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Steyn M, Gerbens LAA, Spuls PI, Mashayekhi S, Deleuran M, Barbarot S, Wollenberg A, Ferguson J, Ibbotson S, Flohr C. Phototherapy for atopic dermatitis: A survey of European practice. J Eur Acad Dermatol Venereol 2024; 38:521-529. [PMID: 38011002 DOI: 10.1111/jdv.19638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Phototherapy is used to treat atopic dermatitis (AD). Evidence for its efficacy, impact on quality of life, cost-effectiveness and short- and long-term safety with real-life usage is weak. OBJECTIVES We established a taskforce to examine how phototherapy is currently being used as a treatment for AD across the United Kingdom and Europe to inform our understanding and guide future research into management of patients with AD using UV-based phototherapies. METHODS An anonymous electronic multiple-response survey exploring phototherapy prescribing practices and experience of phototherapy modalities was developed by the study authors and sent to members of phototherapy networks from the United Kingdom and Europe. Responses were received between February and July 2021. RESULTS About 144 respondents from 27 European countries completed the survey. NBUVB was the most widely used [n = 138 (96%)]. Home-based NBUVB was available in 8/27 countries (25/144 respondents, 17%). Oral psoralen-UVA (PUVA) was more widely available than bath PUVA (n = 106, 74% vs. n = 60, 42%) and used mainly in adult patients. 49/144 (34%) of respondents had access to UVA1. Phototherapy would be considered instead of systemic treatment in 96% of adults and 82% of children for NBUVB, versus 40% of adults and 3% of children for PUVA. Starting doses, standard dosing increments, length of treatment courses, lifetime limits for treatments and thresholds for performing annual skin assessments varied between responders. CONCLUSIONS NBUVB was the most widely used phototherapy for AD in adult and paediatric patients, while PUVA and UVA1 were less used. Prescribing practices varied considerably, highlighting the lack of consensus practice in many different aspects of phototherapy for the treatment of AD in children and adults. This indicates that further studies are required to determine optimal phototherapeutic regimens for AD and informs our understanding of parameters that should be included in future high-quality randomized controlled trials (RCT) of phototherapy.
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Affiliation(s)
- M Steyn
- St John's Institute for Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - L A A Gerbens
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - S Mashayekhi
- St John's Institute for Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Deleuran
- Department of Dermatology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - S Barbarot
- Department of Dermatology, CHU Nantes, Nantes Université, UMR 1280 PhAN, INRA, Nantes, France
| | - A Wollenberg
- Department of Dermatology and Allergy, Augsburg University Hospital, Augsburg, Germany
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | - J Ferguson
- St John's Institute for Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S Ibbotson
- Photobiology Unit, Ninewells Hospital & Medical School, University of Dundee, Dundee, Scotland
| | - C Flohr
- Unit for Paediatric and Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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2
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Axler EN, Lipner SR. Nail lichen planus treatment safety. Expert Opin Drug Saf 2023; 22:1157-1168. [PMID: 38014463 DOI: 10.1080/14740338.2023.2288902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/24/2023] [Indexed: 11/29/2023]
Abstract
AREAS COVERED Topical therapies for nail lichen planus (clobetasol propionate, topical tacrolimus, bath-PUVA), intralesional treatment (triamcinolone), and systemic treatment (corticosteroids, retinoids, small molecule inhibitors (jak/stat inhibitors)), TNF-alpha inhibitors (etanercept), systemic immunomodulators (oral calcineurin inhibitors, mycophenolate mophetil), and antimalarials (chloroquine), each with unique safety profiles and considerations. Herein, we discuss common and uncommon adverse events, as well as utilization for special populations, including pregnant and pediatric patients.
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Affiliation(s)
- Eden N Axler
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Shari R Lipner
- Weill Cornell Medicine, Department of Dermatology, New York, NY, USA
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Stege H, Ghoreschi K, Hünefeld C. [UV phototherapy : UV phototherapy and photodiagnostics-a practical overview]. Hautarzt 2021; 72:14-26. [PMID: 33394067 DOI: 10.1007/s00105-020-04744-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
UV phototherapy is an essential and efficient therapeutic option in the treatment of dermatological diseases. It is an integral part of multiple guidelines and maintains its high clinical significance despite the development of new therapeutic options for systemic treatment. Due to the difficult revenue situation, the market for ready-to-use products of psoralen and UV therapy devices is constantly changing.
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Affiliation(s)
- H Stege
- Klinik für Dermatologie, Klinikum Lippe, Röntgenstr. 18, 32756, Detmold, Deutschland.
| | - K Ghoreschi
- Klinik für Dermatologie, Venerologie u. Allergologie, Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Deutschland
| | - C Hünefeld
- Klinik für Dermatologie, Venerologie u. Allergologie, Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Deutschland.
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Dellatorre G, Antelo DAP, Bedrikow RB, Cestari TF, Follador I, Ramos DG, Silva de Castro CC. Consensus on the treatment of vitiligo - Brazilian Society of Dermatology. An Bras Dermatol 2020; 95 Suppl 1:70-82. [PMID: 33153826 PMCID: PMC7772607 DOI: 10.1016/j.abd.2020.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/15/2020] [Indexed: 01/20/2023] Open
Abstract
Background Vitiligo is a muco-cutaneous, autoimmune, localized, or disseminated disease, which manifests through hypochromic or achromic macules, with loss in quality of life. The prevalence of vitiligo in Brazil was determined to be 0.54%. There is no on-label medication for its treatment. To date, no Brazilian consensus on the treatment of vitiligo had been written. Objectives The objective of this group of Brazilian dermatologists with experience in the treatment of this disease was to reach a consensus on the clinical and surgical treatment of vitiligo, based on articles with the best scientific evidence. Methods Seven dermatologists were invited, and each was assigned two treatment modalities to review. Each treatment (topical, systemic, and phototherapy) was reviewed by three experts. Two experts reviewed the surgical treatment. Subsequently, the coordinator compiled the different versions and drafted a text about each type of treatment. The new version was returned to all experts, who expressed their opinions and made suggestions for clarity. The final text was written by the coordinator and sent to all participants to prepare the final consensus. Results/Conclusion The experts defined the following as standard treatments of vitiligo: the use of topical corticosteroids and calcineurin inhibitors for localized and unstable cases; corticosteroid minipulse in progressive generalized vitiligo; narrowband UVB phototherapy for extensive forms of the disease. Surgical modalities should be indicated for segmental and stable generalized vitiligo. Topical and systemic anti-JAK drugs are being tested, with promising results.
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Affiliation(s)
- Gerson Dellatorre
- Department of Dermatology, Hospital Santa Casa de Misericórdia de Curitiba, Curitiba, PR, Brazil
| | | | | | - Tania Ferreira Cestari
- Department of Dermatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Daniel Gontijo Ramos
- Department of Dermatology, Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, MG, Brazil
| | - Caio Cesar Silva de Castro
- Department of Dermatology, Faculty of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.
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5
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Campbell J. Safe and effective use of phototherapy and photochemotherapy in the treatment of psoriasis. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:547-552. [PMID: 32463760 DOI: 10.12968/bjon.2020.29.10.547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Psoriasis is a chronic, multisystem inflammatory disease, predominantly affecting the skin and joints, which is present in 2-3% of the world's population. Narrow band ultraviolet B (NB-UVB) and Psoralen + ultraviolet A (PUVA) are recognised, effective and, in the case of UVB, economical second-line treatments for psoriasis where topical therapies fail to control the disease or are an impracticable option due to the extent of skin involvement. This article examines the history of phototherapy and photochemotherapy and looks at current phototherapy treatments used for psoriasis. It discusses side effects of treatment and regimens that can be followed to increase effectiveness of treatment and minimise risks. The role of the nurse phototherapist is also discussed.
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Affiliation(s)
- Joanna Campbell
- Phototherapy Specialist Nurse, Photobiology Unit, Department of Dermatology, Ninewells Hospital, Dundee
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6
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Li Y, Li Y, Bai Y, Wang R, Lin L, Sun Y. Semiconductor ZnO based photosensitizer core–shell upconversion nanoparticle heterojunction for photodynamic therapy. RSC Adv 2020; 10:38416-38423. [PMID: 35517544 PMCID: PMC9057283 DOI: 10.1039/d0ra07466g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/12/2020] [Indexed: 11/21/2022] Open
Abstract
NaErF4@ZnO UCNPs for potential application in thyroid tumor cell PDT.
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Affiliation(s)
- Yongmei Li
- NHC Key Laboratory of Hormones and Development
- Tianjin Key Laboratory of Metabolic Diseases
- Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology
- Tianjin Medical University
- Tianjin
| | - Yuemei Li
- Xiamen Cardiovascular Hospital
- Xiamen University
- Xiamen
- China
| | | | - Rui Wang
- School of Chemistry and Chemical Engineering
- Harbin Institute of Technology
- Harbin
- China
| | - Laixiang Lin
- NHC Key Laboratory of Hormones and Development
- Tianjin Key Laboratory of Metabolic Diseases
- Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology
- Tianjin Medical University
- Tianjin
| | - Yina Sun
- NHC Key Laboratory of Hormones and Development
- Tianjin Key Laboratory of Metabolic Diseases
- Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology
- Tianjin Medical University
- Tianjin
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Cheon DU, Kim JE, Ko JY, Ro YS. Efficacy of alitretinoin depending on the concomitant use of topical corticosteroids in chronic hand eczema patients. J Dermatol 2019; 46:998-1005. [PMID: 31535403 DOI: 10.1111/1346-8138.15071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/08/2019] [Indexed: 11/29/2022]
Abstract
Alitretinoin is the only systemic agent approved for the treatment of severe chronic hand eczema (CHE) unresponsive to potent topical corticosteroids. Clinical trials have shown the efficacy of oral alitretinoin with topical emollients for CHE treatment, but most studies have failed to reach a therapeutic success rate of 50%. Reasonably, we thought it would be more effective to combine topical corticosteroids with oral alitretinoin, but the concomitant use of topical corticosteroids has not been studied yet. One-hundred and seven Korean patients diagnosed with CHE were recruited. The participants were divided into two groups depending on the concomitant use of topical corticosteroids. Comparative analysis was performed between the combined therapy (alitretinoin and topical corticosteroids) and monotherapy groups (alitretinoin only) by using physician global assessment (PGA), patient's global assessment (PaGA), modified total lesion symptom score (mTLSS), and recurrence rates. The combined therapy group showed a significantly higher treatment success rate than the alitretinoin monotherapy group for all efficacy parameters (PGA: P < 0.001, PaGA: P < 0.001, mTLSS changes: P < 0.001), but there was no significant difference in recurrence rates between the groups (P = 0.266). Combined use of topical corticosteroids is recommended for CHE patients being treated with oral alitretinoin due to clinically rapid and superior effectiveness.
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Affiliation(s)
- Dong Uk Cheon
- Department of Dermatology, Hanyang University Hospital, Seoul, South Korea
| | - Jeong Eun Kim
- Department of Dermatology, Hanyang University Hospital, Seoul, South Korea
| | - Joo Yeon Ko
- Department of Dermatology, Hanyang University Hospital, Seoul, South Korea
| | - Young Suck Ro
- Department of Dermatology, Hanyang University Hospital, Seoul, South Korea
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Christoffers WA, Coenraads P, Svensson Å, Diepgen TL, Dickinson‐Blok JL, Xia J, Williams HC. Interventions for hand eczema. Cochrane Database Syst Rev 2019; 4:CD004055. [PMID: 31025714 PMCID: PMC6484375 DOI: 10.1002/14651858.cd004055.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hand eczema is an inflammation of the skin of the hands that tends to run a chronic, relapsing course. This common condition is often associated with itch, social stigma, and impairment in employment. Many different interventions of unknown effectiveness are used to treat hand eczema. OBJECTIVES To assess the effects of topical and systemic interventions for hand eczema in adults and children. SEARCH METHODS We searched the following up to April 2018: Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, AMED, LILACS, GREAT, and four trials registries. We checked the reference lists of included studies for further references to relevant trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared interventions for hand eczema, regardless of hand eczema type and other affected sites, versus no treatment, placebo, vehicle, or active treatments. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Primary outcomes were participant- and investigator-rated good/excellent control of symptoms, and adverse events. MAIN RESULTS We included 60 RCTs, conducted in secondary care (5469 participants with mild to severe chronic hand eczema). Most participants were over 18 years old. The duration of treatment was short, generally up to four months. Only 24 studies included a follow-up period. Clinical heterogeneity in treatments and outcome measures was evident. Few studies performed head-to-head comparisons of different interventions. Risk of bias varied considerably, with only five studies at low risk in all domains. Twenty-two studies were industry-funded.Eighteen trials studied topical corticosteroids or calcineurin inhibitors; 10 studies, phototherapy; three studies, systemic immunosuppressives; and five studies, oral retinoids. Most studies compared an active intervention against no treatment, variants of the same medication, or placebo (or vehicle). Below, we present results from the main comparisons.Corticosteroid creams/ointments: when assessed 15 days after the start of treatment, clobetasol propionate 0.05% foam probably improves participant-rated control of symptoms compared to vehicle (risk ratio (RR) 2.32, 95% confidence interval (CI) 1.38 to 3.91; number needed to treat for an additional beneficial outcome (NNTB) 3, 95% CI 2 to 8; 1 study, 125 participants); the effect of clobetasol compared to vehicle for investigator-rated improvement is less clear (RR 1.43, 95% CI 0.86 to 2.40). More participants had at least one adverse event with clobetasol (11/62 versus 5/63; RR 2.24, 95% CI 0.82 to 6.06), including application site burning/pruritus. This evidence was rated as moderate certainty.When assessed 36 weeks after the start of treatment, mometasone furoate cream used thrice weekly may slightly improve investigator-rated symptom control compared to twice weekly (RR 1.23, 95% CI 0.94 to 1.61; 1 study, 72 participants) after remission is reached. Participant-rated symptoms were not measured. Some mild atrophy was reported in both groups (RR 1.76, 95% CI 0.45 to 6.83; 5/35 versus 3/37). This evidence was rated as low certainty.Irradiation with ultraviolet (UV) light: local combination ultraviolet light therapy (PUVA) may lead to improvement in investigator-rated symptom control when compared to local narrow-band UVB after 12 weeks of treatment (RR 0.50, 95% CI 0.22 to 1.16; 1 study, 60 participants). However, the 95% CI indicates that PUVA might make little or no difference. Participant-rated symptoms were not measured. Adverse events (mainly erythema) were reported by 9/30 participants in the narrow-band UVB group versus none in the PUVA group. This evidence was rated as moderate certainty.Topical calcineurin inhibitors: tacrolimus 0.1% over two weeks probably improves investigator-rated symptom control measured after three weeks compared to vehicle (14/14 tacrolimus versus 0/14 vehicle; 1 study). Participant-rated symptoms were not measured. Four of 14 people in the tacrolimus group versus zero in the vehicle group had well-tolerated application site burning/itching.A within-participant study in 16 participants compared 0.1% tacrolimus to 0.1% mometasone furoate but did not measure investigator- or participant-rated symptoms. Both treatments were well tolerated when assessed at two weeks during four weeks of treatment.Evidence from these studies was rated as moderate certainty.Oral interventions: oral cyclosporin 3 mg/kg/d probably slightly improves investigator-rated (RR 1.88, 95% CI 0.88 to 3.99; 1 study, 34 participants) or participant-rated (RR 1.25, 95% CI 0.69 to 2.27) control of symptoms compared to topical betamethasone dipropionate 0.05% after six weeks of treatment. The risk of adverse events such as dizziness was similar between groups (up to 36 weeks; RR 1.22, 95% CI 0.80 to 1.86, n = 55; 15/27 betamethasone versus 19/28 cyclosporin). The evidence was rated as moderate certainty.Alitretinoin 10 mg improves investigator-rated symptom control compared with placebo (RR 1.58, 95% CI 1.20 to 2.07; NNTB 11, 95% CI 6.3 to 26.5; 2 studies, n = 781) and alitretinoin 30 mg also improves this outcome compared with placebo (RR 2.75, 95% CI 2.20 to 3.43; NNTB 4, 95% CI 3 to 5; 2 studies, n = 1210). Similar results were found for participant-rated symptom control: alitretinoin 10 mg RR 1.73 (95% CI 1.25 to 2.40) and 30 mg RR 2.75 (95% CI 2.18 to 3.48). Evidence was rated as high certainty. The number of adverse events (including headache) probably did not differ between alitretinoin 10 mg and placebo (RR 1.01, 95% CI 0.66 to 1.55; 1 study, n = 158; moderate-certainty evidence), but the risk of headache increased with alitretinoin 30 mg (RR 3.43, 95% CI 2.45 to 4.81; 2 studies, n = 1210; high-certainty evidence). Outcomes were assessed between 48 and 72 weeks. AUTHORS' CONCLUSIONS Most findings were from single studies with low precision, so they should be interpreted with caution. Topical corticosteroids and UV phototherapy were two of the major standard treatments, but evidence is insufficient to support one specific treatment over another. The effect of topical calcineurin inhibitors is not certain. Alitretinoin is more effective than placebo in controlling symptoms, but advantages over other treatments need evaluating.Well-designed and well-reported, long-term (more than three months), head-to-head studies comparing different treatments are needed. Consensus is required regarding the definition of hand eczema and its subtypes, and a standard severity scale should be established.The main limitation was heterogeneity between studies. Small sample size impacted our ability to detect differences between treatments.
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Affiliation(s)
- Wietske Andrea Christoffers
- University Medical Center Groningen, University of GroningenDepartment of DermatologyHanzeplein 1GroningenNetherlands9700RB
| | - Pieter‐Jan Coenraads
- University Medical Center Groningen, University of GroningenDepartment of DermatologyHanzeplein 1GroningenNetherlands9700RB
| | - Åke Svensson
- Skåne University HospitalDepartment of DermatologyMalmöSwedenS 205 02
| | - Thomas L Diepgen
- Heidelberg University HospitalDepartment of Clinical Social MedicineThibautstrasse 3HeidelbergGermany69115
| | | | - Jun Xia
- The University of Nottingham NingboNottingham China Health Institute199 Taikang E RdYinzhou QuNingboZhejiang ShengChina315000
| | - Hywel C Williams
- University of NottinghamCentre of Evidence Based DermatologyQueen's Medical CentreDerby RoadNottinghamUKNG7 2UH
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Ibbotson SH. A Perspective on the Use of NB-UVB Phototherapy vs. PUVA Photochemotherapy. Front Med (Lausanne) 2018; 5:184. [PMID: 30013973 PMCID: PMC6036147 DOI: 10.3389/fmed.2018.00184] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/01/2018] [Indexed: 12/22/2022] Open
Abstract
Narrowband UVB (NB-UVB) phototherapy and psoralen-UVA (PUVA) photochemotherapy are widely used phototherapeutic modalities for a range of skin diseases. The main indication for NB-UVB and PUVA therapies is psoriasis, and other key diagnoses include atopic eczema, vitiligo, cutaneous T-cell lymphoma (CTCL), and the photodermatoses. The decision on choice of phototherapy is important and NB-UVB is usually the primary choice. NB-UVB phototherapy is a safe and effective therapy which is usually considered when topical agents have failed. PUVA requires prior psoralen sensitization but remains a highly effective mainstay therapy, often used when NB-UVB fails, there is rapid relapse following NB-UVB or in specific indications, such as pustular or erythrodermic psoriasis. This review will provide a perspective on the main indications for use of NB-UVB and PUVA therapies and provide comparative information on these important dermatological treatments.
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Affiliation(s)
- Sally H. Ibbotson
- Photobiology Unit, Dermatology Department, Ninewells Hospital, University of Dundee School of Medicine, Dundee, United Kingdom
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Herzinger T, Berneburg M, Ghoreschi K, Gollnick H, Hölzle E, Hönigsmann H, Lehmann P, Peters T, Röcken M, Scharffetter-Kochanek K, Schwarz T, Simon J, Tanew A, Weichenthal M. S1-Leitlinie zur UV-Phototherapie und Photochemotherapie. J Dtsch Dermatol Ges 2018; 14:e1-e25. [PMID: 27509439 DOI: 10.1111/ddg.12912_g] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Die heilsame Wirkung des Sonnenlichts war teilweise schon im Altertum bekannt und fand in der zweiten Hälfte des 19. Jahrhunderts wieder zunehmend Beachtung. Den Beginn der modernen Phototherapien markiert die Entwicklung einer Apparatur zur ultravioletten Bestrahlung der Hauttuberkulose durch Finnsen zu Beginn des zwanzigsten Jahrhunderts. Zur Therapie von Hauterkrankungen finden beinahe ausschließlich die spektralen Bereiche unterhalb des sichtbaren Lichtes (ultraviolett) Anwendung. Seit den 1970er Jahren stehen zunehmend leistungsfähige künstliche Strahlenquellen bereit für die Therapie mit UVB, UVA und die Kombination von UVA mit Photosensibilisatoren (Photochemotherapie). Hohe strukturelle und prozedurale Qualitätsstandards sind unabdingbare Voraussetzung für die Durchführung einer gleichermaßen wirkungsvollen wie auch sicheren Phototherapie. Die Leitlinie formuliert den aktuellen Konsens führender Experten auf dem Gebiet der Phototherapie in Bezug auf die Indikationen für die jeweiligen Therapieverfahren, deren Gegenanzeigen und Nebenwirkungen und insbesondere für die Wahl der korrekten Dosis zu Beginn und im Verlauf einer Therapie sowie das Management von Nebenwirkungen.
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Affiliation(s)
- Thomas Herzinger
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München
| | - Mark Berneburg
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
| | | | - Harald Gollnick
- Universitätsklinik für Dermatologie und Venerologie, Otto-von-Guericke-Universität Magdeburg
| | - Erhard Hölzle
- Klinik für Dermatologie und Allergologie, Klinikum Oldenburg
| | - Herbert Hönigsmann
- Universitätsklinik für Dermatologie, Allgemeines Krankenhaus der Stadt Wien
| | - Percy Lehmann
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, HELIOS-Klinikum Wuppertal
| | - Thorsten Peters
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Ulm
| | | | | | | | - Jan Simon
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig
| | - Adrian Tanew
- Universitätsklinik für Dermatologie, Allgemeines Krankenhaus der Stadt Wien
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11
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Brass D, Fouweather T, Stocken DD, Macdonald C, Wilkinson J, Lloyd J, Farr PM, Reynolds NJ, Hampton PJ. An observer-blinded randomized controlled pilot trial comparing localized immersion psoralen-ultraviolet A with localized narrowband ultraviolet B for the treatment of palmar hand eczema. Br J Dermatol 2018; 179:63-71. [PMID: 29235664 DOI: 10.1111/bjd.16238] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hand eczema is a common inflammatory dermatosis that causes significant patient morbidity. Previous studies comparing psoralen-ultraviolet A (PUVA) with narrowband ultraviolet B (NB-UVB) have been small, nonrandomized and retrospective. OBJECTIVES To conduct an observer-blinded randomized controlled pilot study using validated scoring criteria to compare immersion PUVA with NB-UVB for the treatment of chronic hand eczema unresponsive to topical steroids. METHODS Sixty patients with hand eczema unresponsive to clobetasol propionate 0·05% were randomized to receive either immersion PUVA or NB-UVB twice weekly for 12 weeks with assessments at intervals of 4 weeks. The primary outcome measure was the proportion of patients achieving 'clear' or 'almost clear' Physician's Global Assessment (PGA) response at 12 weeks. Secondary outcome measures included assessment of the modified Total Lesion and Symptom Score (mTLSS) and the Dermatology Life Quality index (DLQI). RESULTS In both treatment arms, 23 patients completed the 12-week assessment for the primary outcome measure. In the PUVA group, five patients achieved 'clear' and eight 'almost clear' [intention-to-treat (ITT) response rate 43%]. In the NB-UVB group, two achieved 'clear' and five 'almost clear' (ITT response rate 23%). For the secondary outcomes, median mTLSS scores were similar between groups at baseline (PUVA 9·5, NB-UVB 9) and at 12 weeks (PUVA 3, NB-UVB 4). Changes in DLQI were similar, with improvements in both groups. CONCLUSIONS In this randomized pilot trial recruitment was challenging. After randomization, there were acceptable levels of compliance and safety in each treatment schedule, but lower levels of retention. Using validated scoring systems - PGA, mTLSS and DLQI - as measures of treatment response, the trial demonstrated that both PUVA and NB-UVB reduced the severity of chronic palmar hand eczema.
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Affiliation(s)
- D Brass
- Newcastle Dermatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, U.K
| | - T Fouweather
- Biostatistics Research Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, U.K
| | - D D Stocken
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, U.K
| | - C Macdonald
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, U.K
| | - J Wilkinson
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, U.K
| | - J Lloyd
- Newcastle Dermatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, U.K
| | - P M Farr
- Newcastle Dermatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, U.K
| | - N J Reynolds
- Newcastle Dermatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, U.K.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, U.K
| | - P J Hampton
- Newcastle Dermatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, U.K
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12
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Lund TT, Agner T. Hand Eczema: Treatment Options. CURRENT TREATMENT OPTIONS IN ALLERGY 2017. [DOI: 10.1007/s40521-017-0148-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Esmat S, Hegazy RA, Shalaby S, Hu SCS, Lan CCE. Phototherapy and Combination Therapies for Vitiligo. Dermatol Clin 2017; 35:171-192. [PMID: 28317527 DOI: 10.1016/j.det.2016.11.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Vitiligo is a disease characterized by disappearance of melanocytes from the skin. It can negatively influence the physical appearance of affected individuals, and may profoundly affect a person's psychosocial function and quality of life. Therefore, vitiligo should not be considered as merely a condition that affects a patient's appearance, but needs to be actively treated in patients who seek medical help. Phototherapy has been used as the main treatment modality for patients with vitiligo. Different forms of phototherapy for vitiligo include broadband UVB, narrowband UVB, excimer light and excimer laser, and psoralen plus UVA.
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Affiliation(s)
- Samia Esmat
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Rehab A Hegazy
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Suzan Shalaby
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Stephen Chu-Sung Hu
- Department of Dermatology, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No 100, Tzyou 1st Road, Kaohsiung 807, Taiwan
| | - Cheng-Che E Lan
- Department of Dermatology, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No 100, Tzyou 1st Road, Kaohsiung 807, Taiwan.
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14
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Phenylpropanoid composition in fig (Ficus carica L.) leaves. J Nat Med 2017; 71:770-775. [DOI: 10.1007/s11418-017-1093-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 05/12/2017] [Indexed: 10/19/2022]
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15
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Wrześniok D, Beberok A, Rok J, Delijewski M, Hechmann A, Oprzondek M, Rzepka Z, Bacler-Żbikowska B, Buszman E. UVA radiation augments cytotoxic activity of psoralens in melanoma cells. Int J Radiat Biol 2017; 93:734-739. [DOI: 10.1080/09553002.2017.1297903] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Dorota Wrześniok
- Department of Pharmaceutical Chemistry, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Artur Beberok
- Department of Pharmaceutical Chemistry, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Jakub Rok
- Department of Pharmaceutical Chemistry, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Marcin Delijewski
- Department of Pharmaceutical Chemistry, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Anna Hechmann
- Student Scientific Society at the Department of Pharmaceutical Chemistry, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Martyna Oprzondek
- Student Scientific Society at the Department of Pharmaceutical Chemistry, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Zuzanna Rzepka
- Department of Pharmaceutical Chemistry, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Barbara Bacler-Żbikowska
- Department of Pharmaceutical Botany and Herbal Medicine, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Ewa Buszman
- Department of Pharmaceutical Chemistry, Medical University of Silesia in Katowice, Sosnowiec, Poland
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16
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Smith IL, Brown S, Nixon J, Cowdell FC, Ersser S, Fernandez C, Goodfield M, Green CM, Hampton P, Lear JT, Smith CH, Sunderland L, Tubeuf S, Wittmann M. Treatment of severe, chronic hand eczema: results from a UK-wide survey. Clin Exp Dermatol 2016; 42:185-188. [PMID: 27910127 DOI: 10.1111/ced.13015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2016] [Indexed: 11/30/2022]
Abstract
Treatment of severe hand eczema (HE) that is resistant to topical potent corticosteroid treatment is challenging. In 2013, we surveyed 194 UK dermatologists to obtain information about their usual treatment pathways to inform the choice of the comparator in a trial of alitretinoin in severe HE (ALPHA trial); the results indicated that the treatment approaches favoured by UK dermatologists differ. Psoralen combined with ultraviolet A (PUVA) and alitretinoin were identified as the most frequent first-line treatment options for hyperkeratotic HE, whereas oral corticosteroids were identified as the most frequent first-line treatment for vesicular HE, followed by PUVA and alitretinoin. In terms of potential adverse effects of long-term or repeated use, oral steroids and ciclosporin A were reported to cause most concern. There is uncertainty about which treatment gives the best short and long-term outcomes, because of a lack of definitive randomised controlled trials evaluating the effectiveness of different treatment pathways in severe HE.
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Affiliation(s)
- I L Smith
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, Yorkshire, UK
| | - S Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, Yorkshire, UK
| | - J Nixon
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, Yorkshire, UK
| | - F C Cowdell
- Faculty of Health Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - S Ersser
- School of Healthcare, University of Leeds, Leeds, Yorkshire, UK
| | - C Fernandez
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, Yorkshire, UK
| | - M Goodfield
- Department of Dermatology, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, UK
| | - C M Green
- Department of Dermatology, Ninewells Hospital, Dundee, Tayside, UK
| | - P Hampton
- Department of Dermatology, Newcastle Hospitals, Newcastle, Tyne and Wear, UK
| | - J T Lear
- Department of Dermatology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - C H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - S Tubeuf
- Academic Unit of Health Economics, University of Leeds, Leeds, Yorkshire, UK
| | - M Wittmann
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, Yorkshire, UK.,NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, Yorkshire, UK.,Department of Dermatology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, Yorkshire, UK
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17
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Herzinger T, Berneburg M, Ghoreschi K, Gollnick H, Hölzle E, Hönigsmann H, Lehmann P, Peters T, Röcken M, Scharffetter-Kochanek K, Schwarz T, Simon J, Tanew A, Weichenthal M. S1-Guidelines on UV phototherapy and photochemotherapy. J Dtsch Dermatol Ges 2016; 14:853-76. [DOI: 10.1111/ddg.12912] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Thomas Herzinger
- Department of Dermatology and Allergology; Ludwig Maximilians University; Munich Germany
| | - Mark Berneburg
- Department of Dermatology; University Medical Center; Regensburg Germany
| | | | - Harald Gollnick
- Department of Dermatology and Venereology; University Hospital; Otto von Guericke University; Magdeburg Germany
| | - Erhard Hölzle
- Department of Dermatology and Allergology; Medical Center Oldenburg; Oldenburg Germany
| | | | - Percy Lehmann
- Department of Dermatology; Allergology and Dermatosurgery; HELIOS-Medical Center; Wuppertal Germany
| | - Thorsten Peters
- Department of Dermatology and Allergology; University Medical Center; Ulm Germany
| | | | | | | | - Jan Simon
- Department of Dermatology; Venereology and Allergology; University Medical Center; Leipzig Germany
| | - Adrian Tanew
- Department of Dermatology; General Hospital of Vienna; Vienna Austria
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18
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Kwon HI, Kim JE, Ko JY, Ro YS. Efficacy and Safety of Alitretinoin for Chronic Hand Eczema in Korean Patients. Ann Dermatol 2016; 28:364-70. [PMID: 27274636 PMCID: PMC4884714 DOI: 10.5021/ad.2016.28.3.364] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/04/2016] [Accepted: 02/15/2016] [Indexed: 11/28/2022] Open
Abstract
Background Chronic hand eczema (CHE) tends to be refractory to conventional therapy. Previous clinical trials have found that a 24-week treatment course of oral alitretinoin is effective and well tolerated for CHE treatment. Objective The aim of this study was to investigate the efficacy and safety of oral alitretinoin in Korean CHE patients. Methods A total of 27 patients with moderate to severe CHE took 30 mg of alitretinoin daily for 12 weeks. The primary efficacy parameter was the physician's global assessment (PGA). The response was defined as a patient being "clear" or "almost clear" of disease. The secondary efficacy parameters were the modified total lesion symptom score (mTLSS) and the patients' global assessment (PaGA). All adverse events and laboratory abnormalities were recorded during the treatment period. Results Alitretinoin led to CHE symptom improvement in 44.4% of patients. The PGA, mTLSS, and PaGA scores correlated well with each other. Reported adverse events were typical retinoid class effects and headache was the most common. Conclusion Taking 30 mg of oral alitretinoin daily for 12 weeks was found to be effective in treating Korean patients with CHE, compared with the 24 week-treatment shown in previous studies.
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Affiliation(s)
- Hyoung Il Kwon
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Jeong Eun Kim
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Joo Yeon Ko
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Young Suck Ro
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
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19
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Ling T, Clayton T, Crawley J, Exton L, Goulden V, Ibbotson S, McKenna K, Mohd Mustapa M, Rhodes L, Sarkany R, Dawe R, McHenry P, Hughes J, Griffiths M, McDonagh A, Buckley D, Nasr I, Swale V, Duarte Williamson C, Levell N, Leslie T, Mallon E, Wakelin S, Hunasehally P, Cork M, Ungureanu S, Donnelly J, Towers K, Saunders C, Davis R, Brain A, Exton L, Mohd Mustapa M. British Association of Dermatologists and British Photodermatology Group guidelines for the safe and effective use of psoralen–ultraviolet A therapy 2015. Br J Dermatol 2016; 174:24-55. [DOI: 10.1111/bjd.14317] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2015] [Indexed: 01/28/2023]
Affiliation(s)
- T.C. Ling
- Dermatology Centre Faculty of Medical and Human Sciences Salford Royal NHS Foundation Trust Salford Manchester M6 8HD U.K
| | - T.H. Clayton
- Dermatology Centre Faculty of Medical and Human Sciences Salford Royal NHS Foundation Trust Salford Manchester M6 8HD U.K
| | - J. Crawley
- Department of Dermatology University College Hospital 235 Euston Road London NW1 2BU U.K
| | - L.S. Exton
- British Association of Dermatologists Willan House 4 Fitzroy Square London W1T 5HQ U.K
| | - V. Goulden
- Department of Dermatology Leeds Teaching Hospitals NHS Trust Leeds LS7 4SA U.K
| | - S. Ibbotson
- Department of Dermatology Ninewells Hospital and Medical School University of Dundee Dundee DD1 9SY U.K
| | - K. McKenna
- Department of Dermatology Belfast City Hospital Belfast BT9 7AB U.K
| | - M.F. Mohd Mustapa
- British Association of Dermatologists Willan House 4 Fitzroy Square London W1T 5HQ U.K
| | - L.E. Rhodes
- Dermatology Research Centre Faculty of Medical and Human Sciences Salford Royal NHS Foundation Trust Salford Manchester M6 8HD U.K
| | - R. Sarkany
- Department of Dermatology University College Hospital 235 Euston Road London NW1 2BU U.K
| | - R.S. Dawe
- Department of Dermatology Ninewells Hospital and Medical School University of Dundee Dundee DD1 9SY U.K
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20
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Al-Ismail D, Edwards C, Anstey AV. Erythema action spectrum of topical 8-methoxypsoralen-sensitized skin re-evaluated: implications for routine clinical practice. Br J Dermatol 2015; 174:131-5. [PMID: 26383592 DOI: 10.1111/bjd.14101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Published methodology used to determine psoralen plus ultraviolet A (PUVA) erythemal action spectrum does not reflect current clinical practice for psoralen sensitization. We re-evaluated the PUVA action spectrum using aqueous 8-methoxypsoralen (8-MOP) 2·6 mg L(-1) as used routinely in current clinical practice. OBJECTIVES To determine the UVA erythema action spectrum of topical 8-MOP-sensitized normal skin. METHODS Twenty healthy volunteers with skin phototypes I-V were recruited. Forearms were psoralen-sensitized at 37 °C for 10 min. Six UVA irradiations at 10-nm intervals between 325 and 375 nm were randomly allocated to forearm sites and were applied using a 10-nm bandwidth irradiation monochromator. The visual minimal phototoxic dose (MPD) was recorded on each site at 96 h. RESULTS Volunteer Boston phototypes were: I, n = 2; II, n = 6; III, n = 6; IV, n = 5 and V, n = 1. The mean MPD (J cm(-2) ) for all subjects at each wavelength was as follows: 325 nm, 0·64 (SD 0·37); 335 nm, 0·80 (SD 0·58); 345 nm, 0·96 (SD 0·55); 355 nm, 1·50 (SD 0·85); 365 nm, 2·19 (SD 0·90); and 375 nm, 2·89 (SD 1·06). Therefore, the relative sensitization at each wavelength (erythemal action spectrum) was: 1, 0·83, 0·67, 0·43, 0·29 and 0·22. There were significant differences between the PUVA erythemal effectiveness at different wavelengths but none between skin types. CONCLUSIONS This study has established the erythemal action spectrum for bath/soak PUVA therapy as is currently performed. In all volunteers, the peak sensitivity was at 325 nm. All volunteers showed a similar trend across the wavelengths studied irrespective of skin type. The determination of the action spectrum for PUVA-induced erythema is important as it permits reliable estimates of erythemal efficacy of any UVA source where the emission spectrum of the lamp is known or can be measured.
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Affiliation(s)
- D Al-Ismail
- Department of Dermatology, St Woolos Hospital, Aneurin Bevan University Health Board, Newport, NP20 2UB, U.K.,Cardiff University, Heath Park, Cardiff, CF14 4XN, U.K
| | - C Edwards
- Department of Dermatology, St Woolos Hospital, Aneurin Bevan University Health Board, Newport, NP20 2UB, U.K
| | - A V Anstey
- Cardiff University, Heath Park, Cardiff, CF14 4XN, U.K.,Department of Dermatology, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, LL57 2PY, U.K
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21
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Abstract
UV phototherapy has a long history of use for the treatment of select diseases in dermatology. Its use has evolved into more effective and targeted modalities, including psoralen + UV-A photochemotherapy, narrowband UV-B, excimer laser, and UV-A1 phototherapy. With its proven record of efficacy and safety, UV phototherapy is an excellent option in the treatment of an ever-growing number of skin conditions.
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Affiliation(s)
- Mariam B Totonchy
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Melvin W Chiu
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, 52-121 Center for the Health Sciences, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
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22
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Yang MF, Baron ED. Update on the immunology of UV and visible radiation therapy: phototherapy, photochemotherapy and photodynamic therapy. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17469872.3.1.85] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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23
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Al-Ismail D, Edwards C, Al-Ofi O, Anstey A. Minimal phototoxic dose (MPD) measurements for topical photochemotherapy using a semiautomated MPD tester. Br J Dermatol 2013; 169:687-9. [DOI: 10.1111/bjd.12395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2013] [Indexed: 12/01/2022]
Affiliation(s)
- D. Al-Ismail
- Department of Dermatology; Aneurin Bevan Health Board; St Woolos Hospital; Newport; U.K
| | - C. Edwards
- Department of Dermatology; Aneurin Bevan Health Board; St Woolos Hospital; Newport; U.K
| | - O. Al-Ofi
- Department of Dermatology; Aneurin Bevan Health Board; St Woolos Hospital; Newport; U.K
| | - A.V. Anstey
- Department of Dermatology; Aneurin Bevan Health Board; St Woolos Hospital; Newport; U.K
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24
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25
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Abstract
Hand eczema is an inflammation of the skin; the cause is often multifactorial. Initial management includes avoiding causative irritants or allergens (e.g., by wearing impermeable gloves) and applying emollients and potent topical glucocorticoids.
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Affiliation(s)
- Pieter-Jan Coenraads
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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26
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Lapolla W, Yentzer BA, Bagel J, Halvorson CR, Feldman SR. A review of phototherapy protocols for psoriasis treatment. J Am Acad Dermatol 2011; 64:936-49. [PMID: 21429620 DOI: 10.1016/j.jaad.2009.12.054] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 12/04/2009] [Accepted: 12/31/2009] [Indexed: 11/28/2022]
Abstract
Phototherapy is a mainstay in the treatment of psoriasis and is available as psoralen plus UVA (PUVA), broadband UVB (BB-UVB), and narrowband UVB (NB-UVB). Phototherapy can be administered in the hospital, outpatient clinic, or in the patient's home. The purpose of this review is to provide some practical guidance to general dermatologists and residents on the specifics of using phototherapy, which, despite its decreasing use, remains one of our most safe and effective treatment strategies for psoriasis care. We conducted a literature review of home phototherapy, BB-UVB, NB-UVB, and PUVA phototherapy using PubMed, MD Consult, and reference lists. A variety of protocols for BB-UVB, NB-UVB, and PUVA have been used in clinical trials. NB-UVB is more effective than BB-UVB and safer than PUVA. Typical regimens for NB-UVB involve dosing 3 times per week for at least 3 months. Treatment must be independently developed to suit each participant's needs. Ultraviolet light is an effective, relatively safe modality that is a valuable tool in the treatment of psoriasis. NB-UVB phototherapy is considered the first-line treatment for extensive plaque type psoriasis.
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Affiliation(s)
- Whitney Lapolla
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1071, USA
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27
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Berroeta L, Man I, Dawe RS, Ferguson J, Ibbotson SH. Randomized double-blind comparative study of 8-methoxypsoralen bath plus UV-A treatment regimens. ACTAS DERMO-SIFILIOGRAFICAS 2011; 101:729-30. [PMID: 20965019 DOI: 10.1016/j.ad.2010.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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28
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Bissonnette R, Diepgen TL, Elsner P, English J, Graham-Brown R, Homey B, Luger T, Lynde C, Maares J, Maibach HI. Redefining treatment options in chronic hand eczema (CHE). J Eur Acad Dermatol Venereol 2010; 24 Suppl 3:1-20. [DOI: 10.1111/j.1468-3083.2010.03615.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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Randomized Double-Blind Comparative Study of 8-Methoxypsoralen Bath Plus UV-A Treatment Regimens. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/s1578-2190(10)70706-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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30
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Rodgers M, Griffin S, Paulden M, Slack R, Duffy S, Ingram JR, Woolacott N, Sculpher M. Alitretinoin for severe chronic hand eczema: a NICE single technology appraisal. PHARMACOECONOMICS 2010; 28:351-62. [PMID: 20131924 DOI: 10.2165/11532160-000000000-00000] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The National Institute for Health and Clinical Excellence (NICE) invited the manufacturer of alitretinoin (Basilea Pharmaceuticals Ltd, Basel, Switzerland) to submit evidence for the clinical and cost effectiveness of this drug for the treatment of patients with severe chronic hand eczema (CHE), as part of the Institute's single technology appraisal (STA) process. The Centre for Reviews and Dissemination and the Centre for Health Economics at the University of York were commissioned to act as the Evidence Review Group (ERG). This article provides a description of the company submission, the ERG review and NICE's subsequent decisions. The ERG produced a critical review of the evidence for the clinical and cost effectiveness of the technology based upon the manufacturer's submission to NICE. The ERG also independently searched for relevant evidence and modified the manufacturer's decision analytic model to examine the impact of altering some of the key assumptions. The main clinical effectiveness data were derived from a single-placebo randomized controlled trial (RCT) of daily treatment with alitretinoin for 12-24 weeks, with follow-up for a further 24 weeks, in patients with severe CHE unresponsive to topical corticosteroids. A significantly greater proportion of patients achieved 'clear' or 'almost clear' hands by week 24 with alitretinoin than those using placebo: 48% with alitretinoin 30 mg (p < 0.001); 28% with alitretinoin 10 mg (p < 0.005); 17% with placebo. Most patients who responded remained in remission during the 24-week follow-up period. The most commonly reported adverse event was dose-dependent headache, with rates of 20% in the alitretinoin 30 mg group and 11% in the alitretinoin 10 mg group, respectively. Serious adverse events were rare, although alitretinoin was associated with increases in both total cholesterol and triglycerides. No direct or indirect comparisons of alitretinoin with any of the relevant treatment comparators (psoralen + UVA [PUVA], ciclosporin or azathioprine) were available. In the manufacturer's original submission to NICE, the base-case incremental cost-effectiveness ratios (ICERs) reported for alitretinoin were pound8614 per QALY versus ciclosporin, - pound469 per QALY versus PUVA (with alitretinoin dominant) and pound10 612 per QALY versus azathioprine (year 2007-8 values). In response to a request from the ERG, the manufacturers provided a revised model that compared alitretinoin only with placebo, for which the ICER was reported to be pound12 931. However, the omission of adverse events entirely from this revised model, in combination with a number of other factors, led the ERG to conclude that the model underestimated the costs of treatment associated with alitretinoin. Estimates of health-related quality of life (HR-QOL) were the primary source of uncertainty, with the use of values from an alternative source producing ICERs of around pound30 000 per QALY gained. The ERG concluded that, although the evidence presented indicates that alitretinoin is efficacious in the treatment of severe CHE, it gives little indication of alitretinoin's efficacy relative to likely alternative treatment options or its efficacy and safety in the longer term. Although the ICERs estimated by the manufacturer suggested that alitretinoin may be cost effective for use in the UK NHS, utilizing the alternative HR-QOL estimates resulted in a 2-fold increase in the ICER. Thus, there was considerable uncertainty as to the true ICER of alitretinoin versus the relevant treatment comparators. The Appraisal Committee recommended that alitretinoin be provided to those patients with severe CHE and a Dermatology Life Quality Index (DLQI) score of at least 15. They recommended that treatment be stopped as soon as an adequate response was observed, or if CHE remained severe at 12 weeks, or if response was inadequate at 24 weeks.
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Affiliation(s)
- Mark Rodgers
- Centre for Reviews and Dissemination, University of York, Heslington, York, UK
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31
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Rodríguez-Granados M, Pereira-Rodríguez M, Vázquez-Vizoso F. Eficacia terapéutica del baño-PUVA en psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s0001-7310(09)70537-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Berroeta L, Attili S, Wong A, Man I, Dawe RS, Ferguson J, Ibbotson SH. Time course for development of psoralen plus ultraviolet A erythema following oral administration of 5-methoxypsoralen. Br J Dermatol 2009; 160:717-9. [PMID: 19183168 DOI: 10.1111/j.1365-2133.2008.09007.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Therapeutic Effectiveness of Psoralen-U V-A Bath Therapy In Psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s1578-2190(09)70047-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Delrosso G, Bornacina C, Farinelli P, Bellinzona F, Leigheb G, Colombo E. Bath PUVA and Psoriasis: Is a Milder Treatment a Worse Treatment? Dermatology 2008; 216:191-3. [DOI: 10.1159/000112924] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Accepted: 07/24/2007] [Indexed: 11/19/2022] Open
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Man I, Dawe RS, Ferguson J, Ibbotson SH. An Intraindividual Study of the Characteristics of Erythema Induced by Bath and Oral Methoxsalen Photochemotherapy and Narrowband Ultraviolet B¶. Photochem Photobiol 2007. [DOI: 10.1562/0031-8655(2003)0780055aisotc2.0.co2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Rodríguez-Granados MT, Carrascosa JM, Gárate T, Gómez-Díez S, Guimaraens-Juantorena D. Documento de consenso sobre la modalidad terapéutica del baño-PUVA. ACTAS DERMO-SIFILIOGRAFICAS 2007; 98:164-70. [PMID: 17504700 DOI: 10.1016/s0001-7310(07)70040-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Bath PUVA is a variant of phototherapy as efficacious as oral PUVA therapy that avoids many of the adverse effects associated to this treatment. Nevertheless, the special features and the specialized equipment required for its employment have limited its application in the dermatologic clinics of our country. Following the trend initiated after the publication of the consensus document on oral PUVA therapy and narrow band (NB) UVB therapy, the Spanish Photobiology Group from the Spanish Academy of Dermatology and Venereology has developed a therapeutic guideline for bath PUVA therapy based on the literature review and the experience of its members. The document aims to be a practical reference guide for those dermatological centres that include phototherapy among their services. It reviews the concept and indications of this type of treatment and proposes recommendations concerning therapeutic procedures, drug associations of interest and prophylaxis and management of adverse effects.
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Martin JA, Laube S, Edwards C, Gambles B, Anstey AV. Rate of acute adverse events for narrow-band UVB and Psoralen-UVA phototherapy. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2007; 23:68-72. [PMID: 17523927 DOI: 10.1111/j.1600-0781.2007.00278.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Ultraviolet (UV) radiation therapies are commonly used to treat a wide range of dermatological conditions. However, no published data exist regarding the rate of acute adverse events occurring within the different UV therapy modalities. AIM The aim of this study was to determine the rate of acute adverse events experienced by patients receiving narrow-band UVB or photochemotherapy in 3 neighboring dermatology units. METHOD Standardized adverse event forms from all 3 units were retrospectively analysed over a 12-month period between October 2003 and September 2004. The treatments included were narrow-band UVB and systemic, bath and hand/foot PUVA. RESULTS A total of 8784 treatments were given over the study period. The total number of acute adverse events recorded for all phototherapy treatments was 70 (0.8%). The rates of acute adverse events for each treatment modality were 0.6% for narrow-band UVB, 1.3% for systemic PUVA, 1.3% for bath PUVA and 0.8% for hand/foot PUVA. Adverse events were due to patient non-compliance with standard operating procedures in 15 cases (21%) and operator error in 2 (3%). Only 4 of the acute adverse events were considered to be severe, accounting for 0.05% of all treatments. CONCLUSIONS The rates of acute adverse events with phototherapy in this analysis were low, in particular the rate of severe adverse events. The highest rate was seen with both systemic and bath PUVA. The number of adverse events resulting from operator error was low. These published rates for adverse events associated with narrow-band UVB and PUVA may help other units when analyzing their own rate of adverse events.
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Affiliation(s)
- J A Martin
- Department of Dermatology, University Hospital of Wales, Heath Park, Cardiff, UK.
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Abstract
Fototerapia é a modalidade terapêutica que aplica exposições repetidas e controladas de radiação ultravioleta para alterar a fisiologia cutânea de modo a induzir a regressão ou controlar a evolução de diversas dermatoses. Este texto apresenta uma visão geral das práticas correntes que utilizam a radiação ultravioleta isolada ou em combinação com fotossensibilizantes ou outras medicações. Serão ainda discutidos os mecanismos de ação de cada modalidade, as indicações mais aceitas, seus esquemas de prescrição, efeitos adversos e cuidados especiais.
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Affiliation(s)
- Tania F. Cestari
- Universidade Federal do Rio Grande do Sul; Hospital de Clínicas, Brasil
| | | | - Gustavo Pinto Corrêa
- Sociedade Brasileira de Dermatologia; Secretaria Estadual de Saúde do Rio Grande do Sul, Brasil
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Rodríguez-Granados M, Carrascosa J, Gárate T, Gómez-Díez S, Guimaraens-Juantorena D. Consensus Document on Therapy With Bath Psoralen-UV-A. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s1578-2190(07)70420-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Kalu PU, Myers S. Recreational use of Psoralens to fortify skin tanning. Burns 2006; 32:929-31. [PMID: 17000050 DOI: 10.1016/j.burns.2006.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2005] [Accepted: 04/06/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Peter U Kalu
- Department of Plastic and Reconstructive Surgery, Dawson Ward, Third Floor, Royal Free Hospital, Pond Street, London NW3 2QG, United Kingdom.
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Thappa DM, Laxmisha C. Suit PUVA as an effective and safe modality of treatment in guttate psoriasis. J Eur Acad Dermatol Venereol 2006; 20:1146-7. [PMID: 16987282 DOI: 10.1111/j.1468-3083.2006.01642.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Grimmer J, Weiss T, Weber L, Meixner D, Scharffetter-Kochanek K. Successful treatment of lichen amyloidosis with combined bath PUVA photochemotherapy and oral acitretin. Clin Exp Dermatol 2006; 32:39-42. [PMID: 17004989 DOI: 10.1111/j.1365-2230.2006.02244.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Lichen amyloidosis (LA) is a chronic, pruritic skin disorder characterized by brownish-grey papules on extensor surfaces of legs and rarely on the trunk. Thioflavin T-positive amyloid deposits are found in the papillary dermis of affected skin, which is the only organ involved. A variety of therapeutic regimens for lichen amyloidosis have been described; however, in many cases with only limited effect. We report on two patients with lichen amyloidosis with typical clinical symptoms not responding to local treatment. A combined regimen with bath psoralen ultraviolet A (PUVA) and oral acitretin was initiated, resulting in nearly complete resolution of the papules and impressive relief from the severe pruritus. The beneficial response has persisted for 8 months. The suggested combined therapy with bath PUVA photochemotherapy and oral acitretin represents an efficacious and practical treatment modality for lichen amyloidosis with long-lasting effects.
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Affiliation(s)
- J Grimmer
- Department of Dermatology and Allergic Diseases, University of Ulm, Germany
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Diffey B. The contribution of medical physics to the development of psoralen photochemotherapy (PUVA) in the UK: a personal reminiscence. Phys Med Biol 2006; 51:R229-44. [PMID: 16790905 DOI: 10.1088/0031-9155/51/13/r14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Psoralen photochemotherapy (PUVA) is the combined treatment of skin disorders with a photosensitizing drug (Psoralen) and UltraViolet A radiation. The introduction of PUVA therapy has arguably been the most important development in dermatology over the past 30 years and from the first days of the treatment being introduced in the UK, British medical physicists were an integral part of the effort to establish it. Medical physicists have contributed to this development in a number of ways, from designing irradiation units in the early days of the technique, through to collaborating with dermatologists in prosecuting clinical and experimental studies aimed at improving patient outcomes. That the dose of UVA radiation is administered quantitatively, and not qualitatively, has probably been the single most important contribution made by several medical physicists over this period. However, despite concerns that were expressed almost 30 years ago about the accuracy with which UVA doses are administered to patients, the medical physics community still has some way to go before we can be satisfied that statements about UVA irradiance and dose can be made with confidence.
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Affiliation(s)
- Brian Diffey
- Regional Medical Physics Department, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE, UK.
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Broniarczyk-Dyla G, Wawrzycka-Kaflik A, Dubla-Berner M, Prusinska-Bratos M. Effects of psoralen-UV-A-Turban in alopecia areata. Skinmed 2006; 5:64-8. [PMID: 16603835 DOI: 10.1111/j.1540-9740.2006.04240.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND Psoralen-UV-A (PUVA)-turban is a modification of PUVA-bath therapy used in alopecia areata. OBJECTIVE The aim of this study was to assess the efficacy of PUVA-turban in different forms of alopecia areata. Twenty patients completed the study: nine with alopecia areata vulgaris and 11 with alopecia areata totalis or universalis. METHODS 8-methoxypsoralen in a dilution of 0.0001% (1 mg/L) was administered to the scalp for 20 minutes using a cotton towel as a turban. The application was followed by UV-A radiation. Treatments were performed two or three times weekly. The cumulative doses ranged from 48.2-253.4 J/cm2, and single fractions ranged from 0.3-6.5 J/cm2. RESULTS Hair regrowth was observed in 15 patients (total regrowth in six patients and partial regrowth in nine patients). Five patients did not respond to the therapy. CONCLUSIONS PUVA-turban was significantly more effective in alopecia areata vulgaris than in alopecia areata totalis or universalis and proved to be a safe, well tolerated method without the systemic side effects of PUVA.
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Affiliation(s)
- Grazyna Broniarczyk-Dyla
- Department of General, Esthetic Dermatology and Dermatosurgery, Medical University of Lodz, Poland.
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Hofer A, Fink-Puches R, Kerl H, Quehenberger F, Wolf P. Paired comparison of bathwater versus oral delivery of 8-methoxypsoralen in psoralen plus ultraviolet A therapy for chronic palmoplantar psoriasis. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2006; 22:1-5. [PMID: 16436174 DOI: 10.1111/j.1600-0781.2006.00196.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Both bath psoralen plus ultraviolet A (PUVA) and oral PUVA with 8-methoxypsoralen (8-MOP) have been successfully used for the treatment of recalcitrant palmoplantar psoriasis. This trial was designed to assess the efficacy and side effects of the different treatment modalities in a randomized half-side comparison. METHODS Eight patients with moderate-to-severe psoriasis on soles (n = 6) and/or palms (n = 8) were randomly assigned to receive bath PUVA treatment on one side and oral PUVA on the other. Initial treatment dose was 50% of the minimal phototoxic dose evaluated for bath PUVA and oral PUVA. Treatment was given three times a week for 4 weeks. Before treatment and every week a severity index (SI) was assessed by summing the scores of erythema, infiltration, scaling and vesicles evaluated on a scale from 0 to 4. After 4 weeks of treatment the half-side trial was finished and the treatment was continued on both sides with the more effective treatment regimen. RESULTS Both bath PUVA and oral PUVA achieved a reduction of the mean initial SI from 5.9 (95% confidence intervals (CI) 4.5-8.0) to 3.3 (1.8-6.0) (44% SI reduction, P < 0.005, Student's paired t-test) and 6.0 (5.0-7.8) to 2.9 (1.8-4.0) (52% SI reduction; P < 0.005), respectively. The statistical comparison of the entire 4-week study period revealed a significant better effect in lesions treated with oral PUVA compared with bath PUVA (P = 0.033). However, at 4 weeks, there was no significant difference between the achieved SI reduction of oral PUVA and bath PUVA. Systemic side effects (nausea and/or dizziness) were only observed after oral PUVA. CONCLUSION This study gives evidence that in the first 4 treatment weeks oral PUVA is slightly more effective than bath PUVA but the former has more systemic side effects.
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Affiliation(s)
- A Hofer
- Research Unit of Photodermatology, Medical University Graz, Graz, Austria
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Pozo-Román T, González-López A, Velasco-Vaquero ME, Núñez-Cabezón M. Psoralen cream plus ultraviolet A photochemotherapy (PUVA cream): our experience. J Eur Acad Dermatol Venereol 2006; 20:136-42. [PMID: 16441619 DOI: 10.1111/j.1468-3083.2006.01378.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psoralen ultraviolet A (PUVA) bath photochemotherapy has been proved highly effective in the treatment of various dermatoses without potential side-effects of systemic therapy. Another form of topical PUVA therapy (PUVA cream) without the logistical requirements for bath tubs has recently been developed. OBJECTIVE We sought to develop preparation and treatment standards to PUVA cream and to confirm its clinical efficacy in the treatment of various dermatoses. METHODS In the first phase, the safety of a novel cream containing 0.002% 8-methoxypsoralen (8-MOP) was determined in six healthy volunteers. In a second phase, 40 patients with different dermatoses were treated with a minor concentration (0.001% 8-MOP), following the guidelines for topical PUVA of the British Photodermatology Group. RESULTS Plasma levels of psoralen after the application of the novel cream containing 0.002% 8-MOP, were less than 34 ng/mL, the maximum 8-MOP concentration reported for topical PUVA. With a minor concentration (0.001% 8-MOP), important improvement or healing was found in 53.3% of the cycles, generally with a good response since the first month of treatment. Only mild side-effects were detected in 14 patients. CONCLUSIONS Based on our data, PUVA cream photochemotherapy is well accepted by patients and may be a highly effective treatment even if previous therapy was unsuccessful. In addition, PUVA cream is easier to use than PUVA bath.
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Affiliation(s)
- T Pozo-Román
- Service of Dermatology, Hospital Del Río Hortega, Valladolid, Spain.
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Engin B, Oguz O. Evaluation of time-dependent response to psoralen plus UVA (PUVA) treatment with topical 8-methoxypsoralen (8-MOP) gel in palmoplantar dermatoses. Int J Dermatol 2006; 44:337-9. [PMID: 15811091 DOI: 10.1111/j.1365-4632.2004.02153.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Topical psoralen plus UVA (PUVA) is an effective treatment for localized forms of eczema, psoriasis, and palmoplantar pustulosis, which avoids some of the undesirable side-effects of systemic psoralens. Aims In this study, the efficacy of topical PUVA treatment with 8-methoxypsoralen (8-MOP) gel was compared with placebo plus UVA in chronic recurrent palmoplantar dermatoses. METHODS Twenty-two patients with palmoplantar disease (11 with psoriasis vulgaris, six with eczema, and five with pustulosis) were enrolled in the study. The study design was a left-right comparison: one hand or foot was treated with 8-MOP 0.01% gel plus UVA, whilst the contralateral hand or foot received placebo and UVA for 6 weeks. Twenty minutes after application of the gel, both sides were exposed to UVA. The treatment regimen was three times a week, and the UVA dose was increased weekly by 20%. RESULTS A comparison of the pre- and post-treatment scores with regard to the severity of the clinical picture and the infiltration of plaques showed a significant decrease (from 7.5 +/- 2.0 to 2.5 +/- 2.1 and from 2.0 +/- 0.7 to 0.3 +/- 0.5, respectively) in the sites treated with 8-MOP gel compared with placebo after 6 weeks. CONCLUSION The results of the study indicate that at least 18 courses of local PUVA within 6 weeks, with a cumulative dose of 87 J/cm(2), are required to induce a significant decrease in the disease severity and an improvement in the infiltration of plaques due to 8-MOP gel at a concentration of 0.01% when treating chronic recurrent palmoplantar dermatoses.
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Affiliation(s)
- Burhan Engin
- Dermatology Department, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
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Abstract
Skin transplants can be a useful and efficacious method to treat vitiligo. The aim is to repopulate areas lacking melanocytes with functional cells taken from normally pigmented areas. Several procedures have been devised and tested: some consist in the simple transfer of epidermis sampled and implanted as is, whereas others are based on the transplantation of disaggregated and manipulated cells. The therapeutic success of the former methods is partly determined by the ability and experience of the surgeon performing the operation, whereas the results of the latter methods mainly depend on the laboratory facilities and abilities of the personnel who manipulate the cells to be transplanted. The transplantation of cultured cells is the most fascinating and promising procedure but requires the observance of still not completely predictable procedures. The use of biological material of animal origin and the use of factors to stimulate cell proliferation, such as growth factors and promoting agents, are other points that require attention.
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Affiliation(s)
- Elisa Pianigiani
- Department of Dermatologic Sciences, University of Siena, Policlinico Le Scotte, 53100 Siena, Italy
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