CRC - Phototherapy and Photochemotherapy for Skin Disease

Organization: CRC
Publication Date: 18 July 2005
Page Count: 350


The third edition of this book has the same overall aim as the first two editions: to be a practical handbook for physicians and other medical personnel interested in using UV therapy. It is not meant to be an academic tome but instead is based on 30 years of experience practicing phototherapy blended with an appraisal of the many hundreds of published studies on the subject.

There have been dramatic changes in the use of light to treat skin disease in the past decade and these changes are reflected in this reorganized and updated edition. The most important innovation has been narrowband (311 nm) UV phototherapy. First introduced more than 20 years ago, it became available in North America only 7 years ago and is an effective alternative to PUVA therapy for psoriasis and other diseases in many patients. Protocols for this treatment, its therapeutic spectrum, advantages, and limitations are described in detail. The introduction of targeted therapy using high-output sources such as the excimer laser for treatment of localized psoriasis is an outgrowth of this new modality using a similar wavelength (308 nm) and providing opportunities to treat disease of the scalp and other areas previously off limits to phototherapy. Coupled with these changes has been a declining use of PUVA therapy due particularly to concern about adverse effects such as melanoma, photoaging, and squamous cell carcinoma. This treatment may be in decline but it is not dead since it retains many advantages for the therapist and patients; a balanced evaluation of present and safe use of PUVA therapy is presented. There are some emerging new modalities such as UVA-1 phototherapy and use of light to treat acne and the most recent information on these treatments is evaluated.

More than 60% of the book has been revised and several new chapters have been added. Phototherapy for psoriasis is often used as a combination treatment rather than a monotherapy and this is reflected in the addition of a separate chapter for this subject. Introduction of the so-called biologic treatments for psoriasis make combination therapy even more important since they are likely to influence use of phototherapy and vice versa. Similarly, phototherapy is not just a treatment for psoriasis and this is emphasized because more than 40% of patients receiving this treatment may not have psoriasis as it has become the standard of care for more than 30 other diseases. A separate chapter on treatment of children has been included since there are many aspects to their treatment that are different from adult therapy.

This edition has been extensively reorganized with two aims. First, greater integration of basic principles into the ''practical'' chapters to allow easier understanding of protocols, problems, and their solutions. Second, many new tables have been added to highlight important information and concepts. Finally, new attention has been focused on the economics of the delivery of phototherapy since without attention to the bottom line this treatment can easily go the way of the Dodo bird.