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February 21, 2011

A Randomized Comparison of Methods of Selecting Narrowband UV-B Starting Dose to Treat Chronic Psoriasis

Author Affiliations

Author Affiliations: Photobiology Unit, Department of Dermatology, Ninewells Hospital & Medical School, Dundee, Scotland.

Arch Dermatol. 2011;147(2):168-174. doi:10.1001/archdermatol.2010.286

When topical therapies alone are insufficient, the standard next-line therapy for psoriasis in many centers is narrowband UV-B (NB–UV-B).1 This is more effective than broadband UV-B sources,2 even with a treatment regimen intended to be suberythemogenic.3 An individual patient assessment of threshold erythemogenic dose, the minimal erythemal dose (MED), is frequently used to guide the NB–UV-B starting dose. This ensures that the starting dose is not too high and identifies patients with previously unsuspected severe photosensitivity,4 as well taking into account possible drug-induced photosensitivity.5 However, it is not known whether the method of determining the starting dose influences treatment efficacy. In our predominantly skin phototype I to III population, we have previously examined some aspects of treatment methodology. Based on these studies addressing different methodological aspects of NB–UV-B phototherapy (Table 1),6-10 our standard regimen to treat psoriasis is now a 3-times-weekly treatment with a 20% followed by a 10% incremental reduction in dose after an MED-based starting dose.