Ultraviolet Therapy for Psoriasis

  • Tien V. Nguyen
  • John Y. M. Koo


Total-body ultraviolet therapy (UV) for moderate-to-severe psoriasis consists of narrowband and broadband-UVB, psoralen plus UVA (PUVA – where psoralen can be ingested orally or applied topically), inpatient phototherapy (i.e. Goeckerman Therapy, Ingram therapy), non-office-based phototherapy (i.e. use of commercial sunlamps/sunbeds or home UVB for psoriasis treatment, heliotherapy, climatotherapy), and combined UVB/PUVA with retinoid or biologic agents. For each type of UV therapy discussed in this chapter, essential information regarding dosage and administration, efficacy (including comparator data if available), short-term side effects, and long-term photocarcinogenic risks are discussed. A well-balanced understanding of the advantages and drawbacks of each photo-therapeutic option can help phototherapy practitioners optimize clinical outcomes as well as enhance the quality of life for patients affected by this chronic skin condition.


Ultraviolet therapy NB-UVB BB-UVB PUVA Goeckerman Therapy Ingram therapy Tanning Home UVB Heliotherapy Climatotherapy Combination therapy 


  1. 1.
    Gattu S, Pugashetti R, Koo JY. The art and practice of UVB phototherapy and laser for the treatment of moderate-to-severe psoriasis. In: Koo JYM, Lee CS, Lebwohl MG, Weinstein GD, Gottlieb A, editors. Moderate-to-severe psoriasis. 3rd ed. New York: Informa Healthcare; 2009. p. 75–113.Google Scholar
  2. 2.
    Menter A, Korman NJ, Elmets CA, et al. 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. 2010;62(1):114–35.PubMedCrossRefGoogle Scholar
  3. 3.
    Do AN, Koo JYM. Initiating narrow-band UVB for the treatment of psoriasis. Psoriasis Forum. 2004;10(1):1–6.Google Scholar
  4. 4.
    Green C, Ferguson J, Lakshmipathi T, Johnson BE. 311 nm UVB phototherapy–an effective treatment for psoriasis. Br J Dermatol. 1988;119(6):691–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Coven TR, Burack LH, Gilleaudeau P, Keogh M, Ozawa M, Krueger JG. Narrowband UV-B produces superior clinical and histopathological resolution of moderate-to-severe psoriasis in patients compared with broadband UV-B2. Arch Dermatol. 1997;133(12):1514–22.PubMedCrossRefGoogle Scholar
  6. 6.
    Karakawa M, Komine M, Takekoshi T, et al. Duration of remission period of narrowband ultraviolet B therapy on psoriasis vulgaris. J Dermatol. 2011;38(7):655–60.PubMedCrossRefGoogle Scholar
  7. 7.
    Parrish JA, Jaenicke KF. Action spectrum for phototherapy of psoriasis. J Invest Dermatol. 1981;76(5):359–62.PubMedCrossRefGoogle Scholar
  8. 8.
    Lee ES, Heller MM, Kamangar F, Park K, Koo JYM. Current treatment options: phototherapy. In: Feldman SR, ed. Current & Emerging Treatments for Psoriasis. 1st ed. Future Medicine. 2011:60–71. Accessed on Aug 2011.Google Scholar
  9. 9.
    Boyd AS, Menter A. Erythrodermic psoriasis. Precipitating factors, course, and prognosis in 50 patients. J Am Acad Dermatol. 1989;21(5):985–91.PubMedCrossRefGoogle Scholar
  10. 10.
    Flindt-Hansen H, McFadden N, Eeg-Larsen T, Thune P. Effect of a new narrow-band UVB lamp on photocarcinogenesis in mice. Acta Derm Venereol. 1991;71(3):245–8.PubMedGoogle Scholar
  11. 11.
    Wulf HC, Hansen AB, Bech-Thomsen N. Differences in narrow-band ultraviolet B and broad-spectrum ultraviolet photocarcinogenesis in lightly pigmented hairless mice. Photodermatol Photoimmunol Photomed. 1994;10(5):192–7.PubMedGoogle Scholar
  12. 12.
    Lee E, Koo J, Berger T. UVB phototherapy and skin cancer risk: a review of the literature. Int J Dermatol. 2005;44(5):355–60.PubMedCrossRefGoogle Scholar
  13. 13.
    Hannuksela-Svahn A, Pukkala E, Laara E, Poikolainen K, Karvonen J. Psoriasis, its treatment, and cancer in a cohort of Finnish patients. J Invest Dermatol. 2000;114(3):587–90.PubMedCrossRefGoogle Scholar
  14. 14.
    Black RJ, Gavin AT. Photocarcinogenic risk of narrowband ultraviolet B (TL-01) phototherapy: early follow-up data. Br J Dermatol. 2006;154(3):566–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Hearn RMR, Kerr AC, Rahim KF, Ferguson J, Dawe RS. Incidence of skin cancers in 3867 patients treated with narrow-band ultraviolet B phototherapy. Br J Dermatol. 2008;159(4):931–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Weischer M, Blum A, Eberhard F, Rocken M, Berneburg M. No evidence for increased skin cancer risk in psoriasis patients treated with broadband or narrowband UVB phototherapy: a first retrospective study. Acta Derm Venereol. 2004;84(5):370–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Man I, Crombie IK, Dawe RS, Ibbotson SH, Ferguson J. The photocarcinogenic risk of narrowband UVB (TL-01) phototherapy: early follow-up data. Br J Dermatol. 2005;152(4):755–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Sivanesan SP, Gattu S, Hong J, et al. Randomized, double-blind, placebo-controlled evaluation of the efficacy of oral psoralen plus ultraviolet A for the treatment of plaque-type psoriasis using the Psoriasis Area Severity Index score (improvement of 75 % or greater) at 12 weeks. J Am Acad Dermatol. 2009;61(5):793–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Henseler T, Wolff K, Honigsmann H, Christophers E. Oral 8-methoxypsoralen photochemotherapy of psoriasis. The European PUVA study: a cooperative study among 18 European centres. Lancet. 1981;1(8225):853–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Snellman E, Klimenko T, Rantanen T. Randomized half-side comparison of narrowband UVB and trimethylpsoralen bath plus UVA treatments for psoriasis. Acta Derm Venereol. 2004;84(2):132–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Dawe RS, Cameron H, Yule S, et al. A randomized controlled trial of narrowband ultraviolet B vs bath-psoralen plus ultraviolet A photochemotherapy for psoriasis. Br J Dermatol. 2003;148(6):1194–204.PubMedCrossRefGoogle Scholar
  22. 22.
    Gordon PM, Diffey BL, Matthews JN, Farr PM. A randomized comparison of narrow-band TL-01 phototherapy and PUVA photochemotherapy for psoriasis. J Am Acad Dermatol. 1999;41(5):728–32.PubMedCrossRefGoogle Scholar
  23. 23.
    Yones SS, Palmer RA, Garibaldinos TT, Hawk JLM. Randomized double-blind trial of the treatment of chronic plaque psoriasis: efficacy of psoralen-UV-a therapy vs narrowband UV-B therapy. Arch Dermatol. 2006;142(7):836–42.PubMedGoogle Scholar
  24. 24.
    Malanos D, Stern RS. Psoralen plus ultraviolet A does not increase the risk of cataracts: a 25-year prospective study. J Am Acad Dermatol. 2007;57(2):231–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Wolff K. Side-effects of psoralen photochemotherapy (PUVA). Br J Dermatol. 1990;122 Suppl 36:117–25.PubMedCrossRefGoogle Scholar
  26. 26.
    Abel EA, Reid H, Wood C, Hu C-H. PUVA-induced melanocytic atypia: is it confined to PUVA lentigines? J Am Acad Dermatol. 1985;13(5):761–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Honigsmann H, Wolff K, Gschnait F, Brenner W, Jaschke E. Keratoses and nonmelanoma skin tumors in long-term photochemotherapy (PUVA). J Am Acad Dermatol. 1980;3(4):406–14.PubMedCrossRefGoogle Scholar
  28. 28.
    Lobel E, Paver K, King R, Le Guay J, Poyzer K, Wargon O. The relationship of skin cancer to PUVA therapy in Australia. Australas J Dermatol. 1981;22(3):100–3.PubMedCrossRefGoogle Scholar
  29. 29.
    Lassus A, Reunala T, Idanpaa-Heikkila J, Juvakoski T, Salo O. PUVA treatment and skin cancer: a follow-up study. Acta Derm Venereol. 1981;61(2):141–5.PubMedGoogle Scholar
  30. 30.
    Lindskov R. Skin carcinomas and treatment with photochemotherapy (PUVA). Acta Derm Venereol. 1983;63(3):223–6.PubMedGoogle Scholar
  31. 31.
    Ros AM, Wennersten G, Lagerholm B. Long-term photochemotherapy for psoriasis: a histopathological and clinical follow-up study with special emphasis on tumour incidence and behavior of pigmented lesions. Acta Derm Venereol. 1983;63(3):215–21.PubMedGoogle Scholar
  32. 32.
    Reshad H, Challoner F, Pollock DJ, Baker H. Cutaneous carcinoma in psoriatic patients treated with PUVA. Br J Dermatol. 1984;110(3):299–305.PubMedCrossRefGoogle Scholar
  33. 33.
    Eskelinen A, Halme K, Lassus A, Idanpaan-Heikkila J. Risk of cutaneous carcinoma in psoriatic patients treated with PUVA. Photodermatol. 1985;2(1):10–4.PubMedGoogle Scholar
  34. 34.
    Tanew A, Honigsmann H, Ortel B, Zussner C, Wolff K. Nonmelanoma skin tumors in long-term photochemotherapy treatment of psoriasis. An 8-year follow-up study. J Am Acad Dermatol. 1986;15(5 Pt 1):960–5.PubMedCrossRefGoogle Scholar
  35. 35.
    Henseler T, Christophers E, Honigsmann H, Wolff K. Skin tumors in the European PUVA Study. Eight-year follow-up of 1,643 patients treated with PUVA for psoriasis. J Am Acad Dermatol. 1987;16(1 Pt 1):108–16.PubMedCrossRefGoogle Scholar
  36. 36.
    Barth J, Meffert H, Schiller F, Sonnichsen N. 10 Jahre PUVA-Therapie in der DDR-Analyse Lanzeitrisiko. Z Klin Med. 1987;42:889–92.Google Scholar
  37. 37.
    Cox NH, Jones SK, Downey DJ, et al. Cutaneous and ocular side-effects of oral photochemotherapy: results of an 8-year follow-up study. Br J Dermatol. 1987;116(2):145–52.PubMedCrossRefGoogle Scholar
  38. 38.
    Torinuki W, Tagami H. Incidence of skin cancer in Japanese psoriatic patients treated with either methoxsalen phototherapy, Goeckerman regimen, or both therapies. A 10-year follow-up study. J Am Acad Dermatol. 1988;18(6):1278–81.PubMedCrossRefGoogle Scholar
  39. 39.
    Abdullah AN, Keczkes K. Cutaneous and ocular side-effects of PUVA photochemotherapy–a 10-year follow-up study. Clin Exp Dermatol. 1989;14(6):421–4.PubMedCrossRefGoogle Scholar
  40. 40.
    Forman AB, Roenigk Jr HH, Caro WA, Magid ML. Long-term follow-up of skin cancer in the PUVA-48 cooperative study. Arch Dermatol. 1989;125(4):515–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Bruynzeel I, Bergman W, Hartevelt HM, et al. ‘High single-dose’ European PUVA regimen also causes an excess of non-melanoma skin cancer. Br J Dermatol. 1991;124(1):49–55.PubMedCrossRefGoogle Scholar
  42. 42.
    Chuang TY, Heinrich LA, Schultz MD, Reizner GT, Kumm RC, Cripps DJ. PUVA and skin cancer. A historical cohort study on 492 patients. J Am Acad Dermatol. 1992;26(2 Pt 1):173–7.PubMedCrossRefGoogle Scholar
  43. 43.
    Lever LR, Farr PM. Skin cancers or premalignant lesions occur in half of high-dose PUVA patients. Br J Dermatol. 1994;131(2):215–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Gritiyarangsan P, Sindhavananda J, Rungrairatanaroj P, Kullavanijaya P. Cutaneous carcinoma and PUVA lentigines in Thai patients treated with oral PUVA. Photodermatol Photoimmunol Photomed. 1995;11(4):174–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Maier H, Schemper M, Ortel B, Binder M, Tanew A, Honigsmann H. Skin tumors in photochemotherapy for psoriasis: a single-center follow-up of 496 patients. Dermatology. 1996;193(3):185–91.PubMedCrossRefGoogle Scholar
  46. 46.
    McKenna KE, Patterson CC, Handley J, McGinn S, Allen G. Cutaneous neoplasia following PUVA therapy for psoriasis. Br J Dermatol. 1996;134(4):639–42.PubMedCrossRefGoogle Scholar
  47. 47.
    Hannuksela A, Pukkala E, Hannuksela M, Karvonen J. Cancer incidence among Finnish patients with psoriasis treated with trioxsalen bath PUVA. J Am Acad Dermatol. 1996;35(5 Pt 1):685–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Cockayne SE, August PJ. PUVA photocarcinogenesis in Cheshire. Clin Exp Dermatol. 1997;22(6):300–1.PubMedCrossRefGoogle Scholar
  49. 49.
    Stern RS, Nichols KT, Vakeva LH. Malignant melanoma in patients treated for psoriasis with methoxsalen (psoralen) and ultraviolet A radiation (PUVA). The PUVA Follow-Up Study. N Engl J Med. 1997;336(15):1041–5.PubMedCrossRefGoogle Scholar
  50. 50.
    Stern RS. The risk of melanoma in association with long-term exposure to PUVA. J Am Acad Dermatol. 2001;44(5):755–61.PubMedCrossRefGoogle Scholar
  51. 51.
    LindelÖF B, Sigurgeirsson B, Tegner E, et al. PUVA and cancer risk: the Swedish follow-up study. Br J Dermatol. 1999;141(1):108–12.PubMedCrossRefGoogle Scholar
  52. 52.
    Hannuksela S, Sigurgeirsson B, Pukkala E, et al. Trioxsalen bath PUVA did not increase the risk of squamous cell skin carcinoma and cutaneous malignant melanoma in a joint analysis of 944 Swedish and Finnish patients with psoriasis. Br J Dermatol. 1999;141(3):497–501.PubMedCrossRefGoogle Scholar
  53. 53.
    Whitmore SE, Morison WL. Melanoma after PUVA therapy for psoriasis. N Engl J Med. 1997;337(7):502–3.PubMedCrossRefGoogle Scholar
  54. 54.
    Rigel DS, Friedman RJ, Kopf AW. The incidence of malignant melanoma in the United States: issues as we approach the 21st century. J Am Acad Dermatol. 1996;34(5 Pt 1):839–47.PubMedCrossRefGoogle Scholar
  55. 55.
    Nijsten TEC, Stern RS. The increased risk of skin cancer is persistent after discontinuation of psoralen + ultraviolet A: a cohort study. J Invest Dermatol. 2003;121(2):252–8.PubMedCrossRefGoogle Scholar
  56. 56.
    Murase JE, Lee EE, Koo J. Effect of ethnicity on the risk of developing nonmelanoma skin cancer following long-term PUVA therapy. Int J Dermatol. 2005;44(12):1016–21.PubMedCrossRefGoogle Scholar
  57. 57.
    Roelandts R. The history of phototherapy: something new under the sun? J Am Acad Dermatol. 2002;46(6):926–30.PubMedCrossRefGoogle Scholar
  58. 58.
    Serrao R, Davis MDP. Goeckerman treatment for remission of psoriasis refractory to biologic therapy. J Am Acad Dermatol. 2009;60(2):348–9.PubMedCrossRefGoogle Scholar
  59. 59.
    Menter A, Cram DL. The Goeckerman regimen in two psoriasis day care centers. J Am Acad Dermatol. 1983;9(1):59–65.PubMedCrossRefGoogle Scholar
  60. 60.
    Lee E, Koo J. Modern modified ‘ultra’ Goeckerman therapy: a PASI assessment of a very effective therapy for psoriasis resistant to both prebiologic and biologic therapies. J Dermatolog Treat. 2005;16(2):102–7.PubMedCrossRefGoogle Scholar
  61. 61.
    DesGroseilliers JP, Cullen AE, Rouleau GA. Ambulatory Goeckerman treatment of psoriasis: experience with 200 patients. Can Med Assoc J. 1981;124(8):1018–20.PubMedCentralPubMedGoogle Scholar
  62. 62.
    Gupta AK, Pierson CL, Rasmussen JE, Weiss JS. Bacteriology of pustules occurring during treatment of psoriasis. Arch Dermatol. 1987;123(7):890–2.PubMedCrossRefGoogle Scholar
  63. 63.
    Starke JC, Jillson OF. Photosensitization to coal tar. A cause of psoriatic erythroderma. Arch Dermatol. 1961;84:935–6.PubMedCrossRefGoogle Scholar
  64. 64.
    Pittelkow MR, Perry HO, Muller SA, Maughan WZ, O’Brien PC. Skin cancer in patients with psoriasis treated with coal tar: a 25-year follow-up study. Arch Dermatol. 1981;117(8):465–8.PubMedCrossRefGoogle Scholar
  65. 65.
    De Bersaques J. A retrospective study of the inpatient treatment of psoriasis with dithranol. Dermatologica. 1987;175(2):64–8.PubMedCrossRefGoogle Scholar
  66. 66.
    Schulze H-J, Schauder S, Mahrle G, Steigleder GK. Combined tar-anthralin versus anthralin treatment lowers irritancy with unchanged antipsoriatic efficacy: modifications of short-contact therapy and Ingram therapy. J Am Acad Dermatol. 1987;17(1):19–24.PubMedCrossRefGoogle Scholar
  67. 67.
    Fleischer AB, Clark AR, Rapp SR, Reboussin DM, Feldman SR. Commercial tanning bed treatment is an effective psoriasis treatment: results from an uncontrolled clinical trial. J Invest Dermatol. 1997;109(2):170–4.PubMedCrossRefGoogle Scholar
  68. 68.
    Autier P, Boniol M, Boyle P, et al. Exposure to artificial UV radiation and skin cancer. Lyon: IARC; 2005.Google Scholar
  69. 69.
    Swerdlow AJ, Weinstock MA. Do tanning lamps cause melanoma? An epidemiologic assessment. J Am Acad Dermatol. 1998;38(1):89–98.PubMedCrossRefGoogle Scholar
  70. 70.
    Gallagher RP, Spinelli JJ, Lee TK. Tanning beds, sunlamps, and risk of cutaneous malignant melanoma. Cancer Epidemiol Biomarkers Prev. 2005;14(3):562–6.PubMedCrossRefGoogle Scholar
  71. 71.
    Fears TR, Sagebiel RW, Halpern A, et al. Sunbeds and sunlamps: who used them and their risk for melanoma. Pigment Cell Melanoma Res. 2011;24(3):574–81.PubMedCentralPubMedCrossRefGoogle Scholar
  72. 72.
    Nolan BV, Yentzer BA, Feldman SR. A review of home phototherapy for psoriasis. Dermatol Online J. 2010;16(2):1.PubMedGoogle Scholar
  73. 73.
    Koek MBG, Buskens E, van Weelden H, Steegmans PHA, Bruijnzeel-Koomen CAFM, Sigurdsson V. Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: pragmatic multicentre randomised controlled non-inferiority trial (PLUTO study). BMJ. 2009;338.Google Scholar
  74. 74.
    Snellman S, Lauharanta J, Reunanen A, et al. Effect of heliotherapy on skin and joint symptoms in psoriasis: a 6-month follow-up study. Br J Dermatol. 1993;128(2):172–7.PubMedCrossRefGoogle Scholar
  75. 75.
    Harari M, Novack L, Barth J, David M, Friger M, Moses SW. The percentage of patients achieving PASI 75 after 1 month and remission time after climatotherapy at the Dead Sea. Int J Dermatol. 2007;46(10):1087–91.PubMedCrossRefGoogle Scholar
  76. 76.
    Frentz G, Olsen JH, Avrach WW. Malignant tumours and psoriasis: climatotherapy at the Dead Sea. Br J Dermatol. 1999;141(6):1088–91.PubMedCrossRefGoogle Scholar
  77. 77.
    Even-Paz Z, Efron D. Skin cancer and climatotherapy in psoriasis. Br J Dermatol. 2001;144(1):202.PubMedCrossRefGoogle Scholar
  78. 78.
    Ruzicka T, Sommerburg C, Braun-Falco O, he mult D, et al. Efficiency of acitretin in combination with UV-B in the treatment of severe psoriasis. Arch Dermatol. 1990;126(4):482–6.PubMedCrossRefGoogle Scholar
  79. 79.
    Spuls PI, Rozenblit M, Lebwohl M. Retrospective study of the efficacy of narrowband UVB and acitretin. J Dermatolog Treat. 2003;14(2):17–20.PubMedCrossRefGoogle Scholar
  80. 80.
    Busse K, Koo J. Introducing the delayed retinoid burn: a case report and discussion of this potential risk of retinoid-phototherapy combination management. J Am Acad Dermatol. 2011;64(5):1011–2.PubMedCrossRefGoogle Scholar
  81. 81.
    Tanew A, Guggenbichler A, Honigsmann H, Geiger JM, Fritsch P. Photochemotherapy for severe psoriasis without or in combination with acitretin: a randomized, double-blind comparison study. J Am Acad Dermatol. 1991;25(4):682–4.PubMedCrossRefGoogle Scholar
  82. 82.
    Green C, Lakshmipathi T, Johnson BE, Ferguson J. A comparison of the efficacy and relapse rates of narrowband UVB (TL-01) monotherapy vs. etretinate (re-TL-01) vs. etretinate-PUVA (re-PUVA) in the treatment of psoriasis patients. Br J Dermatol. 1992;127(1):5–9.PubMedCrossRefGoogle Scholar
  83. 83.
    Ozdemir M, Engin B, Baysal I, Mevlitoglu I. A randomized comparison of acitretin-narrow-band TL-01 phototherapy and acitretin-psoralen plus ultraviolet A for psoriasis. Acta Derm Venereol. 2008;88(6):589–93.PubMedGoogle Scholar
  84. 84.
    Gambichler T, Tigges C, Scola N, Weber J, Skrygan M. Etanercept plus narrowband ultraviolet B phototherapy of psoriasis is more effective than etanercept monotherapy at 6 weeks. Br J Dermatol. 2011;164(6):1383–6.PubMedCrossRefGoogle Scholar
  85. 85.
    De Simone C, D’Agostino M, Capizzi R, Capponi A, Venier A, Caldarola G. Combined treatment with etanercept 50 mg once weekly and narrow-band ultraviolet B phototherapy in chronic plaque psoriasis. Eur J Dermatol. 2011;21(4):568–72.PubMedGoogle Scholar
  86. 86.
    Bagel J. Adalimumab plus narrowband ultraviolet B light phototherapy for the treatment of moderate to severe psoriasis. J Drugs Dermatol. 2011;10(4):366–71.PubMedGoogle Scholar
  87. 87.
    Kircik L, Bagel J, Korman N, et al. Utilization of narrow-band ultraviolet light B therapy and etanercept for the treatment of psoriasis (UNITE): efficacy, safety, and patient-reported outcomes. J Drugs Dermatol. 2008;7(3):245–53.PubMedGoogle Scholar
  88. 88.
    Lebwohl M, Tannis C, Carrasco D. Acitretin suppression of squamous cell carcinoma: case report and literature review. J Dermatolog Treat. 2003;14(2):3–6.PubMedCrossRefGoogle Scholar
  89. 89.
    Nijsten TE, Stern RS. Oral retinoid use reduces cutaneous squamous cell carcinoma risk in patients with psoriasis treated with psoralen-UVA: a nested cohort study. J Am Acad Dermatol. 2003;49(4):644–50.PubMedCrossRefGoogle Scholar
  90. 90.
    Gambichler T, Tigges C, Dith A, et al. Impact of etanercept treatment on ultraviolet B-induced inflammation, cell cycle regulation and DNA damage. Br J Dermatol. 2011;164(1):110–5.PubMedCrossRefGoogle Scholar
  91. 91.
    Koo J, Lebwohl M. Duration of remission of psoriasis therapies. J Am Acad Dermatol. 1999;41(1):51–9.PubMedCrossRefGoogle Scholar
  92. 92.
    Leon A, Nguyen A, Letsinger J, Koo J. An attempt to formulate an evidence-based strategy in the management of moderate-to-severe psoriasis: a review of the efficacy and safety of biologics and prebiologic options. Expert Opin Pharmacother. 2007;8(5):617–32.PubMedCrossRefGoogle Scholar
  93. 93.
    Spuls PI, Witkamp L, Bossuyt PM, Bos JD. A systematic review of five systemic treatments for severe psoriasis. Br J Dermatol. 1997;137(6):943–9.PubMedCrossRefGoogle Scholar
  94. 94.
    Bonis B, Kemeny L, Dobozy A, Bor Z, Szabo G, Ignacz F. 308 nm UVB excimer laser for psoriasis. Lancet. 1997;350(9090):1522.PubMedCrossRefGoogle Scholar
  95. 95.
    Feldman SR, Mellen BG, Housman TS, et al. Efficacy of the 308-nm excimer laser for treatment of psoriasis: results of a multicenter study. J Am Acad Dermatol. 2002;46(6):900–6.PubMedCrossRefGoogle Scholar
  96. 96.
    Gerber W, Arheilger B, Ha TA, Hermann J, Ockenfels HM. Ultraviolet B 308-nm excimer laser treatment of psoriasis: a new phototherapeutic approach. Br J Dermatol. 2003;149(6):1250–8.PubMedCrossRefGoogle Scholar
  97. 97.
    Gattu S, Pang ML, Pugashetti R, et al. Pilot evaluation of supra-erythemogenic phototherapy with excimer laser in the treatment of patients with moderate to severe plaque psoriasis. J Dermatolog Treat. 2010;21(1):54–60.PubMedCrossRefGoogle Scholar

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© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Department of DermatologyUCSF Medical Center, Psoriasis and Skin Treatment CenterSan FranciscoUSA

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