Abstract
Phototherapy is an effective treatment modality for several skin diseases which has been in use from the era of the Egyptians. Insight into its mode of action has gradually accumulated over the past decades. A crucial biological effect of ultraviolet radiation is the induction of apoptosis in T lymphocytes and in keratinocytes in the epidermis. Via this mechanism inflammation-induced pathological changes characteristic of psoriasis are counteracted.
Phototherapy remains the only therapeutic option for certain patient groups where modification of the systemic immune reactions is contraindicated, such as by HIV, internal malignancy or pregnancy. UVB treatment is highly cost-effective, which is important in this age of increasing health care costs.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Lim HW et al (2015) Phototherapy in dermatology: a call for action. J Am Acad Dermatol 72(6):1078–1080
Bolognia J, Jorizzo J, Rapini R (2003) Dermatology, vol 2. Mosby, Edinburgh/London/New York/Oxford/Philadelphia/St Louis/Sidney/Toronto
Stern R (2007) Psoralen and ultraviolet a light therapy for psoriasis. N Engl J Med 357(7):682–690
McGregor J, Hawk J (2003) Acute effects of ultraviolet radiation on the skin. In: Freedberg I et al (eds) Fitzpatrick’s dermatology in general medicine. The McGraw-Hill Companies, Inc., New York
Maccubbin AE et al (1995) DNA damage in UVB-irradiated keratinocytes. Carcinogenesis 16(7):1659–1660
Jans J et al (2006) Differential role of basal keratinocytes in UV-induced immunosuppression and skin cancer. Mol Cell Biol 26(22):8515–8526
Rácz E et al (2011) Effective treatment of psoriasis with narrow-band UVB phototherapy is linked to suppression of the IFN and Th17 pathways. J Invest Dermatol 131:1547
De Fabo EC, Noonan FP (1983) Mechanism of immune suppression by ultraviolet irradiation in vivo. I. Evidence for the existence of a unique photoreceptor in skin and its role in photoimmunology. J Exp Med 158(1):84–98
Kammeyer A et al (1997) Prolonged increase of cis-urocanic acid levels in human skin and urine after single total-body ultraviolet exposures. Photochem Photobiol 65(3):593–598
Snellman E et al (1992) Effect of psoriasis heliotherapy on epidermal urocanic acid isomer concentrations. Acta Derm Venereol 72(3):231–233
Schade N, Esser C, Krutmann J (2005) Ultraviolet B radiation-induced immunosuppression: molecular mechanisms and cellular alterations. Photochem Photobiol Sci 4(9):699–708
Rosette C, Karin M (1996) Ultraviolet light and osmotic stress: activation of the JNK cascade through multiple growth factor and cytokine receptors. Science 274(5290):1194–1197
Aragane Y et al (1998) Ultraviolet light induces apoptosis via direct activation of CD95 (Fas/APO-1) independently of its ligand CD95L. J Cell Biol 140(1):171–182
Krueger JG et al (1995) Successful ultraviolet B treatment of psoriasis is accompanied by a reversal of keratinocyte pathology and by selective depletion of intraepidermal T cells. J Exp Med 182(6):2057–2068
Weatherhead SC et al (2011) Keratinocyte apoptosis in epidermal remodeling and clearance of psoriasis induced by UV radiation. J Invest Dermatol 131(9):1916–1926
El-Domyati M et al (2013) Evaluation of apoptosis regulatory proteins in response to PUVA therapy for psoriasis. Photodermatol Photoimmunol Photomed 29(1):18–26
Walters IB et al (2003) Narrowband (312-nm) UV-B suppresses interferon gamma and interleukin (IL) 12 and increases IL-4 transcripts: differential regulation of cytokines at the single-cell level. Arch Dermatol 139(2):155–161
Piskin G et al (2003) IL-4 expression by neutrophils in psoriasis lesional skin upon high-dose UVB exposure. Dermatology 207(1):51–53
Zhang D et al (2016) Ultraviolet irradiation promotes FOXP3 transcription via p53 in psoriasis. Exp Dermatol 25(7):513–518
Gui J et al (2016) Therapeutic elimination of the type 1 interferon receptor for treating psoriatic skin inflammation. J Invest Dermatol 136:1990
Furuhashi T et al (2013) Photo(chemo)therapy reduces circulating Th17 cells and restores circulating regulatory T cells in psoriasis. PLoS One 8(1):e54895
Sigmundsdottir H et al (2005) Narrowband-UVB irradiation decreases the production of pro-inflammatory cytokines by stimulated T cells. Arch Dermatol Res 297:39
Batycka-Baran A et al (2016) The effect of phototherapy on systemic inflammatory process in patients with plaque psoriasis. J Photochem Photobiol B 161:396–401
Osmancevic A et al (2009) Vitamin D production in psoriasis patients increases less with narrowband than with broadband ultraviolet B phototherapy. Photodermatol Photoimmunol Photomed 25(3):119–123. 2009. 25(3): p. 119-23
Gupta A et al (2016) Efficacy of narrowband ultraviolet B phototherapy and levels of serum vitamin D3 in psoriasis: a prospective study. Indian Dermatol Online J 7(2):87–92
Ryan C et al (2010) Clinical and genetic predictors of response to narrowband ultraviolet B for the treatment of chronic plaque psoriasis. Br J Dermatol 163(5):1056–1063
Callis Duffin K et al (2014) Patient satisfaction with treatments for moderate-to-severe plaque psoriasis in clinical practice. Br J Dermatol 170(3):672–680
Miller DW, Feldman SR (2006) Cost-effectiveness of moderate-to-severe psoriasis treatment. Expert Opin Pharmacother 7(2):157–167
Nast A et al (2015) European S3-Guidelines on the systemic treatment of psoriasis vulgaris – Update 2015 – Short version – EDF in cooperation with EADV and IPC. J Eur Acad Dermatol Venereol 29(12):2277–2294
Chen X et al (2013) Narrow-band ultraviolet B phototherapy versus broad-band ultraviolet B or psoralen-ultraviolet A photochemotherapy for psoriasis. Cochrane Database Syst Rev 10:CD009481
Lapolla W et al (2011) A review of phototherapy protocols for psoriasis treatment. J Am Acad Dermatol 64(5):936–949
Markham T, Rogers S, Collins P (2003) Narrowband UV-B (TL-01) phototherapy vs oral 8-methoxypsoralen psoralen-UV-A for the treatment of chronic plaque psoriasis. Arch Dermatol 139(3):325–328
Archier E et al (2012) Efficacy of psoralen UV-A therapy vs. narrowband UV-B therapy in chronic plaque psoriasis: a systematic literature review. J Eur Acad Dermatol Venereol 26(Suppl 3):11–21
Coimbra S et al (2013) Principal determinants of the length of remission of psoriasis vulgaris after topical, NB-UVB, and PUVA therapy: a follow-up study. Am J Clin Dermatol 14(1):49–53
Gerber W et al (2003) Ultraviolet B 308-nm excimer laser treatment of psoriasis: a new phototherapeutic approach. Br J Dermatol 149(6):1250–1258
Almutawa F et al (2015) Efficacy of localized phototherapy and photodynamic therapy for psoriasis: a systematic review and meta-analysis. Photodermatol Photoimmunol Photomed 31(1):5–14
Fitzmaurice S, Bhutani T, Koo J (2013) Goeckerman regimen for management of psoriasis refractory to biologic therapy: the University of California San Francisco experience. J Am Acad Dermatol 69(4):648–649
Bailey EE et al (2012) Combination treatments for psoriasis: a systematic review and meta-analysis. Arch Dermatol 148(4):511–522
Ruzicka T et al (1990) Efficiency of acitretin in combination with UV-B in the treatment of severe psoriasis. Arch Dermatol 126(4):482–486
Asawanonda P, Nateetongrungsak Y (2006) Methotrexate plus narrowband UVB phototherapy versus narrowband UVB phototherapy alone in the treatment of plaque-type psoriasis: a randomized, placebo-controlled study. J Am Acad Dermatol 54(6):1013–1018
Wolf P et al (2011) 311 nm ultraviolet B-accelerated response of psoriatic lesions in adalimumab-treated patients. Photodermatol Photoimmunol Photomed 27(4):186–189
Nast A et al (2012) German S3-guidelines on the treatment of psoriasis vulgaris (short version). Arch Dermatol Res 304(2):87–113
Menter A et al (2010) Guidelines of care for the management of psoriasis and psoriatic arthritis: section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy. J Am Acad Dermatol 62(1):114–135
Nakamura M, Bhutani T, Koo JY (2016) Narrowband UVB-induced iatrogenic polymorphous light eruption: a case and suggestions to overcome this rare complication. Dermatol Online J 22(6)
Wolf P et al (2016) Desired response to phototherapy versus photo-aggravation in psoriasis: what makes the difference? Exp Dermatol 25(12):937–944
D'Souza LS, Payette MJ (2015) Estimated cost efficacy of systemic treatments that are approved by the US Food and Drug Administration for the treatment of moderate to severe psoriasis. J Am Acad Dermatol 72(4):589–598
Koek MB et al (2009) Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: pragmatic multicentre randomised controlled non-inferiority trial (PLUTO study). BMJ 338:b1542
Koek MB et al (2010) Cost effectiveness of home ultraviolet B phototherapy for psoriasis: economic evaluation of a randomised controlled trial (PLUTO study). BMJ 340:c1490
Arzpayma P et al (2016) Creation and assessment of a computerized modeling tool for optimizing planning of home and hospital-based phototherapy. Br J Dermatol 176:1390
Pathirana D et al (2009) European S3-guidelines on the systemic treatment of psoriasis vulgaris. J Eur Acad Dermatol Venereol 23(Suppl 2):1–70
Racz E, Prens EP (2015) Phototherapy and photochemotherapy for psoriasis. Dermatol Clin 33(1):79–89
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing AG
About this chapter
Cite this chapter
Rácz, E., Prens, E.P. (2017). Phototherapy of Psoriasis, a Chronic Inflammatory Skin Disease. In: Ahmad, S. (eds) Ultraviolet Light in Human Health, Diseases and Environment. Advances in Experimental Medicine and Biology, vol 996. Springer, Cham. https://doi.org/10.1007/978-3-319-56017-5_24
Download citation
DOI: https://doi.org/10.1007/978-3-319-56017-5_24
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-56016-8
Online ISBN: 978-3-319-56017-5
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)