Background: Psoriasis is a common chronic inflammatory disorder associated with much physical and psychological comorbidity. There is currently no cure for psoriasis, and it is a disorder characterized by alternating periods of relapse and remission. The effectiveness of current treatments, such as psoralen UVA radiation therapy (PUVA), usually correlates with higher toxicity. Newer treatments that are effective, but less harmful are needed. The excimer laser is a newer treatment option for psoriasis that has shown promising effects. This review aims to determine the efficacy of the excimer laser compared to traditional PUVA therapy.
Methods: An exhaustive search of available medical literature was conducted using Medline-Ovid, CINAHL, Evidence-Based Medicine Reviews Multifile, and Web of Science using the keywords: psoriasis, excimer laser, and PUVA therapy. Relevant articles were then assessed for quality using GRADE.
Results: Two studies met inclusion criteria and were included in the systematic review. One randomized controlled trial of 272 patients with psoriasis demonstrated comparable effectiveness in elimination of psoriatic plaques between PUVA monotherapy and PUVA with additional excimer laser therapy. In addition, they determined that the combination group required fewer treatments and thus received a reduced cumulative UVA dose. Another small randomized controlled trial of 10 patients with palmoplantar psoriasis also demonstrated equal effectiveness of topical PUVA and excimer laser therapy.
Conclusion: The available data suggest that PUVA and excimer laser therapies offer similar effectiveness in clearing psoriatic lesions. However, there appear to be some inherent advantages to excimer laser therapy over PUVA monotherapy. When combined with PUVA therapy, the excimer laser decreases the number of treatments required for remission and therefore the total UVA dosage administered. The excimer laser also does not require additional medications to be taken prior to treatment. Further study is necessary to determine long-term efficacy and side effects of use, but currently this therapy appears promising as an option in the treatment of psoriasis.
Keywords: psoriasis, excimer laser, PUVA therapy
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