman is a consultant to Phtomedex, has received grant support from Bristol-Myers Squibb Dermatology and Novartis, and has been a consultant to Allergan.

References

1. Feldman SR, Mellen BG, Housman TS, Fitzpatrick RE, Geronemus RG, Friedman PM, Vasily DB, Morison WL. Efficacy of the 308-nm excimer laser for treatment of psoriasis: Results of a multicenter study. J Am Acad Dermatol, in press.

2. Muller SA, Perry HO. The Goeckerman treatment in psoriasis: six decades of experience at the Mayo Clinic. Cutis 1987:265-268.

3. Kreuger JG, Wolfe JT, Nabeya RT, Vallat VP, Gilleaudeau P, Heftler NS, Austin LM, Gottlieb AB. Successful ultraviolet B treatment of psoriasis is accompanied by a reversal of keratinocyte pathology and by selective depletion of intraepithelial T cell. J Exp Med 12-1-1995;182:2057-2068.

4. Coven TR, Walters IB, Cardinale I, Kreuger JG. PUVA-induced lymphocyte apoptosis: mechanism of action in psoriasis. Photodermatol Photoimmunol Photomed 1999;15:22-27.

5. Koo J, Lebwohl M. Duration of remission of psoriasis therapies. J Am Acad Dermatol 1999;41:51-9.

6. Rodewald EJ, Housman TS, Mellen BG, Feldman SR. Follow up survey of 308nm laser treatment of psoriasis. Submitted for publication.

© 2002 Dermatology Online Journal