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Figure 1.
Flowchart of patients with chronic plaque psoriasis randomized to treatment. PUVA indicates psoralen–UV-A; TL-01, narrowband UV-B.

Flowchart of patients with chronic plaque psoriasis randomized to treatment. PUVA indicates psoralen–UV-A; TL-01, narrowband UV-B.

Figure 2.
The adverse effects in each treatment group. E1 indicates grade 1 erythema; E2, grade 2 erythema; PLE, polymorphic light eruption; PUVA, psoralen–UV-A; and TL-01, narrowband UV-B.

The adverse effects in each treatment group. E1 indicates grade 1 erythema; E2, grade 2 erythema; PLE, polymorphic light eruption; PUVA, psoralen–UV-A; and TL-01, narrowband UV-B.

Table 1. 
TL-01 and PUVA Treatment Regimens
TL-01 and PUVA Treatment Regimens
Table 2. 
Demographic Data and Pretreatment Psoriasis Extent and PASI Scores of Both Treatment Groups
Demographic Data and Pretreatment Psoriasis Extent and PASI Scores of Both Treatment Groups
Table 3. 
Clearance and Remission Data of Treatment Groups*
Clearance and Remission Data of Treatment Groups*
Table 4. 
Remission Data of Treatment Group*
Remission Data of Treatment Group*
1.
Parrish  JAFitzpatrick  TBTanenbaum  LPathak  MA Photochemotherapy of psoriasis with oral methoxsalen and longwave ultraviolet light. N Engl J Med. 1974;2911207- 1211Article
2.
Wolff  KFitzpatrick  TBParrish  JA  et al.  Photochemotherapy for psoriasis with orally administered methoxsalen. Arch Dermatol. 1976;112943- 950Article
3.
Melski  JWTanenbaum  LParrish  JAFitzpatrick  TBBleich  HL Oral methoxsalen photochemotherapy for the treatment of psoriasis: a cooperative clinical trial. J Invest Dermatol. 1977;68328- 335Article
4.
Henseler  THönigsmann  HWolff  KChristophers  E Oral 8 methoxypsoralen photochemotherapy of psoriasis. Lancet. 1981;1853- 857Article
5.
Rogers  SMarks  JShuster  SBriffa  DVWarin  AGreaves  M Comparison of photochemotherapy and dithranol in the treatment of chronic plaque psoriasis. Lancet. 1979;1455- 458Article
6.
Linelöf  BSigurgeirsson  BTegner  E  et al.  PUVA and cancer: a large-scale epidemiological study. Lancet. 1991;33891- 93Article
7.
Stern  RSLunder  EJ Risk of squamous cell carcinoma and methoxsalen (psoralen) and UV-A radiation (PUVA): a meta-analysis. Arch Dermatol. 1998;1341582- 1585
8.
Stern  RLaird  N The carcinogenic risk of treatments for severe psoriasis. Cancer. 1994;732759- 2764Article
9.
Stern  R The risk of melanoma in association with long term exposure to PUVA. J Am Acad Dermatol. 2001;44755- 761Article
10.
Parrish  JAJaenicke  KF Action spectrum for phototherapy of psoriasis. J Invest Dermatol. 1981;76359- 362Article
11.
Fisher  T UV-light treatment of psoriasis. Derm Venereol. 1976;56473- 479
12.
Van Weelden  HDe la Faille  HBYoung  EVan Der Leun  JC A new development in UVB phototherapy of psoriasis. Br J Dermatol. 1988;11911- 19Article
13.
British Photodermatology Group, An appraisal of narrowband (TL01) UVB phototherapy: British Photodermatology Group Workshop Report (April 1996). Br J Dermatol. 1997;137327- 330Article
14.
Green  CFerguson  JLakshmipathi  TJohnson  BE 311nm UVB phototherapy—an effective treatment for psoriasis. Br J Dermatol. 1988;119691- 696Article
15.
Storbeck  KHölze  ESchürer  NLehmann  PPlewig  G Narrow-band UVB (311nm) versus conventional broad-band UVB with and without dithranol in phototherapy for psoriasis. J Am Acad Dermatol. 1993;28227- 231Article
16.
Coven  TRBurack  LHGilleaudeau  PKeogh  MOzawa  MKrueger  JG Narrowband UVB produces superior clinical and histological resolution of moderate to severe psoriasis I patients compared with broadband UVB. Arch Dermatol. 1997;1331514- 1522Article
17.
Picot  EMeunier  LPicot-Debeze  MCPeyron  JLMeynadier  J Treatment of psoriasis with a 311-nm UVB lamp. Br J Dermatol. 1992;127509- 512Article
18.
Larkö  O Treatment of psoriasis with a new lamp. Acta Derm Venereol (Stockh). 1989;69357- 359
19.
Markham  TCollins  P An audit of adverse effects of oral 8-methoxypsoralen ultraviolet (UV)A and narrowband UVB phototherapy in the management of chronic plaque psoriasis [abstract]. Br J Dermatol. 2001;145 (suppl 59) 44Article
20.
Young  AR Carcinogenicity of UVB phototherapy assessed. Lancet. 1995;3451431- 1432Article
21.
De Gruijl  FR Long-term side effects and carcinogenesis risk in UVB therapy. Honigsmann  HJori  GYoung  AReds.The Fundamental Bases of Phototherapy Milan, Italy OEMF Spa1996;153- 170
22.
Van Weelden  HDe la Faille  HBYoung  EVan Der Leun  JC Comparison of narrowband UVB phototherapy and PUVA photochemotherapy in the treatment of psoriasis. Acta Derm Venereol. 1990;70212- 215
23.
Tanew  ARadakovic-Fijan  SSchemper  MHonigsmann  H Narrowband UV-B phototherapy vs photochemotherapy in the treatment of chronic plaque psoriasis. Arch Dermatol. 1999;135519- 524Article
24.
Gordon  PMDiffey  LMatthews  JNSFarr  PM A randomised comparison of narrow-band TL-01 phototherapy and PUVA photochemotherapy for psoriasis. J Am Acad Dermatol. 1999;41728- 732Article
25.
Dawe  RSCameron  HYule  S  et al.  A comparison of TL01 UVB phototherapy and bath-PUVA for chronic plaque psoriasis [abstract]. Br J Dermatol. 2000;143 (suppl 57) 15
26.
De Berker  DARSakuntabhai  ADiffey  BLFarr  PM Comparison of psoralen-UVB and psoralen UVA photochemotherapy in the treatment of psoriasis. J Am Acad Dermatol. 1997;36577- 581Article
27.
Dawe  RSWainwright  NJCameron  HFerguson  J Narrow-band (TL-01) ultraviolet B phototherapy for chronic plaque psoriasis: three times or five times weekly treatment? Br J Dermatol. 1998;138833- 839Article
28.
Gibson  GCodd  MBMurphy  GM Skin type distribution and skin disease in Ireland. Ir J Med Sci. 1997;16672- 74Article
Study
March 2003

Narrowband UV-B (TL-01) Phototherapy vs Oral 8-Methoxypsoralen Psoralen–UV-A for the Treatment of Chronic Plaque Psoriasis

Author Affiliations

From the City of Dublin Skin and Cancer Hospital, Dublin, Ireland. The authors have no relevant financial interest in this article.

Arch Dermatol. 2003;139(3):325-328. doi:10.1001/archderm.139.3.325
Abstract

Objective  To compare the efficacy of narrowband UV-B (TL-01) phototherapy with oral 8-methoxypsoralen photochemotherapy (8-MOP psoralen–UV-A [PUVA]) in patients with chronic plaque psoriasis (CPP).

Design  Open, randomized, controlled study.

Setting  Phototherapy unit in a dermatology hospital.

Patients  Fifty-four patients with CCP.

Interventions  Patients received whole-body threshold erythemogenic dose of either 3-times weekly TL-01 or twice-weekly oral 8-MOP PUVA, based on minimal erythema or phototoxic doses. Patients were treated until completely clear.

Outcome Measures  Number of treatments to clear, number of days in treatment, number of days in remission, and adverse effects of both therapies were assessed.

Results  Forty-five patients completed the study. Those in the PUVA group required significantly fewer treatments to clear (P = .03). There was no significant difference in the number of days to clear or number of days in remission. A similar percentage of patients in the TL-01 and PUVA groups developed minimal perceptible erythema, showing that the regimens were equally erythemogenic. Asymptomatic, well-defined erythema occurred only in the PUVA group. Pruritus and polymorphic light eruption occurred equally in both groups, but only patients in the PUVA group developed nausea.

Conclusion  Narrowband UV-B phototherapy, used 3 times weekly, is as effective for the treatment of CPP as oral 8-MOP PUVA used twice weekly.

ORAL 8-methoxypsoralen photochemotherapy (8-MOP psoralen–UV-A [PUVA]) is a well-established and effective treatment for psoriasis.15 The main concern with PUVA is the risk of nonmelanoma skin cancers68 and more recently the risk of melanoma.9 The action spectra of phototherapy for psoriasis10,11 led to the development by Philips (Eindhoven, the Netherlands) of a fluorescent lamp emitting narrowband UV-B between 311 and 313 nm, referred to as the TL-01 lamp. This has been shown to be more effective than broadband UV-B in the treatment of psoriasis.1217 A review of these treatments and guidelines has been published by the British Photodermatology Group.18

Narrowband UV-B (TL-01) phototherapy has gradually replaced PUVA as the first-line treatment for chronic plaque psoriasis (CPP) in our unit. Patients prefer it because they do not have to wear protective eyewear, take tablets, or experience adverse effects such as nausea. Also, TL-01 has the advantage of being suitable for use during pregnancy and in children. A recent audit of adverse effects of TL-01 and oral 8-MOP PUVA in our unit showed that both treatments were well tolerated.19 The long-term skin cancer risk is thought to be less than that of PUVA.20,21 Therefore, TL-01 has considerable advantages over PUVA and, if its efficacy was equal to PUVA, would be preferred.

Van Weelden et al22 reported that TL-01 was as effective as PUVA in 10 patients after 4 weeks of treatment. Tanew et al23 confirmed that both treatments were equally effective but suggested that oral 8-MOP PUVA was superior for patients with severe plaque psoriasis. During this trial, 2 other groups24,25 have reported studies comparing these modalities. One showed PUVA to be more effective. We performed a randomized, controlled trial to compare TL-01 and PUVA in terms of efficacy, time to clear, remission, and adverse effects to help decide if one had an advantage in the treatment of CPP.

METHODS

The trial was approved by the ethics committee of the City of Dublin Skin and Cancer Hospital (Dublin, Ireland), and patients gave written informed consent to participate in the study. Fifty-four consecutive patients with CPP affecting trunk and limbs were recruited from outpatient clinics between January 1999 and June 2000. All patients had at least 8% psoriasis extent on the trunk and limbs as assessed by the rule of nines by one observer (P.C.). Patients had not received any specific antipsoriatic treatment within 2 weeks prior to the study or phototherapy for 4 months beforehand. Exclusion criteria included age younger than 16 years, pregnancy or lactation, renal or hepatic disease, active systemic therapy within the previous 8 weeks for psoriasis, abnormal photosensitivity, or previous failure or intolerance to phototherapy.

Psoriasis area and severity index score (PASI), skin type, and phototherapy risk factor profile were established for each patient. Patients with skin types I, II, and III, representative of our local population, were included and randomly allocated to either treatment group. Patients wore UV protective goggles, and men wore genital protection in the cabinet. Aqueous cream (Emulsifying Ointment British Pharmacopoeia [30% wt/wt] [Ovelle Pharmaceuticals Ltd, Dundalk, Ireland], purified water, and phenoxyethanol) was allowed as required. Vioform HC cream (3% clioquinol and 1% hydrocortisone; Novartis, Dublin, Ireland) was applied twice daily to flexural psoriasis, and tar pomade (6% coal tar, 2% salicylic acid, yellow soft paraffin, emulsifying wax, liquid paraffin, and polysorbate 80 [Foran Chemicals Ltd, Dublin]) was applied to the scalp. The end point of the study was complete clearance of psoriasis. Patients were reviewed once weekly during the study and monthly after clearance for 12 months by 1 blinded observer (P.C.) to determine the duration of remission in days. Relapse was defined as 50% of the original extent. Outcome measures included the number of treatments to clear, the number of days in treatment, the number of days in remission, and adverse effects.

NARROWBAND UV-B PHOTOTHERAPY

Eight 2 × 2-cm sites 1.5 cm apart on unaffected upper back skin were exposed to narrowband UV-B (50, 70, 100, 140, 200, 280, 390, 550, 770, and 1080 mJ/cm2) from a bank of 4 TL-01 fluorescent tubes. The first 8 test doses were used for patients with skin types I and II and the last 8 were used for those with skin type III. The minimal erythema dose was defined as the dose that caused just perceptible erythema 24 hours after irradiation. Irradiance (5.22-5.39 mW/cm2) was measured monthly at a distance of 20 cm midway along the center of the bank of 4 tubes using the calibrated IL1400A radiometer and sensor. The UV-B time dosage table was adjusted accordingly.

Phototherapy was administered 3 times a week on Monday, Wednesday, and Friday. Psoriasis plaques were assessed for scale, erythema, and induration at each visit. The treatment regimen is outlined in Table 1. Incremental increases of the previous dose were made at each visit to a maximum dose of 2140 mJ/cm2. Psoriasis plaques were assessed at each visit for scale, erythema, and induration. The grade of erythema, pigmentation, pruritus, polymorphic light eruption, and any adverse effect was recorded at each visit.

ORAL 8-MOP PUVA

Oral 8-MOP crystalline tablets (10 mg of Deltapsoralen; Crawford Pharmaceuticals, Milton Keynes, England) at a dose of 0.6 mg/kg rounded up to the nearest 10 mg were taken 2 hours before UV-A exposure. Patients who could not tolerate 8-MOP (3 patients) were given 5-MOP (20 mg of Pentaderm; Crawford Pharmaceuticals) at a dose of 1.2 mg/kg. Patients were treated twice weekly on Monday and Thursday or Tuesday and Friday. They wore UV-A protective spectacles for 24 hours after treatment.

Eight 2 × 2-cm squares 1.5 cm apart on unaffected upper back skin were exposed to UV-A 2 hours after ingestion of psoralen at a distance of 20 cm from a bank of 6 Waldmann UV-A fluorescent tubes (Waldmann GmbH, Schwenningen, Germany). The first 8 test doses (0.5, 0.7, 1.0, 1.4, 2.0, 2.8, 3.9, and 5.5 J/cm2) were used for patients with skin types I and II, and patients with skin type III received the second 6 doses (2.0, 2.8, 3.9, 5.5, 7.7, and 10.8 J/cm2). The minimal phototoxic dose was defined as the dose that induced minimal perceptible erythema 72 hours after irradiation. Irradiance (7.4-8.3 mW/cm2) was measured monthly at a distance of 20 cm midway along the center of the bank of tubes using a calibrated Waldmann PUVA meter and sensor (Waldmann GmbH).

DOSIMETRY

Whole-body UV-B was given in a Waldmann 5000 cabinet (Waldmann GmbH) incorporating twenty-four 100-W Philips TL-01 fluorescent lamps (311-313 nm). Whole-body UV-A was given in a Waldmann 6000 cabinet incorporating forty 100-W Waldmann UV-A fluorescent lamps (315-400, peak 352 nm). Irradiance was measured each month by a person standing in the cabinet at 20 cm from the bulbs at 4 sides of the cabinet at 3 levels (shoulder, umbilicus, and lateral thigh), using a IL1400A radiometer and calibrated sensor. The mean of 12 readings was taken.Tables for UV time and dosage with 20% and 10% incremental scales were adjusted accordingly each month. The IL1400A radiometer and sensors were calibrated annually against a reference standard (A. Coleman, Medical Physics, Guys and St Thomas' Hospital Trust, London, England).

STATISTICAL ANALYSIS

Median and interquartile values were calculated. The data were not normally distributed and, therefore, a nonparametric test was used to compare data. The number of treatments, days in treatment and days in remission were compared using the Mann-Whitney test. A P value less than .05 was deemed significant, and 95% confidence intervals were calculated. Sample size estimation as previously reported26 suggested that for 80% power to detect a decrease in median exposure of 25% at the 5% significance level, 2 groups of 50 patients would be required.

RESULTS

Fifty-four patients were recruited (30 men and 24 women), and 29 were randomly allocated to the TL-01 group and 25 to the PUVA group. The 2 groups were well matched for age, sex, skin type, psoriasis extent, and PASI score (Table 2). A similar number of patients in each group received previous courses of TL-01 and/or PUVA. Our aim was to recruit 100 patients; however, many patients refused to participate because they did not want PUVA therapy, citing protective eyewear and taking tablets as the main reasons for refusal.

Forty-five patients completed the study. Six patients failed to complete treatment (TL-01, 4; PUVA, 2): 2 went on holidays during the treatment period and 4 defaulted. Three were withdrawn (TL-01, 1; PUVA, 2) because of flaring and required inpatient treatment (Figure 1). Data on the number of treatments, the number of days to clear, and the number of days in remission are presented for the 45 patients who completed the study (Table 3). There was a statistically significant difference in the number of treatments to clear for those receiving PUVA therapy (P = .03). There was no significant difference in the number of days to clear or duration of remission (Table 3). Remission data are available for 43 of 45 patients and are presented in Table 4.

Both groups were divided according to PASI score. Those with a PASI score less than 14 were in the low PASI group, and those with a score of 14 or higher were in the high PASI group. There was no significant difference in the number of treatments to clear, days in treatment, or number of days in remission between the 2 treatments.

A similar percentage of patients in each group (TL-01, 75%; PUVA, 80%) developed grade 1 erythema, showing that the regimens were equally erythemogenic (Figure 2). Grade 2 erythema occurred only in the PUVA group. Pruritus and polymorphic light eruption occurred equally in both groups, but only patients in the PUVA group developed nausea. No other significant adverse effects of treatment were noted.

COMMENT

Oral 8-MOP PUVA therapy is effective in the management of CPP and is the yardstick against which new forms of phototherapy should be measured. In this study, patients were treated with equi-erythemogenic dosages of 3-times weekly TL-01 or twice-weekly oral PUVA until completely clear. Patients were well matched and a similar number in both groups had previously been treated with phototherapy and PUVA. There was no statistically significant difference in the number of days taken to clear or days in remission between the groups. Adverse effects were comparable with both therapies. Patients treated with PUVA received fewer treatments, and this was the only statistically significant difference between the groups. However, the power of this study is limited because of difficulty in recruiting sufficient numbers.

Other groups have compared TL-01 and PUVA using half-body comparison19,23,25 and randomized controlled trials.23,25 Van Weelden et al22 treated 10 patients with twice-weekly TL-01 and PUVA until there was a sustained benefit to one half of the body. Patients then chose which treatment they preferred. There was no difference between these modalities in 5 patients, but PUVA was superior in 2 and TL-01 in 3. Seven patients favored whole-body treatment with TL-01, and 3 preferred PUVA. Tanew et al,23 in another half-body comparison, treated patients 3 times weekly with TL-01 and PUVA up to a maximum of 18 exposures. There was no significant difference in PASI score reduction on each side after 15 exposures. However, when patients were stratified according to pretreatment PASI score, those patients with the highest scores cleared better with PUVA. We therefore divided our patients according to pretreatment PASI score but failed to confirm that PUVA was more effective for patients with higher PASI scores.

Gordon et al24 randomized 100 patients to receive either twice-weekly TL-01 or PUVA.24 Clearance of psoriasis was faster and occurred in a greater proportion of patients with PUVA. Patients treated with PUVA remained clear for longer also. In a recent half-body comparison, Dawe et al25 treated 18 patients with 3-times weekly TL-01 and twice-weekly trimethyl psoralen bath UV-A and reported that both treatments were equally effective. Remission data from this study24 and that of Dawe et al25 show no significant difference between TL-01 and PUVA. However, if TL-01 is only used twice weekly, remission data with PUVA are superior.24 It seems from these studies that TL-01 is as effective as PUVA but only if used 3 times weekly. Twice-weekly PUVA is as effective as 3-times weekly PUVA.3 Three-times weekly TL-01 is preferable to daily therapy,27 but there are no published data comparing 3-times weekly and twice-weekly TL-01.

In our unit we favor twice-weekly PUVA and 3-times weekly TL-01, as used in the present study, to be the optimum regimens for our predominantly skin type I (25%) and type II (50%) population.28 We have been using TL-01 since 1996, and it has gradually displaced PUVA as the phototherapy of choice for 70% patients with CPP. It is safer because of a lower long-term risk factor profile21 compared with PUVA.79 It is more popular with patients because they do not have to take tablets or wear protective spectacles. Also, it can be used during pregnancy and in children. The advantages of TL-01 compared with PUVA may only be worthwhile if TL-01 is as effective as PUVA for the treatment of CPP. Our results are consistent with those of other studies and suggest that 3-times weekly TL-01 is as effective as twice-weekly PUVA. Others have suggested that patients with more severe psoriasis may respond better to PUVA, but we were unable to reproduce their findings.23 Therefore, we recommend TL-01 as the phototherapy of choice for patients with CPP.

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Article Information

Corresponding author and reprints: Trevor Markham, MB, MRCPI, City of Dublin Skin and Cancer Hospital, Hume St, Dublin 2, Ireland (e-mail: trevormarkham@hotmail.com).

Accepted for publication July 30, 2002.

This study was presented at British Association of Dermatologists 2001 annual meeting, Cardiff, Wales (Br J Dermatol. 2001;145 [suppl 59]:25).

We thank Imelda Waters, SRN, Nora Treacy, SRN, and Sister Felicity Fitzpatrick at the Day Care Unit, City of Dublin Skin and Cancer Hospital, for their help in conducting this study. We also thank Kathleen O'Sullivan, University College Cork, Cork, Ireland, for the statistical analysis.

References
1.
Parrish  JAFitzpatrick  TBTanenbaum  LPathak  MA Photochemotherapy of psoriasis with oral methoxsalen and longwave ultraviolet light. N Engl J Med. 1974;2911207- 1211Article
2.
Wolff  KFitzpatrick  TBParrish  JA  et al.  Photochemotherapy for psoriasis with orally administered methoxsalen. Arch Dermatol. 1976;112943- 950Article
3.
Melski  JWTanenbaum  LParrish  JAFitzpatrick  TBBleich  HL Oral methoxsalen photochemotherapy for the treatment of psoriasis: a cooperative clinical trial. J Invest Dermatol. 1977;68328- 335Article
4.
Henseler  THönigsmann  HWolff  KChristophers  E Oral 8 methoxypsoralen photochemotherapy of psoriasis. Lancet. 1981;1853- 857Article
5.
Rogers  SMarks  JShuster  SBriffa  DVWarin  AGreaves  M Comparison of photochemotherapy and dithranol in the treatment of chronic plaque psoriasis. Lancet. 1979;1455- 458Article
6.
Linelöf  BSigurgeirsson  BTegner  E  et al.  PUVA and cancer: a large-scale epidemiological study. Lancet. 1991;33891- 93Article
7.
Stern  RSLunder  EJ Risk of squamous cell carcinoma and methoxsalen (psoralen) and UV-A radiation (PUVA): a meta-analysis. Arch Dermatol. 1998;1341582- 1585
8.
Stern  RLaird  N The carcinogenic risk of treatments for severe psoriasis. Cancer. 1994;732759- 2764Article
9.
Stern  R The risk of melanoma in association with long term exposure to PUVA. J Am Acad Dermatol. 2001;44755- 761Article
10.
Parrish  JAJaenicke  KF Action spectrum for phototherapy of psoriasis. J Invest Dermatol. 1981;76359- 362Article
11.
Fisher  T UV-light treatment of psoriasis. Derm Venereol. 1976;56473- 479
12.
Van Weelden  HDe la Faille  HBYoung  EVan Der Leun  JC A new development in UVB phototherapy of psoriasis. Br J Dermatol. 1988;11911- 19Article
13.
British Photodermatology Group, An appraisal of narrowband (TL01) UVB phototherapy: British Photodermatology Group Workshop Report (April 1996). Br J Dermatol. 1997;137327- 330Article
14.
Green  CFerguson  JLakshmipathi  TJohnson  BE 311nm UVB phototherapy—an effective treatment for psoriasis. Br J Dermatol. 1988;119691- 696Article
15.
Storbeck  KHölze  ESchürer  NLehmann  PPlewig  G Narrow-band UVB (311nm) versus conventional broad-band UVB with and without dithranol in phototherapy for psoriasis. J Am Acad Dermatol. 1993;28227- 231Article
16.
Coven  TRBurack  LHGilleaudeau  PKeogh  MOzawa  MKrueger  JG Narrowband UVB produces superior clinical and histological resolution of moderate to severe psoriasis I patients compared with broadband UVB. Arch Dermatol. 1997;1331514- 1522Article
17.
Picot  EMeunier  LPicot-Debeze  MCPeyron  JLMeynadier  J Treatment of psoriasis with a 311-nm UVB lamp. Br J Dermatol. 1992;127509- 512Article
18.
Larkö  O Treatment of psoriasis with a new lamp. Acta Derm Venereol (Stockh). 1989;69357- 359
19.
Markham  TCollins  P An audit of adverse effects of oral 8-methoxypsoralen ultraviolet (UV)A and narrowband UVB phototherapy in the management of chronic plaque psoriasis [abstract]. Br J Dermatol. 2001;145 (suppl 59) 44Article
20.
Young  AR Carcinogenicity of UVB phototherapy assessed. Lancet. 1995;3451431- 1432Article
21.
De Gruijl  FR Long-term side effects and carcinogenesis risk in UVB therapy. Honigsmann  HJori  GYoung  AReds.The Fundamental Bases of Phototherapy Milan, Italy OEMF Spa1996;153- 170
22.
Van Weelden  HDe la Faille  HBYoung  EVan Der Leun  JC Comparison of narrowband UVB phototherapy and PUVA photochemotherapy in the treatment of psoriasis. Acta Derm Venereol. 1990;70212- 215
23.
Tanew  ARadakovic-Fijan  SSchemper  MHonigsmann  H Narrowband UV-B phototherapy vs photochemotherapy in the treatment of chronic plaque psoriasis. Arch Dermatol. 1999;135519- 524Article
24.
Gordon  PMDiffey  LMatthews  JNSFarr  PM A randomised comparison of narrow-band TL-01 phototherapy and PUVA photochemotherapy for psoriasis. J Am Acad Dermatol. 1999;41728- 732Article
25.
Dawe  RSCameron  HYule  S  et al.  A comparison of TL01 UVB phototherapy and bath-PUVA for chronic plaque psoriasis [abstract]. Br J Dermatol. 2000;143 (suppl 57) 15
26.
De Berker  DARSakuntabhai  ADiffey  BLFarr  PM Comparison of psoralen-UVB and psoralen UVA photochemotherapy in the treatment of psoriasis. J Am Acad Dermatol. 1997;36577- 581Article
27.
Dawe  RSWainwright  NJCameron  HFerguson  J Narrow-band (TL-01) ultraviolet B phototherapy for chronic plaque psoriasis: three times or five times weekly treatment? Br J Dermatol. 1998;138833- 839Article
28.
Gibson  GCodd  MBMurphy  GM Skin type distribution and skin disease in Ireland. Ir J Med Sci. 1997;16672- 74Article
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