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PSORIASIS:

Phototherapy and
Photochemotherapy
Dosing Guidelines
American Academy of Dermatology
DOSING GUIDELINES FOR BROADBAND UVB*,1,4
According to Skin Type:

Skin Type Initial UVB dose UVB Increase After Each Treatment
Type I 20 mJ/cm 2
5 mJ/cm2
Type II 25 mJ/cm2 10 mJ/cm2
Type III 30 mJ/cm 2
15 mJ/cm2
Type IV 40 mJ/cm2 20 mJ/cm2
Type V 50 mJ/cm 2
25 mJ/cm2
Type VI 60 mJ/cm 2
30 mJ/cm2

*(Administered 3-5 times a week)

According to Minimal Erythema Dose*:

Initial UVB 50% of the MED


Treatment 1 -10 Increase by 25% of the initial MED

Treatment 11-20 Increase by 10% of the initial MED


Treatment 21 and after As ordered by physician

*(Administered 3-5 times a week)

If subsequent treatments are missed for:

4-7 days Keep dose same


1-2 weeks Decrease the dose by 50%

2-3 weeks Decrease the dose by 75%


3-4 weeks Start over

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DOSING GUIDELINES FOR NARROWBAND UVB*,#,2,4
According to Skin Type:
Skin Type Initial UVB UVB Increase Maximum
dose After Each Treatment dose
Type I 130 mJ/cm2 15 mJ/cm2 2000 mJ/cm2
Type II 220 mJ/cm2 25 mJ/cm2 2000 mJ/cm2
Type III 260 mJ/cm2 40 mJ/cm2 3000 mJ/cm2
Type IV 330 mJ/cm 2
45 mJ/cm 2
3000 mJ/cm2
Type V 350 mJ/cm 2
60 mJ/cm 2
5000 mJ/cm2
Type VI 400 mJ/cm2 65 mJ/cm2 5000 mJ/cm2

*(Administered 3-5 times a week)


#
Since there is a broad range of MED for NB-UVB by skin type, MED testing is generally recommended
It is critically important to meter the UVB machine once weekly. UVB lamps steadily lose power. If the UV output is not periodically
measured and the actual output calibrated into the machine, the clinician may have the false impression that the patient can be
treated with higher doses when the machine is actually delivering a much lower dose than the number entered.

According to Minimal Erythema Dose*:

Initial UVB 50% of the MED


Treatment 1-20 Increase by 10% of the initial MED
Treatment 21 and after increase as ordered by physician
*(Administered 3 times a week)

If subsequent treatments are missed for:

4-7 days Keep dose same


1-2 weeks Decrease the dose by 25%
2-3 weeks Decrease the dose by 50% or start over
3-4 weeks Start over

Maintenance Therapy for NB-UVB after >95% clearance:

1/ week NB-UVB for 4 weeks Keep the dose same


1/ 2 weeks NB-UVB for 4 weeks Decrease dose by 25%
1/ 4 weeks NB-UVB 50% of highest dose
The minimum frequency of phototherapy sessions required per week for successful maintenance as well as the length of maintenance
period varies tremendously between individuals. The above table represents the most ideal situation where the patient can taper off
phototherapy. In reality, many patients require once a week NB-UVB phototherapy indefinitely for successful long term maintenance.

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DOSING GUIDELINES FOR TARGETED THERAPY3,4
Initial Dose for Psoriasis:
Plaque Induration Fitzpatrick skin type 1-3 Fitzpatrick skin type 4-6
Thickness Score (Dose in mJ/cm2) (Dose in mJ/cm2)
None 0
Mild 1 500 400
Moderate 2 500 600

Severe 3 700 900

Dose for Subsequent Treatments:


No Minimal Good Considerable Moderate/
Effect Effect Effect Improvement severe erythema
(with or without
No erythema Slight erythema Mild to moderate Significant blistering)
at 12-24 at 12-24 hours erythema improvement
hours and but no significant response with plaque
no plaque improvement 12-24 hours thinning or
improvement reduced
scaliness or
pigmentation
occurred

Typical Dosing Change from Prior Treatment Dose


Increase Increase Dose by Maintain Dose Maintain Dose Reduce Dose
dose by 25% 15% or Reduce by 25% (Treat
Dose by 15% around blistered
area, do no treat
blistered area
until it heals or
crust disappears)

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DOSING OF 8-METHOXYPSORALEN FOR ORAL PUVA1,4
Patient Weight:

(Pounds) (Kilograms) Drug Dose (mgs)


< 66 <30 10
66-143 30-65 20
144-200 66-91 30
>200 >91 40

DOSING OF UVA RADIATION FOR ORAL PUVA1,4


According to Skin Type:
Skin Type Initial Dose Increments Max
(J/cm2) (J/cm2) (J/cm2)
I 0.5 0.5 8
II 1.0 0.5 8
III 1.5 1.0 12
IV 2.0 1.0 12
V 2.5 1.5 20
VI 3.0 1.5 20

REFERENCES
1.  Adapted with permission from Zanolli MD, Feldman SR. Phototherapy treatment protocols
for psoriasis and other phototherapy responsive dermatoses. 2nd ed. New York: Informa
Healthcare; 2004.
2. A
 dapted with permission from Do A, Koo J. Initiating narrow-band UVB for the treatment of
psoriasis: how to do MED skin testing. Psoriasis Forum 2004;10:7-11.
3. XTRAC Treatment Guidelines, 12-95359-01 Rev. A March 2007.
4. M
 enter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb A, Koo
JY, Lebwohl M, Lim HW, Van Voorhees AS, Beutner KR, Bhushan R. 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 Jan;62(1):114-35.

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American Academy of Dermatology
Correspondence: PO Box 4014
Schaumburg, Illinois 60168
Toll-free: 866.503.SKIN (7546)
International: 847.240.1280
Fax: 847.240.1859

For more information:


http://www.aad.org/research/guidelines/index.html

 enter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon
M
KB, Gottlieb A, Koo JY, Lebwohl M, Lim HW, Van Voorhees AS, Beutner
KR, Bhushan R. 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 Jan;62(1):114-35.

Copyright 2010 American Academy of Dermatology. All rights reserved.


Artwork by Reva Bhushan and Nicole Torling

10-653D