Clinical effectiveness of whole-body aerocryotherapy combined with phototherapy in psoriasis

BACKGROUND: Psoriasis is often resistant to standard treatment modalities, and disease relapse frequently occurs even after a full course of phototherapy. Whole-body aerocryotherapy (ACT) may provide an additional therapeutic benefit in psoriasis management. Of particular interest is its potential effect on reducing vascular endothelial growth factor (VEGF) levels and vascularization within psoriatic plaques, which may enhance the efficacy of photochemotherapy (PUVA), result in a more pronounced therapeutic response, and prolong remission after the main course of treatment. AIM: Thhis study aimed to evaluate the effectiveness of combined PUVA therapy and whole-body aerocryotherapy (PUVA + ACT) compared with PUVA monotherapy in patients with psoriasis. METHODS: This single-center prospective non-randomized comparative clinical study included 40 patients with moderate plaque psoriasis. Patients in group 1 (n = 20) received standard therapy according to clinical guidelines in combination with PUVA. Patients in group 2 (n = 20) received standard therapy according to clinical guidelines combined with PUVA + ACT. The trends of Psoriasis Area and Severity Index (PASI) and the Dermatology Life Quality Index (DLQI) were assessed. Changes in VEGF levels and microcirculatory parameters within psoriatic plaques were evaluated using noninvasive laser Doppler flowmetry with the Lazma MC-1 analyzer (Lazma, Russia). RESULTS: The median PASI score after treatment was lower in the combination therapy group (4.0 vs 6.0; p = 0.048). The relative PASI reduction was 75.0% vs 62.5% (p = 0.003), and the mean PASI improvement was significantly greater (11.75 ± 3.26 vs 9.60 ± 3.22; p = 0.042). No significant difference in DLQI scores after therapy was observed between groups (p = 0.558); however, improvement trends were more pronounced with PUVA + ACT (8.80 ± 3.27 vs 6.30 ± 2.70; p = 0.012). The decrease in VEGF concentration was significantly greater in the combination therapy group (39.0 [30.25–76.75] vs 20.0 [7.25–23.65]; p 0.001). Laser Doppler flowmetry showed reduced perfusion in both groups, with significantly lower final perfusion levels in the PUVA + ACT group (9.58 ± 2.27 vs 11.41 ± 2.83; p = 0.030). Blood flow variability (σ) was higher in the combination therapy group (1.18 vs 0.51; p = 0.023), indicating microcirculatory stabilization; variation coefficients (Kv) did not differ significantly (p 0.3). CONCLUSION: Whole-body aerocryotherapy combined with standard PUVA therapy enhances therapeutic efficacy, as evidenced by greater PASI reduction, significant improvement in quality-of-life indicators, marked VEGF decrease, and normalization of microcirculatory parameters compared with PUVA monotherapy.