***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective This study tests the hypothesis that stress reduction methods based on mindfulness meditation can positively influence the rate at which psoriasis clears in patients undergoing phototherapy or photochemotherapy treatment . Methods Thirty-seven patients with psoriasis about to undergo ultraviolet phototherapy ( UVB ) or photochemotherapy ( PUVA )  were r and omly assigned to one of two conditions : a mindfulness meditation-based stress reduction intervention guided by audiotaped instructions during light treatments , or a control condition consisting of the light treatments alone with no taped instructions .  Psoriasis status was assessed in three ways : direct inspection by unblinded clinic nurses ; direct inspection by physicians blinded to the patient 's study condition ( tape or no-tape ) ; and blinded physician evaluation of photographs of psoriasis lesions . Four sequential indicators of skin status were monitored during the study : a First Response Point , a Turning Point , a Halfway Point , and a Clearing Point . Results Cox-proportional hazards regression analysis showed that subjects in the tape groups reached the Halfway Point ( p = .013 ) and the Clearing Point ( p = .033 ) significantly more rapidly than those in the no-tape condition , for both UVB and PUVA treatments . Conclusions A brief mindfulness meditation-based stress reduction intervention delivered by audiotape during ultraviolet light therapy can increase the rate of resolution of psoriatic lesions in patients with psoriasis OBJECTIVE To determine if UV-B phototherapy clears psoriasis through systemic effects . DESIGN R and omized , within-subject comparison of change in psoriasis in 3 plaques in patients attending for whole-body UV-B therapy .  Change in patients ' psoriasis plaques covered during UV-B treatment was compared with plaques in an untreated control group . SETTING University hospital phototherapy unit . PATIENTS The study population comprised 17 patients with chronic plaque psoriasis treated with UV-B and 24 psoriasis control patients awaiting UV-B phototherapy . INTERVENTIONS Treatment with a st and ard 3-times weekly narrowb and TL-01 UV-B regimen . Three similar plaques were r and omly allocated to be covered every treatment , covered for 2 of 3 weekly treatments , and exposed to local UV-B every treatment . Similar plaques were selected in control patients ( awaiting but not yet started UV-B therapy ) . Severity of psoriasis plaques was assessed using a scaling , erythema , and in duration ( SEI ) scoring system . MAIN OUTCOME MEASURES Change in SEI score of the selected plaques over the complete treatment course for UV-B-treated patients and change over 3 weeks in SEI score of plaques covered during UV-B treatment compared with that of plaques in controls . RESULTS There was a significant ( P<.001 ) difference in how much the SEI score changed in the 3 plaques in UV-B-treated patients . It fell by a mean of 7.6 for uncovered plaques compared with 3.2 for plaques covered during each UV-B exposure ( 95 % confidence interval for difference , 3.0 to 5.8 ) . In patients awaiting UV-B , SEI score of plaques fell by a mean of 0.4 over 3 weeks , compared with a mean fall of 1.4 for covered plaques in UV-B-treated patients ( 95 % confidence interval for difference in means , 0.1 to 2.0 ) . CONCLUSIONS If UV-B therapy has any systemic effect capable of improving psoriasis , this effect is small and unlikely to be of clinical importance . It is insufficient to alter interpretation of findings of within-subject comparative phototherapy studies . UV-B phototherapy works for chronic plaque psoriasis through local effects In 2,147 patients suffering from psoriasis , evaluation of the age of onset revealed two peaks , one occurring at the age of 16 years ( female ) or 22 years ( males ) and a second peak at the age of 60 years ( female ) or 57 years ( males ) .  Human lymphocyte antigen ( HLA ) tissue typing  in 112 r and omly assigned patients showed that HLA-Cw6 , known to be at disequilibrium in psoriasis , is present in 85.3 % of patients with early onset . In contrast , 14.7 % patients with late onset showed this marker . Parents ( father or mother ) were affected in approximately half of the patients with early onset and in none belonging to the group with late onset . Furthermore , psoriasis in patients with early onset follows an irregular course and shows a strong tendency to become generalized . On the basis of clearly defined criteria ( e.g. , age of onset , heritability , and clinical course of disease ) , nonpustular psoriasis shows two distinct forms , one of which is hereditary , with early onset , and the other is sporadic and occurs in older age In the continuation of the European PUVA Study , 1,643 patients of the original cohort of 3,175 patients enrolled in this prospect i ve study were reevaluated for  skin tumors  after an average observation period of 96 months . Thirty-six patients with a total of seventy-one tumors ( forty squamous cell carcinomas , twenty-three basal cell carcinomas ) were observed . In contrast to the U.S. sixteen-center study , we were unable to demonstrate a clinical ly relevant increase in the risk of tumors induced by psoralens with ultraviolet A ( PUVA ) , and we also failed to show a clear relationship between PUVA exposure and tumor development . Almost all patients with tumors had been exposed to various carcinogens before the initiation of PUVA . No tumors were detected in patients without such prior treatment , although 10 % of the patients had received more than 3,000 joules/cm2 total cumulative phototoxic PUVA dose during the observation period . The discrepancy between the results of the U.S. study and our findings may partly be explained by a variety of factors such as a different treatment approach , a different attitude toward sun exposure , and the overall lower incidence of skin cancer in the European population OBJECTIVES To study the clinical spectrum of psoriasis and the incidence in the general population and to identify risk factors associated with the occurrence of psoriasis . DESIGN Prospect i ve cohort study with nested case-control analysis . SETTING The data source was the United Kingdom General Practice Research Data base containing computerized clinical information entered by general practitioners ( GPs ) . PATIENTS The study population comprised patients receiving a first-ever diagnosis of psoriasis between January 1 , 1996 , and December 31 , 1997 , and free of cancer . INTERVENTIONS Diagnosis of psoriasis was vali date d in a r and om sample of 14 % of all ascertained cases requesting confirmation by the GPs . Nested case-control analysis included 3994 cases of psoriasis and a r and om sample of 10 000 controls frequency matched to cases by age , sex , and calendar year . MAIN OUTCOME MEASURES Incidence rate of psoriasis and estimates of the odds ratio ( OR ) and 95 % confidence interval ( CI ) for psoriasis as associated with selected risk factors . RESULTS The incidence rate of psoriasis was 14 per 10 000 person-years . Patients with antecedents of skin disorders and skin infection within the last year carried the highest risk of developing psoriasis ( OR , 3.6 [ 95 % CI , 3.2 - 4.1 ] , and OR , 2.1 [ 95 % CI , 1.8 - 2.4 ] , respectively ) . Also , smoking was found to be an independent risk factors for psoriasis ( OR , 1.4 [ 95 % CI , 1.3 - 1.6 ] ) . We did not find an association between risk of psoriasis and antecedents of stress , diabetes , hypertension , hyperlipidemia , cardiovascular disease , or rheumatoid arthritis . CONCLUSIONS The incidence rate in our study was higher than those published in other studies , probably owing to our case definition that considered cases recorded by the GPs independently of a specialist confirmation . Our results confirm the association between psoriasis , skin disorders , and smoking BACKGROUND Combination UVB phototherapeutic regimens were introduced to improve therapeutic results and reduce cumulative UVB doses . OBJECTIVE Broadb and UVB and UVB + bergamot oil ( UVBB ) therapies in the treatment of psoriasis were compared with regard to : efficacy , side effects , mean number of procedures , mean UVB dose , and duration of remissions . PATIENTS / METHODS One hundred and ninety three ( 193 ) patients r and omly divided into two groups were treated : Group I with UVB monotherapy and Group II with UVB and bergamot oil ( UVBB ) . RESULTS Overall assessment of the efficacy of the two treatment regimens demonstrated no statistically significant differences in either the post-therapy PASI values ( t = 0.27 , p = 0.786 ) or the duration of remissions ( t = 0.22 , p = 0.904 ) . However , significant differences in the number of procedures ( t = 2.3 , p = 0.04 ) and the cumulative UVB doses were established ( t = 3.4 , p = 0.004 ) . CONCLUSION UVBB phototherapy significantly reduces the UVB doses and the duration of treatment for psoriatic patients Summary Background Previous studies have demonstrated the ultraviolet (UV)‐sparing effect of combining topical calcipotriol with broadb and UVB in the treatment of psoriasis BACKGROUND / METHODS The treatment of psoriasis with high-dose exposure to oral psoralen and ultraviolet-A light ( i.e. , PUVA ) substantially increases the risk of cutaneous squamous cell cancer , but not of basal cell cancer , within a decade of beginning treatment . To assess the persistence of cancer risk among individuals treated with PUVA , including those who discontinued therapy long ago and those without substantial exposure to other carcinogens , we prospect ively studied a cohort of 1380 patients with psoriasis who were first treated during the period from January 1 , 1975 , through October 1 , 1976 , and evaluated risk factors associated with the development of cutaneous squamous cell cancers and basal cell cancers after 1985 . RESULTS From 1975 through 1996 , 237 patients developed 1422 cutaneous squamous cell cancers .  From 1986 through 1996 , 135 ( 12.5 % ) of 1081 patients without a prior squamous cell cancer developed 593 such tumors . From 1975 through 1997 , 247 patients developed 1042 basal cell cancers ;  these patients included 151 individuals with a first basal cell cancer after 1985 . Among those without a squamous cell or a basal cell cancer in the first decade of the prospect i ve study , a strong dose-related increase in the risk of squamous cell cancer was observed in the subsequent decade ( adjusted relative risk [ > or = 337 treatments versus < 100 treatments ] = 8.6 ; 95 % confidence interval = 4.9 - 15.2 ) . Risk of basal cell cancer was substantially increased only in those patients exposed to very high levels of PUVA ( > or = 337 treatments ) . CONCLUSIONS High-dose exposure to PUVA is associated with a persistent , dose-related increase in the risk of squamous cell cancer , even among patients lacking substantial exposure to other carcinogens and among patients without substantial recent exposure to PUVA . Exposure to PUVA has far less effect on the risk of basal cell cancer . The use of PUVA for psoriasis should be weighed against the increased cancer risk In most cases , patients with moderate to severe psoriasis are treated with narrow-b and UVB phototherapy or with psoralen UVA ( PUVA- ) photochemotherapy . This UV-radiation is given to the whole skin , including unaffected skin . Normally , these two PUVA- and UVB-radiation procedures can not be combined on account of the phototherapeutic side-effects on unaffected skin . The 308-nm excimer laser has been shown to be safe and effective in the treatment of localized mild-to-moderate plaque-type psoriasis whilst sparing healthy skin . Our aim was to compare the therapeutic response to PUVA plus up to 4 UVB308-nm radiations and PUVA monotherapy in patients with moderate-severe plaque-type psoriasis . 272 hospitalized adult patients were enrolled on this prospect i ve r and om study . 256 patients completed the full course of treatment . PUVA treatment was given 4 times weekly to all patients . 123 patients received PUVA as a monotherapy . During the first two weeks , 149 patients were additionally treated up to four times with 308-nm excimer-derived UVB on the affected skin and treatment was evaluated for its efficacy , duration , number of times necessary for complete ( CR ) or partial remission ( PASI reduction > 90 or > 50 % , respectively ) , cumulative light dose , side effects of therapy and duration of remission after therapy . Statistically , there is no significant difference when comparing the efficacy of PUVA ( CR 67.3 % ) and PUVA plus excimer ( CR 63.6 % ) . On average , patients treated by the combination method went into remission in half the treatment time ( 15 + /- 6 versus 27 + /- 7 days ) and with half the cumulative UVA dose ( 22.9 + /- 5.8 versus 53.2 + / 
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Further , some psoriasis patients can be complex medical cases in which diabetes , inflammatory bowel disease , and hypertension are more likely to be present than in control population s and 10 % also suffer from arthritis ( psoriatic arthritis ) .
Overall , the review ers concluded that the efficacy of only five therapies could be supported from the RCT -based evidence review : photochemotherapy or phototherapy , cyclosporin , systemic retinoids , combination topical vitamin D(3 ) analogues ( calcipotriol ) and corticosteroids in combination with phototherapy and fumarates .
The conclusion of the NIHR evidence review was that both photochemotherapy and phototherapy were effective treatments for clearing psoriasis , although their comparative effectiveness was unknown .
In summary , phototherapy provides good control of clinical symptoms in the short term for patients with moderate-to-severe plaque-type psoriasis that have failed or are unresponsive to management with topical agents .