These articles have been accepted for publication in the British Journal of Dermatology and are currently being edited and typeset. Readers should note that articles published below have been fully refereed, but have not been through the copy-editing and proof correction process. WileyBlackwell and the British Association of Dermatologists cannot be held responsible for errors or consequences arising from the use of information contained in these articles; nor do the views and opinions expressed necessarily reflect those of Wiley-Blackwell or the British Association of Dermatologists This article is protected by copyright. All rights reserved. Received Date : 13-May-2014 Revised Date : 22-Sep-2014 Accepted Date : 05-Oct-2014 Article type : Photobiology

Digital ultraviolet (UV) therapy – a novel therapeutical approach for the targeted treatment of psoriasis vulgaris Running title: Digital UV-therapy of psoriasis vulgaris T. Werfel1, F. Holiangu 1, K.-H. Niemann2, O. Schmerling2, F. Lüllau3, A. Zedler4, H.-D. Sträter4, M. Niebuhr1

1

Department of Dermatology and Allergy, Division of Immunodermatology and Allergy Research, Hannover Medical School, Germany

2

Faculty I “Electrical Engineering and Information Technology”, University of Applied Sciences and Arts, Hannover, Germany 3

4

Lüllau Engineering GmbH, Lüneburg, Germany

Institute for Product and Process Innovation (PPI), Leuphana University of Luneburg, Luneburg, Germany

Funding: Supported by the German Federal Ministry of Economics and Technology (Zentrales Innovationsprogramm Mittelstand [ZIM])

This article is protected by copyright. All rights reserved. Disclosures: FL holds patent rights on skintrek® technology (European Patent Organisation PCT/EP 2011/000750 and PCT/EP 2011/005099). The remaining authors have no financial conflict of interest to declare.

Corresponding author:

Margarete Niebuhr, MD Department of Dermatology and Allergy Division of Immunodermatology and Allergy Research Hannover Medical School Carl-Neuberg-Str. 1 D-30449 Hannover, Germany Phone: +49 511 532 5092 Fax: +49 511 532 8115 Email: [email protected]

ABSTRACT Background: 8-methoxypsoralen-UV-A (PUVA) and narrowband UV-B (NB-UVB) are well established treatments for chronic plaque type psoriasis vulgaris. However, long term risks of PUVA therapy are premature skin ageing and squamous cell cancer. Objectives: To develop a device for targeted ultraviolet (UV) therapy of psoriatic plaques with protection of the healthy adjacent skin to reduce the risk for premature skin ageing and squamous cell cancer. Methods: 28 patients with exacerbated psoriasis vulgaris were treated with the Digital Phototherapy Device skintrek® [skintrek® cream PUVA (n=8), skintrek® bath PUVA (n=11) and skintrek® UV-B (n=9)] or with conventional bath PUVA (n=9) and NB-UVB (n=4), respectively.

This article is protected by copyright. All rights reserved. Results: The local PASI score was significantly reduced from a mean of 6.25 at baseline to 2.75 at the end of therapy in the skintrek® cream PUVA group, from a mean 6.4 to 3.0 in the skintrek® bath PUVA group and from 5.5 to 2.0 in the skintrek® UV-B group. Skintrek® cream PUVA reduced the mean local PASI by 54% while skintrek® bath PUVA did so by 51% and skintrek® UV-B by 63%. Targeted skintrek® PUVA and skintrek® UV-B of inflamed psoriatic skin avoided skin pigmentation and were not inferior to conventional bath PUVA and NB-UVB therapy regimes. Conclusions: Targeted UV-therapy of psoriatic plaques with the Digital Phototherapy Device skintrek® is as effective as conventional cream and bath PUVA as well as NB-UVB by simultaneously sparing the healthy adjacent skin and therefore (i) potentially reducing the carcinogenic risk, (ii) reducing premature skin ageing and (iii) avoiding tanning of healthy surroundings.

BULLETED STATEMENTS 

PUVA is effective in psoriasis vulgaris but has long- term carcinogenic risks, especially squamous cell cancer



The Digital Phototherapy Device skintrek® allows digital UV-therapy of diseased skin by simultaneously sparing the healthy adjacent skin and therefore (i) potentially reducing the carcinogenic risk, (ii) reducing premature skin ageing and (iii) avoiding tanning of healthy surroundings.

KEY WORDS Psoriasis vulgaris – ultraviolet therapy – digital - skintrek® - skin cancer

This article is protected by copyright. All rights reserved.

ABBREVIATIONS DMD

Digital Mirror Device

NB

Narrowband

PUVA

8-methoxypsoralen-UV-A

UV

ultraviolet

INTRODUCTION Psoriasis vulgaris is a chronic inflammatory skin disease affecting 2-3% of the population worldwide. Cream and bath 8-methoxypsoralen-UV-A (PUVA) and Narrowband UV-B (NBUVB) are well established highly effective treatment regimen dependent on dose and frequency of irradiation1,2. However, the cutaneous carcinogenic risk is increased upon PUVA treatment. Stern and Lundner showed a 14-fold increased risk for developing squamous cell carcinoma in patients exposed to high dose PUVA (>200 treatments or 2000J/cm2) compared to low dose PUVA (