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Combination effect of methotrexate with Narrowband Ultraviolet B (NB-UVB) phototherapy in psoriasis vulgaris patients in dermatology and venereology outpatient clinic Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

  • Emma Hidayati Sasmito ,
  • Iskandar Zulkarnain ,
  • Muhammad Yulianto Listiawan ,
  • Diah Mira Indramaya ,
  • Linda Astari ,
  • Budi Utomo ,
  • Afif Nurul Hidayati ,

Abstract

Background: Psoriasis is a chronic, recurrent, inflammatory skin disease that alters the quality of life. Systemic therapy and biologic agents are prescribed for severe and widespread psoriasis, but these drugs may have systemic side effects and immune suppression. Narrowband Ultraviolet B (NB-UVB) phototherapy remains one of the most effective and safe treatments for psoriasis.

Methods: This study was an observational retrospective cohort with one group pretest and post-test design. A retrospective analysis was done on 16 medical records of patients who met the inclusion criteria. The efficacy of the therapy was identified and analyzed using the SPSS version 17 for Windows.

Results: This study found that 16 psoriasis patients received NB-UVB phototherapy, 11 (68.75%) in men and 5 (31.25%) in women. The mean age was 47.31 years. There was a statistically significant difference in the reduction in PASI score before and after receiving combination methotrexate with 24 sessions of NB-UVB phototherapy (p=0.000); the delta PASI score was 45,02%. A statistical analysis based on the number of phototherapy sessions per week showed enhanced results when patients attended 3 phototherapy sessions per week (p = 0.001).

Conclusion: There was a statistically significant reduction in PASI score in psoriasis vulgaris patients before and after receiving combination methotrexate with 24 sessions of NB-UVB phototherapy.

References

  1. Armstrong AW, Read C. Pathophysiology, Clinical Presentation, and Treatment of Psoriasis: A Review. JAMA. 2020;323(19):1945-1960.
  2. Mahmood AN, Saeed MY. Extracutaneous manifestations of adult psoriatic patients attending Dermatology Teaching Center in Slemani, Iraq. Bali Medical Journal. 2020;9(1):121-124.
  3. Dogra S, De D. Narrowband ultraviolet B in the treatment of psoriasis: the journey so far!. Indian J Dermatol Venereol Leprol. 2010;76(6):652-661.
  4. Ito T, Takahashi H, Kawada A, Iizuka H, Nakagawa H; Japanese Society For Psoriasis Research. Epidemiological survey from 2009 to 2012 of psoriatic patients in Japanese Society for Psoriasis Research. J Dermatol. 2018;45(3):293-301.
  5. Colombo D, Cassano N, Bellia G, Vena GA. Gender medicine and psoriasis. World J Dermatol. 2014;3(3):36–44.
  6. Han JH, Lee JH, Han KD, Seo HM, Bang CH, Park YM, et al. Epidemiology and Medication Trends in Patients with Psoriasis: A Nationwide Population-based Cohort Study from Korea. Acta Derm Venereol. 2018;98(4):396-400.
  7. Parisi R, Symmons DP, Griffiths CE, Ashcroft DM; Identification and Management of Psoriasis and Associated ComorbidiTy (IMPACT) project team. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol. 2013;133(2):377-385.
  8. Van TN, Van TH, Minh PPT, Trong HN, Van TC, Huu ND, et al. Efficacy of Narrow - Band UVB Phototherapy versus PUVA Chemophototherapy for Psoriasis in Vietnamese Patients. Open Access Maced J Med Sci. 2019;7(2):227-230.
  9. Nakamura M, Farahnik B, Bhutani T. Recent advances in phototherapy for psoriasis. F1000Res. 2016;5:F1000 Faculty Rev-1684.
  10. Chan IL, Cohen S, da Cunha MG, Maluf LC. Characteristics and management of Asian skin. Int J Dermatol. 2019;58(2):131-143.
  11. Pathirana D, Ormerod AD, Saiag P, Smith C, Spuls PI, Nast A, et al. European S3-guidelines on the systemic treatment of psoriasis vulgaris. J Eur Acad Dermatol Venereol. 2009;23 Suppl 2:1-70.
  12. Rai T, Singh SK. Role of folic acid supplementation in reducing side effects of oral methotrexate in patients of psoriasis: A study. Indian J Drugs Dermatol. 2016;2(1):83-86.
  13. Domaga?a A, Szepietowski J, Reich A. Antihistamines in the treatment of pruritus in psoriasis. Postepy Dermatol Alergol. 2017;34(5):457-463.
  14. Elmets CA, Lim HW, Stoff B, Connor C, Cordoro KM, Lebwohl M, et al. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis with phototherapy. J Am Acad Dermatol. 2019;81(3):775-804.
  15. Wang TS, Tsai TF. Managing Scalp Psoriasis: An Evidence-Based Review. Am J Clin Dermatol. 2017;18(1):17-43.
  16. Blakely K, Gooderham M. Management of scalp psoriasis: current perspectives. Psoriasis (Auckl). 2016;6:33-40.
  17. Elghandour TM, Youssef Sel S, Aly DG, Abd Elhameed MS, Abdel Moneim MM. Effect of Narrow Band Ultraviolet B Therapy versus Methotrexate on Serum Levels of Interleukin-17 and Interleukin-23 in Egyptian Patients with Severe Psoriasis. Dermatol Res Pract. 2013;2013:618269.
  18. Rácz E, Prens EP, Kurek D, Kant M, de Ridder D, Mourits S, et al. Effective treatment of psoriasis with narrow-band UVB phototherapy is linked to suppression of the IFN and Th17 pathways. J Invest Dermatol. 2011;131(7):1547-58.
  19. Saleky S, Bulur I, Saraço?lu ZN. Narrowband UVB treatment increases serum 25-hydroxyvitamin D levels in patients with chronic plaque psoriasis. Cutis. 2017;99(6):431-435.
  20. Dogra S, Mahajan R. Systemic methotrexate therapy for psoriasis: past, present and future. Clin Exp Dermatol. 2013;38(6):573-588.
  21. Khadka D, Agrawal S, Dhali T. Methotrexate plus narrow band ultraviolet B (NBUVB) versus methotrexate alone in the treatment of moderate to severe plaque psoriasis: A randomized clinical trial. Nepal Journal of Dermatology, Venereology & Leprology. 2016;13(1):12–23.
  22. Al-Hamamy HR, Al-Mashhadani SA, Mustafa IN. Comparative study of the effect of narrowband ultraviolet B phototherapy plus methotrexate vs. narrowband ultraviolet B alone and methotrexate alone in the treatment of plaque-type psoriasis. Int J Dermatol. 2014;53(12):1531-1535. d
  23. Chang YT, Chen TJ, Liu PC, Chen YC, Chen YJ, Huang YL, et al. Epidemiological study of psoriasis in the national health insurance database in Taiwan. Acta Derm Venereol. 2009;89(3):262-6.
  24. Matos TR, Ling TC, Sheth V. Ultraviolet B radiation therapy for psoriasis: Pursuing the optimal regime. Clin Dermatol. 2016;34(5):587-593.
  25. Ye J, Huang H, Luo G, Yin L, Li B, Chen S, et al NB-UVB irradiation attenuates inflammatory response in psoriasis. Dermatol Ther. 2020;33(4):e13626.

How to Cite

Sasmito, E. H., Zulkarnain, I., Listiawan, M. Y., Indramaya, D. M., Astari, L., Utomo, B., & Hidayati, A. N. (2022). Combination effect of methotrexate with Narrowband Ultraviolet B (NB-UVB) phototherapy in psoriasis vulgaris patients in dermatology and venereology outpatient clinic Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Bali Medical Journal, 11(1), 116–121. https://doi.org/10.15562/bmj.v11i1.3071

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Emma Hidayati Sasmito
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Iskandar Zulkarnain
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Muhammad Yulianto Listiawan
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Diah Mira Indramaya
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Linda Astari
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Budi Utomo
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Afif Nurul Hidayati
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