Conceptos actuales de medicina basada en la evidencia sobre el uso de fototerapia en pacientes con psoriasis

Primera parte: Fotoquimioterapia (PUVA) en psoriasis

  • Manuela Cadavid
  • Sol Beatriz Jiménez
Palabras clave: psoriasis, fotoquimioterapia, PUVA

Resumen

La fototerapia constituye uno de los pilares del tratamiento de la psoriasis y se considera una herramienta de gran eficacia y relativa seguridad. La fotoquimioterapia con radiación ultravioleta A más psoraleno (PUVA), ha sido una de las más utilizadas, demostrando buenos resultados y altas tasas de remisión; sin embargo, dado su potencial carcinogénico, su uso se ha ido restringiendo. Actualmente se reserva para los casos de psoriasis grave y recalcitrante o resistente, o como coadyuvante a otros tratamientos. Se presenta la revisión de algunos aspectos importantes de este tipo de tratamiento y de los protocolos para su uso, con el fin de motivar el uso adecuado de esta opción terapéutica.

Biografía del autor/a

Manuela Cadavid

Médica, residente de Dermatología, Universidad CES, Medellín, Colombia

Sol Beatriz Jiménez

Médica dermatóloga; jefe, Servicio de Dermatología, Grupo Dermatología CES, Universidad CES, Medellín, Colombia

Referencias bibliográficas

5. Lapolla W, Yentzer BA, Bagel J, Halvorson CR, Feldman SR. A review of phototherapy protocols for psoriasis treatment. J Am Acad Dermatol. 2011;64:936-49.
6. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. J Am Acad Dermatol. 2011;65:137-74.
7. Callen JP, Krueger GG, Lebwohl M, McBurney EI, Mease P, Menter A, et al. AAD consensus statement on psoriasis therapies. J Am Acad Dermatol. 2003;49:897-9.
8. Guenther L, Langley RG, Shear NH, Bissonnette R, Ho V, Lynde C, et al. Integrating biologic agents into management of moderateto-severe psoriasis: A consensus of the Canadian Psoriasis Expert Panel. J Cutan Med Surg. 2004;8:321-37.
9. Sterry W, Barker J, Boehncke W-H, Bos JD, Chimenti S, Christophers E, et al. Biological therapies in the systemic management of psoriasis: International Consensus Conference. Br J Dermatol. 2004;151(Suppl.69):3-17.
10. Delrosso G, Bornacina C, Farinelli P, Bellinzona F, Leigheb G, Colombo E. Bath PUVA and psoriasis: Is a milder treatment a worse treatment? Dermatology (Basel). 2008;216:191-3.
11. Zanolli M. Phototherapy treatment of psoriasis today. J Am Acad Dermatol. 2003;49(Suppl.2):S78-86.
12. Feldman SR, Koo JY, Lebwohl MG, Menter A, van Voorhees A. The psoriasis and psoriatic arthritis pocket guide: Treatment algorithms and management options. Third edition. The National Psoriasis Foundation. New York, 2009. pag 84-91
13. Lim HW, Hönigsmann H, Hawk JLM. Photodermatology. Informa healthcare USA, New York, 2007. pag 319-335.
14. Hönigsmann H. Phototherapy for psoriasis. Clin Exp Dermatol. 2001;26:343-50.
15. DeSilva B, McKenzie RC, Hunter JAA, Norval M. Local effects of TL01 phototherapy in psoriasis. Photodermatol Photoimmunol Photomed. 2008;24:268-9.
16. Gläser R, Navid F, Schuller W, Jantschitsch C, Harder J, Schröder JM, et al. UV-B radiation induces the expression of antimicrobial peptides in human keratinocytes in vitro and in vivo. J Allergy Clin Immunol. 2009;123:1117-23.
17. Yoshimura M, Namura S, Akamatsu H, Horio T. Antimicrobial effects of phototherapy and photochemotherapy in vivo and in vitro. Br J Dermatol. 1996;134:528-32.
18. Parrish JA, Jaenicke KF. Action spectrum for phototherapy of psoriasis. J Invest Dermatol. 1981;76:359-62.
19. Storbeck K, Hölzle E, Schürer N, Lehmann P, Plewig G. Narrowband UVB (311 nm) versus conventional broad-band UVB with and without dithranol in phototherapy for psoriasis. J Am Acad Dermatol. 1993;28(Pt.1):227-31.
20. Walters IB, Burack LH, Coven TR, Gilleaudeau P, Krueger JG. Suberythemogenic narrow-band UVB is markedly more effective than conventional UVB in treatment of psoriasis vulgaris. J Am Acad Dermatol. 1999;40(Pt.1):893-900.
21. Coven TR, Burack LH, Gilleaudeau R, Keogh M, Ozawa M, Krueger JG. Narrowband UV-B produces superior clinical and histopathological resolution of moderate-to-severe psoriasis in patients compared with broadband UV-B. Arch Dermatol. 1997;133:1514-22.
22. Yones SS, Palmer RA, Garibaldinos TT, Hawk JLM. Randomized double-blind trial of the treatment of chronic plaque psoriasis: Efficacy of psoralen-UV-A therapy Vs. narrowband UV-B therapy. Arch Dermatol. 2006;142:836-42.
23. Markham T, Rogers S, Collins P. Narrowband UV-B (TL-01) phototherapy Vs. oral 8-methoxypsoralen psoralen-UV-A for the treatment of chronic plaque psoriasis. Arch Dermatol. 2003;139:325-8.
24. Gordon PM, Diffey BL, Matthews JN, Farr PM. A randomized comparison of narrow-band TL-01 phototherapy and PUVA photochemotherapy for psoriasis. J Am Acad Dermatol. 1999;41(Pt.1):728-32.
25. Jury CS, McHenry P, Burden AD, Lever R, Bilsland D. Narrowband ultraviolet B (UVB) phototherapy in children. Clin Exp Dermatol. 2006;31:196-9.
26. Pasic A, Ceovic R, Lipozencic J, Husar K, Susic SM, Skerlev M, et al. Phototherapy in pediatric patients. Pediatr Dermatol. 2003;20:71-7.
27. Valkova S. UVB phototherapeutic modalities. Comparison of two treatments for chronic plaque psoriasis. Acta Dermatovenerol Alp Panonica Adriat. 2007;16:26-30.
28. Kleinpenning MM, Smits T, Boezeman J, van de Kerkhof PCM, Evers AWM, Gerritsen MJP. Narrowband ultraviolet B therapy in psoriasis: Randomized double-blind comparison of high-dose and low-dose irradiation regimens. Br J Dermatol. 2009;161:1351-6.
29. Boztepe G, Akinci H, Sahin S, Karaduman A, Evans SE, Erkin G, et al. In search of an optimum dose escalation for narrowband UVB phototherapy: Is it time to quit 20% increments? J Am Acad Dermatol. 2006;55:269-71.
30. Ibbotson SH, Bilsland D, Cox NH, Dawe RS, Diffey B, Edwards C, et al. An update and guidance on narrowband ultraviolet B phototherapy: A British Photodermatology Group Workshop Report. Br J Dermatol. 2004;151:283-97.
31. Wainwright NJ, Dawe RS, Ferguson J. Narrowband ultraviolet B (TL-01) phototherapy for psoriasis: Which incremental regimen? Br J Dermatol. 1998;139:410-4.
32. Olson RL, Sayre RM, Everett MA. Effect of anatomic location and time on ultraviolet erythema. Arch Dermatol. 1966;93:211-5.
33. Schneider LA, Hinrichs R, Scharffetter-Kochanek K. Phototherapy and photochemotherapy. Clin Dermatol. 2008;26:464-76.
34. Karrer S, Eholzer C, Ackermann G, Landthaler M, Szeimies RM. Phototherapy of psoriasis: Comparative experience of different phototherapeutic approaches. Dermatology (Basel). 2001;202:108-15.
35. Zanolli, MD, Feldman SR. Phototherapy treatment protocols: For psoriasis an other phtotherapy responsive dermatoses. New York: Taylor and Francis Group; 2004.
36. Calle J, Rivas AM, Ruiz MC, Sánchez MA, Trujillo MC, Jiménez SB, et al. Manejo de la psoriasis con luz ultravioleta A más psoraleno (PUVA) y luz ultravioleta B (UVB). Rev Asoc Colomb Dermatol. 2009;17:162-71.
37. Haddican MM, Bhutani T, McClelland PB, Koo JYM. Why are there significant differences in published narrowband ultraviolet B dosimetry recommendations? The need for national standardization of phototherapy treatment. J Am Acad Dermatol. 2011;65:411-4.
38. Cameron H, Dawe RS, Yule S, Murphy J, Ibbotson SH, Ferguson J. A randomized, observer-blinded trial of twice Vs. three times weekly narrowband ultraviolet B phototherapy for chronic plaque psoriasis. Br J Dermatol. 2002;147:973-8.
39. Dawe RS, Wainwright NJ, Cameron H, Ferguson J. Narrow-band (TL-01) ultraviolet B phototherapy for chronic plaque psoriasis: Three times or five times weekly treatment? Br J Dermatol. 1998;138:833-9.
40. Boztepe G, Karaduman A, Sahin S, Hayran M, Kölemen F. The effect of maintenance narrow-band ultraviolet B therapy on the duration of remission for psoriasis: A prospective randomized clinical trial. Int J Dermatol. 2006;45:245-50.
41. Stern RS, Armstrong RB, Anderson TF, Bickers DR, Lowe NJ, Harber L, et al. Effect of continued ultraviolet B phototherapy on the duration of remission of psoriasis: A randomized study. J Am Acad Dermatol. 1986;15:546-52.
42. Kragballe K. Vitamin D and UVB radiation therapy. Cutis. 2002;70(Suppl.5):9-12.
43. Guenther LC. Optimizing treatment with topical tazarotene. Am J Clin Dermatol. 2003;4:197-202.
44. Koo JY, Lowe NJ, Lew-Kaya DA, Vasilopoulos AI, Lue JC, Sefton J, et al. Tazarotene plus UVB phototherapy in the treatment of psoriasis. J Am Acad Dermatol. 2000;43(Pt.1):821-8.
45. Meola T Jr, Soter NA, Lim HW. Are topical corticosteroids useful adjunctive therapy for the treatment of psoriasis with ultraviolet radiation? A review of the literature. Arch Dermatol. 1991;127:1708-13.
46. Morison WL, Parrish JA, Fitzpatrick TB. Controlled study of PUVA and adjunctive topical therapy in the management of psoriasis. Br J Dermatol. 1978;98:125-32.
47. Schmoll M, Henseler T, Christophers E. Evaluation of PUVA, topical corticosteroids and the combination of both in the treatment of psoriasis. Br J Dermatol. 1978;99:693-702.
48. Marcil I, Stern RS. Squamous-cell cancer of the skin in patients given PUVA and ciclosporin: Nested cohort crossover study. Lancet. 2001;358:1042-5.
49. Kaya TI, Tiftik N, Tursen U, Ikizoglu G, Yalcin A. Ultraviolet recall phenomenon associated with methotrexate and cytarabine. J Eur Acad Dermatol Venereol. 2006;20:353-4.
50. Paul BS, Momtaz K, Stern RS, Arndt KA, Parrish JA. Combined methotrexate--ultraviolet B therapy in the treatment of psoriasis. J Am Acad Dermatol. 1982;7:758-62.
51. Lebwohl M, Drake L, Menter A, Koo J, Gottlieb AB, Zanolli M, et al. Consensus conference: Acitretin in combination with UVB or PUVA in the treatment of psoriasis. J Am Acad Dermatol. 2001;45:544-53.
52. Kircik L, Bagel J, Korman N, Menter A, Elmets CA, Koo J, et al. Utilization of narrow-band ultraviolet light B therapy and etanercept for the treatment of psoriasis (UNITE): Efficacy, safety, and patient-reported outcomes. J Drugs Dermatol. 2008;7:245-53.
53. Lucas A, Belinchón I, Pérez-Crespo M, Mataix J, Betlloch I. Successful response to narrow-band UVB in a patient undergoing concomitant treatment with adalimumab for psoriasis. Australas J Dermatol. 2008;49:173-4.
54. Legat FJ, Hofer A, Wackernagel A, Salmhofer W, Quehenberger F, Kerl H, et al. Narrowband UV-B phototherapy, alefacept, and clearance of psoriasis. Arch Dermatol. 2007;143:1016-22.
55. Ibbotson SH, Bilsland D, Cox NH, Dawe RS, Diffey B, Edwards C, et al. An update and guidance on narrowband ultraviolet B phototherapy: A British Photodermatology Group Workshop Report. Br J Dermatol. 2004;151:283-97.
56. Calzavara-Pinton PG, Zane C, Candiago E, Facchetti F. Blisters on psoriatic lesions treated with TL-01 lamps. Dermatology (Basel). 2000;200:115-9.
57. Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Baller AS, Leffell DJ. Fitzpatrick’s Dermatology in General Medicine. Seventh edition, Volume two. McGraw Hill, New York, 2008. pag 2243-2262
58. Lee E, Koo J, Berger T. UVB phototherapy and skin cancer risk: A review of the literature. Int J Dermatol. 2005;44:355-60.
59. Diffey BL. Factors affecting the choice of a ceiling on the number of exposures with TL01 ultraviolet B phototherapy. Br J Dermatol. 2003;149:428-30.
60. Stern RS. The risk of squamous cell and basal cell cancer associated with psoralen and ultraviolet A therapy: A 30-year prospective study. J Am Acad Dermatol. 2012;66:553-62.
61. Mudigonda T, Dabade TS, Feldman SR. A review of targeted ultraviolet B phototherapy for psoriasis. J Am Acad Dermatol. 2012;66:664-72.
Cómo citar
1.
Cadavid M, Jiménez SB. Conceptos actuales de medicina basada en la evidencia sobre el uso de fototerapia en pacientes con psoriasis: Primera parte: Fotoquimioterapia (PUVA) en psoriasis. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 1 de enero de 2013 [citado 17 de agosto de 2022];21(1):38-7. Disponible en: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/262

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Publicado
2013-01-01
Sección
Artículo de revisión

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