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Systematic review of radiotherapy for cutaneous psoriasis: bringing an old treatment into the modern age


International Journal of Radiology & Radiation Therapy
Richard Shaffer,1 MH Seegenschmiedt,2 R Panizzon,3 C Tziotzios,4 C Baker,5 J Ferguson4

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Abstract

Background/Objectives: Radiotherapy has been used successfully over decades to treat psoriasis but has fallen out of favour more recently in many countries. Whilst novel biologic treatments for psoriasis can be very effective in moderate-to-severe and refractorysite disease, they are costly and may have significant side-effects including potential carcinogenesis. Methods: A structured search was conducted for papers looking at the effectiveness of radiotherapy for cutaneous psoriasis. The findings were narratively synthesized. Results: Most studies concluded that radiation has a role in the treatment of patients with psoriasis, particularly in difficult to treat areas such as the nails, scalp, hands and feet. Response rate for scalp psoriasis was 78-89%, with a durable response at 6 months in 31- 53%; Hyperkeratotic psoriasis of the palms and soles had a response rate of 73-94% with durable responses at 1.6 - 4 years in 36-50%. There was weaker evidence for the treatment of nail psoriasis and palmo-plantar pustulosis. Conclusions: Radiotherapy should be considered as a useful adjunct to topical and systemic treatments for psoriasis, although overall there remains a need for further research.

Keywords

Psoriasis, Radiotherapy, Grenz rays, superficial X-rays, Benign, Electrons

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