Predicting remission of psoriasis after phototherapy
Research type
Research Study
Full title
Is the duration of remission of psoriasis increased after complete clearance versus 'almost complete' clearance following narrowband UVB phototherapy?
IRAS ID
137808
Contact name
Sophie Weatherhead
Contact email
Sponsor organisation
Research and Development
Research summary
Psoriasis is a chronic disabling inflammatory skin condition affecting 2% of the UK population. UVB (ultraviolet B) light is one of the few treatments which can clear psoriasis completely. Some patients then stay clear for months or even years. The most commonly used form of UVB treatment is narrowband UVB (NbUVB), which is effective in approximately 70% of patients. Many patients completing a course are ‘almost clear’ on discharge (often with just 1 or 2 small areas remaining), but clinical observation suggests that the psoriasis in these patients may come back quicker than in patients who clear completely.
Psoriasis improves faster, and arguably more completely, when higher exposures of UVB are given. Although psoriatic areas tolerate this well, adjacent uninvolved skin would burn, therefore in routine UVB treatment when the patients’ whole body is exposed, the amount of UVB which can safely be given per treatment session is limited. Recently a 308nm Excimer Lamp has been developed which targets individual patches of psoriasis using medium/ high dose NbUVB, while avoiding exposure of adjacent uninvolved skin. During a course of treatment, there are often a few areas of psoriasis which are slower to clear/ more resistant to treatment. We will assess the adjunctive use of the 308nm Excimer Lamp to these “resistant” areas during routine NbUVB treatment, in an attempt to improve clearance for the patient. During phototherapy, patients with localised resistant plaques will be allocated at random to receive routine NbUVB or routine NbUVB plus 308nm Excimer treatment to these “resistant” plaques. The main outcome of the study will be to see if this extra treatment influences the time patients remain clear after stopping treatment. Patients will be followed up until relapse or up to 18 months following end of their course of phototherapy. Other outcome measures will include assessment of whether baseline clinical and/or laboratory factors predict improvement/ duration of remission.
Understanding whether complete clearance of psoriasis is important for prolonged remission will inform effective management of psoriasis patients’ potentially providing longer disease remission, and with fewer treatment courses required overall. This may reduce the need for systemic treatment, lead to improved safety, and provide insights into mechanism of remission and relapse.
REC name
North East - Newcastle & North Tyneside 1 Research Ethics Committee
REC reference
13/NE/0357
Date of REC Opinion
7 Jan 2014
REC opinion
Further Information Favourable Opinion