Lack of Consensus Among Experts on the Choice of UV Therapy for Psoriasis

Context Each year tens of thousands of patients in the United States are treated with UV-B radiation or psoralen plus UV-A radiation (PUVA) for a variety of skin disorders. Although PUVA is generally considered more effective, it is also more toxic and more expensive. The degree of consensus among experts in prescribing these alternative treatments has not been quantified. Objectives To quantify variation among specialty clinics in the type of ultraviolet therapy used to treat specific skin conditions and assess factors associated with the use of specific treatments. Design Survey conducted during two 2-week periods in the late fall of 1994 and early spring of 1995. Setting Thirty-nine specialty clinics in 17 US geographic areas in 14 states and Washington, DC. Participants A total of 3401 patients treated with UV radiation one or more times. Outcome Measures Type of UV therapy used and indications for treatment, age, sex, number of patients treated, and geographic location of each clinic. Results The proportion of patients at each center treated with PUVA ranged from 0% to 93% (mean, 41%). Clinic size and geographic location, demographic characteristics of the patients, and diagnosis did not explain these large intercenter differences. Conclusions Among specialized clinics, there is little consistency in the use of alternative therapies, which differ substantially in safety and cost, but whose relative efficacy is not well quantified. There is a lack of consensus among experts about the circumstances in which the greater risks and costs of PUVA are outweighed by its possibly greater efficacy, especially in the treatment of psoriasis.