***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: Psoriasis is a chronic inflammatory skin disease with a high social and psychological impact on the quality of life of patients .  Tomesa balneophototherapy is based on bathing in a magnesium-rich salt solution combined with exposure to narrowb and ultraviolet B phototherapy . We conducted a retrospective clinical trial on 174 patients affected by mild to severe psoriasis undergoing Tomesa balneophototherapy .  The basal course consisted of three to five sessions per week for a total of 30 sessions . Subsequently , patients could continue with a maintenance course of one session per week for a total of 30 sessions . We recorded a significant reduction of the mean Psoriasis Area and Severity Index ( PASI ) index with an achievement of at least PASI 75 in 52.1 % of the 119 patients who completed the basal course and an improvement of the ' quality of life ' of patients . The good efficacy obtained by this treatment , and the psychological impact on the quality of life of patients , demonstrated that Tomesa balneophototherapy could be a good option for the treatment of a chronic disease associated with psychological distress , like psoriasis 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 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 Synchronous balneophototherapy ( sBPT ) simulates treatment conditions at the Dead Sea for outpatient use . In the past , sBPT proved to be an effective treatment for psoriasis . However , there is a lack of sufficiently large r and omized controlled clinical trials evaluating the additional benefit of sBPT compared with ultraviolet B ( UVB ) monotherapy . OBJECTIVES The purpose of this study was to compare the effectiveness and safety of sBPT with UVB phototherapy ( PT ) alone in a r and omized controlled effectiveness study . METHODS In this phase III , multicentre effectiveness study , 367 patients with moderate to severe psoriasis were r and omly allocated in a 1 : 1 ratio to receive either sBPT consisting of narrowb and UVB PT with 311 nm and synchronous bathing in 10 % Dead Sea salt solution or PT with 311 nm alone . Primary endpoint , analysed on an intention-to-treat basis ( n = 356 ) , was the relative improvement of the Psoriasis Area and Severity Index ( PASI ) from baseline to end of treatment ( 35 sessions or clearance ) . Sample size calculation aim ed at the detection of superiority of at least 10 % . RESULTS Median PASI values were comparable at baseline ( sBPT : 15.1 , interquartile range : 10.9 - 24.3 ; PT : 15.3 , interquartile range : 10.0 - 23.7 ) . A clinical ly relevant and statistically significant difference of 49.5 % between sBPT and PT could be proven at the end of the therapy phase ( P < 0.001 ; Wilcoxon-Mann-Whitney test ) . Exploratory testing showed a statistically significant superiority of sBPT after 6 months . CONCLUSIONS In routine clinical practice , sBPT is superior to PT alone after 35 treatment sessions and a follow-up of 6 months . Both treatments demonstrated to be safe 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 Ro 10 - 9359 is a retinoic acid derivative , selected for study because of a better tolerance than retinoic acid , shown in animal experiments . Doses of 25 mg b.i.d . , 25 mg t.i.d . and 50 mg b.i.d . were administered orally to 27 patients suffering from severe chronic generalized psoriasis . The clinical efficacy was evaluated by means of a new index , psoriasis area and severity index ( PASI ) based on severity and area of psoriatic lesions . At doses of 25 mg t.i.d . or 50 mg b.i.d . Ro 10 - -9359 proved to be an extremely potent antipsoriatic drug . A more than 90 % reduction of psoriatic lesions could be seen in 10 patients out of 20 after 4 - 8 weeks of treatment . This good effect lasted about 5 weeks after treatment . Side effects were frequent , but mostly mild and completely reversible after termination of treatment BACKGROUND There is a lack of sufficiently large r and omized trials evaluating the effectiveness of saline spa balneophototherapy compared to ultraviolet B ( UVB ) only . OBJECTIVE The study aim ed to evaluate whether highly concentrated saline spa water baths followed by UVB ( HC-SSW-UVB ) are superior to UVB only in moderate to severe psoriasis . METHODS One hundred and sixty ( 160 ) adults with a Psoriasis Area and Severity Index ( PASI ) of > 10 from 4 German spa centers were r and omly allocated to HC-SSW-UVB ( local sodium chloride concentration between 25 % and 27 % ) or UVB only 3 a week until remission ( PASI < 5 ) or for a maximum of 6 weeks . Reduction of PASI > or = 50 % ( PASI-50 ) at the end of the intervention period was defined as primary outcome . Only persons receiving at least 1 intervention were included into the primary analysis . RESULTS Participants allocated to HC-SSW-UVB attained to a statistically significantly higher rate of PASI-50 than patients allocated to UVB only ( 68/79 [ 86 % ] versus 38/71 [ 54 % ] ; p < 0.001 ; number needed to treat , 3.1 ; 95 % confidence interval , 2.1 - 6.0 ) . Postintervention analysis did not yield a clear hint of a persisting effect . CONCLUSIONS The study indicates that HC-SSW-UVB are superior to routine UVB at the end of a 6-week treatment course Psoriasis is a common chronic skin disorder , but the mechanisms involved in the resolution and clearance of plaques remain poorly defined . We investigated the mechanism of action of UVB , which is highly effective in clearing psoriasis and inducing remission , and tested the hypothesis that apoptosis is a key mechanism . To distinguish byst and er effects , equal erythemal doses of two UVB wavelengths were compared following in vivo irradiation of psoriatic plaques ; one is clinical ly effective ( 311 nm ) and one has no therapeutic effect on psoriasis ( 290 nm ) . Only 311 nm UVB induced significant apoptosis in lesional epidermis , and most apoptotic cells were keratinocytes . To determine clinical relevance , we created a computational model of psoriatic epidermis . Modeling predicted apoptosis would occur in both stem and transit-amplifying cells to account for plaque clearance ; this was confirmed and quantified experimentally . The median rate of keratinocyte apoptosis from onset to cell death was 20 minutes . These data were fed back into the model and demonstrated that the observed level of keratinocyte apoptosis was sufficient to explain UVB-induced plaque resolution . Our human studies combined with a systems biology approach demonstrate that keratinocyte apoptosis is a key mechanism in psoriatic plaques clearance , providing the basis for future molecular investigation and therapeutic development OBJECTIVE To evaluate the efficacy of psoralens dissolved in a warm-water bath followed by exposure to UV-A irradiation ( bath PUVA ) or saltwater phototherapy ( SW UV-B ) compared with tap-water phototherapy ( TW UV-B ) or UV-B irradiation alone in psoriasis . DESIGN Multisite , prospect i ve , r and omized , controlled trial with 4 parallel groups . SETTING Total of 102 dermatologic outpatient clinics . PATIENTS Total of 1241 patients with stable psoriasis vulgaris and a Psoriasis Area and Severity Index score of 7 or greater . INTERVENTIONS Four-times-weekly UV-B , TW UV-B , SW UV-B , or bath-PUVA with baths preceding UV irradiation over a maximum of 8 weeks . The UV dose was adapted to erythemal response . MAIN OUTCOME MEASURES Incidence of therapeutic success , defined as a reduction of the Psoriasis Area and Severity Index or affected body surface area of 50 % or more . RESULTS Patients who received TW UV-B had a significantly higher incidence of therapeut 
    Output:
    
Salt bath with artificial ultraviolet B ( UVB ) light may improve psoriasis in people with chronic plaque psoriasis compared with UVB light treatment alone , and there may be no difference in the occurrence of treatment-related adverse events requiring withdrawal .