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Mahé E, Amy De La Bretêque M, Phan C. Perspectives on the pharmacological management of psoriasis in pediatric and adolescent patients. Expert Rev Clin Pharmacol 2021; 14:807-819. [PMID: 33784929 DOI: 10.1080/17512433.2021.1911641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Psoriasis affects about 0.5% of children and adolescents, it has a high impact of social life. Management can be difficult. The beginning of the 21st century has been an interesting period for the management of pediatric psoriasis, with access to new topical and systemic treatments including several biotherapies. AREAS COVERED Herein, we analyze the current therapeutic strategies for managing psoriasis in young patients, ranging from infants to adolescents, in a holistic approach. Usual treatment but also new galenics, new topical associations, and biological (anti-TNF-alpha, anti-interleukin 12/23, anti-interleukin 17) recently developed are presented. Results from clinical trials are detailed, but also real-world evaluations, and recent guidelines. Practical tips for day-to-day management are finally proposed. EXPERT OPINION Currently, we have a wide range of treatments, which we can adapt to all types of psoriasis, depending on the demands of the child and his parents. The near future also looks promising with new topical combinations, new oral therapies (apremilast) and biologics (anti-interleukin 23), as well as genetically targeted therapies for pustular psoriasis.
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Affiliation(s)
- Emmanuel Mahé
- Service De Dermatologie Et Médecine Vasculaire, Hôpital Victor Dupouy, Argenteuil, France
| | | | - Céline Phan
- Service De Dermatologie Et Médecine Vasculaire, Hôpital Victor Dupouy, Argenteuil, France
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2
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Abstract
The excimer laser has emerged as an efficacious treatment modality for many dermatologic diseases. The excimer laser is an alternative to standard narrowband ultraviolet B (NBUVB) phototherapy treatment in patients with limited disease. In comparison to standard NBUVB, the excimer laser requires fewer treatment sessions, has reduced treatment duration, requires a lower cumulative UVB dose, and limits UVB exposure to lesional skin. This review addresses the mechanism, safety, application, and efficacy of the excimer laser for the treatment of these conditions.
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Affiliation(s)
- Karen Ly
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA 94118, USA
| | - Mary P Smith
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA 94118, USA
| | - Quinn G Thibodeaux
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA 94118, USA
| | - Kristen M Beck
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA 94118, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA 94118, USA
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA 94118, USA.
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3
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Abstract
Introduction: Phototherapy has long been used for the treatment of inflammatory skin diseases, such as psoriasis and atopic dermatitis. The most frequent treatment approach utilizes ultraviolet (UV) light, however, recently, different lasers and low-level light therapies (LLLT) emitting wavelengths in the spectrum of the visible light have also been tried for the treatment of inflammatory skin diseases with variable success.Areas covered: This review provides an update on the different forms of phototherapy used for the treatment of psoriasis and atopic dermatitis. The proposed mechanism of action of the different phototherapeutical approaches are covered, including the immunosuppressive effect of UV light, the anti-inflammatory effect of vascular lasers and the LLLT induced photobiomodulation. The clinical efficacy of the different treatment options is also discussed.Expert opinion: Based on the efficacy and safety, NB-UVB represents the gold standard for treating psoriasis and atopic dermatitis. The UVB excimer laser and excimer lamp might be the best option for clearing localized therapy-resistant lesions. Home UV phototherapy systems might promote treatment adherence and better compliance of the patients. Vascular lasers, IPLs and LLLT, however, can not currently be recommended for the treatment of inflammatory skin diseases because of the lack of well-controlled studies.
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Affiliation(s)
- Lajos Kemény
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.,MTA-SZTE Dermatological Research Group, University of Szeged, Szeged, Hungary.,HCEMM-USZ Skin Research Group, Szeged, Hungary
| | - Emese Varga
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Zoltan Novak
- Department of Gynaecology, National Insitute of Oncology, Budapest, Hungary
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Elmets CA, Lim HW, Stoff B, Connor C, Cordoro KM, Lebwohl M, Armstrong AW, Davis DMR, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kiselica M, Kivelevitch D, Korman NJ, Kroshinsky D, Leonardi CL, Lichten J, Mehta NN, Paller AS, Parra SL, Pathy AL, Farley Prater EA, Rupani RN, Siegel M, Strober BE, Wong EB, Wu JJ, Hariharan V, Menter A. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis with phototherapy. J Am Acad Dermatol 2019; 81:775-804. [PMID: 31351884 DOI: 10.1016/j.jaad.2019.04.042] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/11/2019] [Indexed: 01/12/2023]
Abstract
Psoriasis is a chronic inflammatory disease involving multiple organ systems and affecting approximately 3.2% of the world's population. In this section of the guidelines of care for psoriasis, we will focus the discussion on ultraviolet (UV) light-based therapies, which include narrowband and broadband UVB, UVA in conjunction with photosensitizing agents, targeted UVB treatments such as with an excimer laser, and several other modalities and variations of these core phototherapies, including newer applications of pulsed dye lasers, intense pulse light, and light-emitting electrodes. We will provide an in-depth, evidence-based discussion of efficacy and safety for each treatment modality and provide recommendations and guidance for the use of these therapies alone or in conjunction with other topical and/or systemic psoriasis treatments.
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Affiliation(s)
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | | | | | - Kelly M Cordoro
- University of California, San Francisco School of Medicine, Department of Dermatology, San Francisco, California
| | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | | | | | | | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | | | | | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | | | - Reena N Rupani
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Bruce E Strober
- University of Connecticut, Farmington, Connecticut; Probidity Medical Research, Waterloo, Ontario, Canada
| | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, San Antonio, Texas
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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5
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Rattanakaemakorn P, Phusuphitchayanan P, Pakornphadungsit K, Thadanipon K, Suchonwanit P. Efficacy and safety of 308-nm excimer lamp in the treatment of scalp psoriasis: a retrospective study. Photodermatol Photoimmunol Photomed 2019; 35:172-177. [PMID: 30648290 DOI: 10.1111/phpp.12448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/12/2018] [Accepted: 01/02/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Scalp psoriasis is a major therapeutic challenge due to the hindrance caused by hair. Treatment with the 308-nm excimer lamp is purported to provide many benefits over conventional phototherapy. This retrospective study evaluates the efficacy, safety, and effective dosage of 308-nm excimer light in the treatment of scalp psoriasis. METHODS We retrospectively reviewed the medical records of patients with scalp psoriasis who received treatment with 308-nm excimer light. Clinical and epidemiological data as well as details regarding treatment were statistically analyzed to determine the treatment outcomes. RESULTS Twenty patients with scalp psoriasis were included in the study. Their mean age was 47.45 ± 17.93 years. Eleven patients responded to treatment at the end of 10 sessions. The median baseline Psoriatic Scalp Severity Index (PSSI) was 12 (range, 3-32). At the end of the protocol, the median PSSI was 4.5 (range, 0-24), indicating a statistically significant reduction (P < 0.001). Common adverse effects included erythema, irritation, and desquamation. CONCLUSION The 308-nm excimer light appears to be an effective and safe modality that requires short treatment time. The modality could be considered as an alternative or adjuvant treatment for scalp psoriasis.
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Affiliation(s)
- Ploysyne Rattanakaemakorn
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Kallapan Pakornphadungsit
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kunlawat Thadanipon
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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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: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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8
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Fritz K, Salavastru C. [The 308 nm Excimer laser for the treatment of psoriasis and inflammatory skin diseases]. Hautarzt 2018; 69:35-43. [PMID: 29299629 DOI: 10.1007/s00105-017-4105-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Overall, the 308 nm Excimer laser enables not only a more effective and safer UVB therapy than classical UV phototherapy, but also targeted irradiation in higher doses with a lower cumulative load, which results in faster healing of mainly circumscribed skin changes. This also applies to therapy-resistant residual lesions which, despite systemic therapy, did not diminish. Combination therapies usually improve the result and enable the dose of UVB and systemic medication to be reduced. Excimer laser therapy can be used for an increasing number of skin diseases, especially those that respond to phototherapy or photochemotherapy.
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Affiliation(s)
- K Fritz
- Hautärzte- und Laserzentrum Landau (Pfalz), Reduitstr. 13, 76829, Landau, Deutschland. .,Medizinische und Pharmazeutische Universität Carol Davila, Bukarest, Rumänien.
| | - C Salavastru
- Medizinische und Pharmazeutische Universität Carol Davila, Bukarest, Rumänien.,Abteilung für pädiatrische Dermatologie, Colentina-Krankenhaus, Bukarest, Rumänien
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9
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Abstract
Phototherapy is an effective treatment modality for several skin diseases which has been in use from the era of the Egyptians. Insight into its mode of action has gradually accumulated over the past decades. A crucial biological effect of ultraviolet radiation is the induction of apoptosis in T lymphocytes and in keratinocytes in the epidermis. Via this mechanism inflammation-induced pathological changes characteristic of psoriasis are counteracted.Phototherapy remains the only therapeutic option for certain patient groups where modification of the systemic immune reactions is contraindicated, such as by HIV, internal malignancy or pregnancy. UVB treatment is highly cost-effective, which is important in this age of increasing health care costs.
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10
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Higgins E, Ralph N, Ryan S, Koik N, Honari B, Lally A, Collins P. A randomised half body prospective study of low and medium dose regimens using the 308 nm excimer laser in the treatment of localised psoriasis. J DERMATOL TREAT 2016; 28:8-13. [DOI: 10.3109/09546634.2016.1170758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Eleanor Higgins
- The Charles Centre, Department of Dermatology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Nicola Ralph
- The Charles Centre, Department of Dermatology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Sheila Ryan
- The Charles Centre, Department of Dermatology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Nicola Koik
- The Charles Centre, Department of Dermatology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Bahman Honari
- Centre for Support and Training in Analysis and Research (CSTAR), Department of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Aoife Lally
- The Charles Centre, Department of Dermatology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Paul Collins
- The Charles Centre, Department of Dermatology, St. Vincent’s University Hospital, Dublin, Ireland
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12
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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13
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Abstract
Psoriasis is an inflammatory skin condition that affects approximately 2 % of people worldwide. Topical treatments, systemic treatments, biologic agents, and phototherapy are all treatment options for psoriasis. Ultraviolet (UV) B phototherapy is most appropriate for patients with >10 % affected body surface area who have not responded to topical treatments. This review outlines the use, dosage, safety, and efficacy of narrowband UVB (NB-UVB) and targeted phototherapy. NB-UVB and excimer laser are effective treatment options for psoriasis; they are administered two to three times weekly until clearance followed by maintenance treatment before discontinuation. Long-term data on NB-UVB indicate that it has a good safety profile. NB-UVB is commonly used with adjunctive topical treatments such as emollients, calcipotriene, cortico-steroids, retinoids, and tar. NB-UVB can be used in selected patients with traditional systemic agents such as methotrexate, mycophenolate mofetil, and cyclosporine, although the duration of the combined treatment should be kept to a minimum and patients need to be closely monitored. Acitretin can be safely used with phototherapy, but robust data on the combination use of biologic agents or phosphodiesterase inhibitors with phototherapy are lacking.
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Affiliation(s)
- Dhwani Mehta
- Department of Dermatology, Henry Ford Hospital, Henry Ford Medical Center-New Center One, 3031 West Grand Blvd, Suite 800, Detroit, MI, 48202, USA
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Henry Ford Medical Center-New Center One, 3031 West Grand Blvd, Suite 800, Detroit, MI, 48202, USA.
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Kitamura Y, Mizuguchi H, Okamoto K, Kitayama M, Fujii T, Fujioka A, Matsushita T, Mukai T, Kubo Y, Kubo N, Fukui H, Takeda N. Irradiation with narrowband-ultraviolet B suppresses phorbol ester-induced up-regulation of H1 receptor mRNA in HeLa cells. Acta Otolaryngol 2016; 136:409-13. [PMID: 26824787 DOI: 10.3109/00016489.2015.1129555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Conclusion These findings suggest that low dose irradiation with 310 nm NB-UVB specifically suppressed the up-regulation of H1R gene expression without inducing apoptosis and that UVB of shorter or longer wavelength than 310 nm NB-UVB had no such effects. Objective To develop a narrowband-ultraviolet B(NB-UVB) phototherapy for allergic rhinitis, this study investigated the effects of irradiation with NB-UVB at wavelength of 310 nm on phorbol-12-myristate-13-acetate (PMA)-induced up-regulation of histamine H1 receptor (H1R) mRNA in HeLa cells. Methods The mRNA levels of H1R in HeLa cells were measured using real-time RT-PCR. Apoptosis were evaluated with DNA fragmentation assay. Results PMA induced a significant increase in H1R mRNA expression in HeLa cells. Irradiation with 305 nm UVB and 310 nm NB-UVB, but not with 315 nm UVB at doses of 200 and 300 mJ/cm(2) significantly suppressed PMA-induced up-regulation of H1R mRNA. At a dose of 200 mJ/cm(2), irradiation with 305 nm UVB, but not with 310 nm NB-UVB, induced apoptosis, although exposure of the cells to both 305 and 310 nm UVB induced apoptosis at a dose of 300 mJ/cm(2) after PMA treatment in HeLa cells. Conversely, irradiation with 315 nm UVB at doses of 200 and 300 mJ/cm(2) did not induce apoptosis.
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Affiliation(s)
- Yoshiaki Kitamura
- a Department of Otolaryngology , Institute of Medical Biosciences, Tokushima University Graduate School , Tokushima , Japan
| | - Hiroyuki Mizuguchi
- b Department of Molecular Pharmacology , Institute of Medical Biosciences, Tokushima University Graduate School , Tokushima , Japan
| | - Kentaro Okamoto
- b Department of Molecular Pharmacology , Institute of Medical Biosciences, Tokushima University Graduate School , Tokushima , Japan
| | - Mika Kitayama
- b Department of Molecular Pharmacology , Institute of Medical Biosciences, Tokushima University Graduate School , Tokushima , Japan
| | - Tatsuya Fujii
- a Department of Otolaryngology , Institute of Medical Biosciences, Tokushima University Graduate School , Tokushima , Japan
| | | | | | | | - Yoshiaki Kubo
- d Department of Dermatology , Institute of Medical Biosciences, Tokushima University Graduate School , Tokushima , Japan
| | - Nobuo Kubo
- e Miki Medical Corporation SunField Stem Cell Processing Center , Tokyo , Japan
| | - Hiroyuki Fukui
- f Department of Molecular Studies for Incurable Diseases , Institute of Medical Biosciences, Tokushima University Graduate School , Tokushima , Japan
| | - Noriaki Takeda
- a Department of Otolaryngology , Institute of Medical Biosciences, Tokushima University Graduate School , Tokushima , Japan
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15
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Abstract
Phototherapy is a first-line option for the treatment of moderate to severe psoriasis. Systematic reviews indicate near comparable efficacy of the different forms of phototherapy. Localized phototherapy can be an adjunctive treatment of recalcitrant plaques during systemic treatment of psoriasis. More than 200 psoralen-UV-A therapy treatment sessions is associated with an increased risk of keratinocytic cancers, whereas no increased risk has been demonstrated for narrow-band UV-B therapy. The mechanism of action of phototherapy in psoriasis is via inhibition of keratinocyte proliferation; induction of apoptosis in keratinocytes, dendritic, and T cells; and inhibition of Th1 and Th17 pathways, but activation of Th2.
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Affiliation(s)
- Emoke Racz
- Department of Dermatology, Erasmus University Medical Center Rotterdam, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Errol P Prens
- Department of Dermatology, Erasmus University Medical Center Rotterdam, PO Box 2040, Rotterdam 3000 CA, The Netherlands.
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16
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Alshiyab D, Edwards C, Chin MF, Anstey AV. Targeted ultraviolet B phototherapy: definition, clinical indications and limitations. Clin Exp Dermatol 2014; 40:1-5. [DOI: 10.1111/ced.12441] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 11/29/2022]
Affiliation(s)
- D. Alshiyab
- Department of Dermatology; Faculty of Medicine; Jordan University of Science and Technology; Irbid Jordan
| | - C. Edwards
- Academic Dermatology Unit; St Woolos Hospital; Newport UK
| | - M. F. Chin
- Department of Dermatology; University Hospital of Wales; Cardiff UK
| | - A. V. Anstey
- Academic Dermatology Unit; St Woolos Hospital; Newport UK
- Cardiff University; Cardiff UK
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18
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Almutawa F, Thalib L, Hekman D, Sun Q, Hamzavi I, Lim HW. Efficacy of localized phototherapy and photodynamic therapy for psoriasis: a systematic review and meta-analysis. Photodermatol Photoimmunol Photomed 2013; 31:5-14. [DOI: 10.1111/phpp.12092] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Fahad Almutawa
- Department of Medicine, Faculty of Medicine; Kuwait University; Al-jabriya Kuwait
| | - Lukman Thalib
- Department of Community Medicine (Biostatistics); Faculty of Medicine; Kuwait University; Al-jabriya Kuwait
| | - Daniel Hekman
- Grand Rapids Medical Education Partners; Grand Rapids MI USA
| | - Qing Sun
- Department of Dermatology; Qilu Hospital of Shandong University; Jinan China
| | - Iltefat Hamzavi
- Department of Dermatology; Henry Ford Hospital; Detroit MI USA
| | - Henry W. Lim
- Department of Dermatology; Henry Ford Hospital; Detroit MI USA
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19
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Abstract
Ultraviolet B (UVB) is a highly effective, relatively safe, affordable and widely used therapeutic option for moderate psoriasis.
Ultraviolet B (UVB) is a highly effective, relatively safe, affordable and widely used therapeutic option for moderate psoriasis. Several types of UVB lamp are available to treat psoriasis, both broadband and narrowband, allowing a choice of spectral emission. However despite years of clinical use, the mechanism of action of UVB in clearing psoriasis remained incompletely understood. Moreover, there has been little insight into how the relative effectiveness of different UVB wavelengths linked to the mechanism of action, although it is known that the action spectrum for clearance of psoriasis differs from the action spectrum of erythema. This paper examines the existing literature from which our current treatments have evolved, and offers new insight into the use of keratinocyte apoptosis as a biomarker which may help to optimise UV treatment in the future. When combined with a systems biology approach, this potential biomarker may provide insight into which wavelengths of UV are the most effective in clearing psoriasis, allowing a more rational and potentially an individually tailored approach to optimising phototherapy for psoriasis.
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Kagen M, Cao LY, Oyetakin-White P, Tacastacas JD, Yan C, McCormick TS, Cooper KD. Single administration of lesion-limited high-dose (TURBO) ultraviolet B using the excimer laser: clinical clearing in association with apoptosis of epidermal and dermal T cell subsets in psoriasis. Photodermatol Photoimmunol Photomed 2012; 28:293-8. [DOI: 10.1111/j.1600-0781.2012.00692.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mark Kagen
- Department of Dermatology; University Hospitals Case Medical Center; Cleveland; OH; USA
| | - Lauren Y. Cao
- Case Western Reserve University School of Medicine; Cleveland; OH; USA
| | | | - Joselin D. Tacastacas
- Department of Dermatology; University Hospitals Case Medical Center; Cleveland; OH; USA
| | - Chunlin Yan
- Department of Dermatology; University Hospitals Case Medical Center; Cleveland; OH; USA
| | - Thomas S. McCormick
- Department of Dermatology; University Hospitals Case Medical Center; Cleveland; OH; USA
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Dong J, He Y, Zhang X, Wang Y, Tian Y, Wang J. Clinical efficacy of flumetasone/salicylic acid ointment combined with 308-nm excimer laser for treatment of psoriasis vulgaris. Photodermatol Photoimmunol Photomed 2012; 28:133-6. [PMID: 22548394 DOI: 10.1111/j.1600-0781.2012.00654.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jie Dong
- Department of Dermatology; Beijing Chaoyang Hospital; Beijing; China
| | - Yanling He
- Department of Dermatology; Beijing Chaoyang Hospital; Beijing; China
| | - Xiuying Zhang
- Department of Dermatology; Beijing Chaoyang Hospital; Beijing; China
| | - Yixuan Wang
- Department of Dermatology; Beijing Chaoyang Hospital; Beijing; China
| | - Yongjing Tian
- Department of Dermatology; Beijing Chaoyang Hospital; Beijing; China
| | - Jie Wang
- Department of Dermatology; Beijing Chaoyang Hospital; Beijing; China
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Carrascosa J, López-Estebaranz J, Carretero G, Daudén E, Ferrándiz C, Vidal D, Belinchón I, Sánchez-Regaña M, Puig L. Documento de consenso de fototerapia en psoriasis del Grupo Español de Psoriasis: ultravioleta B de banda estrecha (UVBBE), láser y fuentes monocromáticas de excímeros y terapia fotodinámica. Actas Dermo-Sifiliográficas 2011; 102:175-86. [DOI: 10.1016/j.ad.2010.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 11/10/2010] [Indexed: 01/22/2023] Open
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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: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Carrascosa J, López-Estebaranz J, Carretero G, Daudén E, Ferrándiz C, Vidal D, Belinchón I, Sánchez-Regaña M, Puig L. Narrowband UV-B, Monochromatic Excimer Laser, and Photodynamic Therapy in Psoriasis: A Consensus Statement of the Spanish Psoriasis Group. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1578-2190(11)70782-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Hammes S, Hermann J, Roos S, Ockenfels H. UVB 308-nm excimer light and bath PUVA: combination therapy is very effective in the treatment of prurigo nodularis. J Eur Acad Dermatol Venereol 2010; 25:799-803. [DOI: 10.1111/j.1468-3083.2010.03865.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kemény L, Csoma Z, Bagdi E, Banham A, Krenács L, Koreck A. Targeted phototherapy of plaque-type psoriasis using ultraviolet B-light-emitting diodes. Br J Dermatol 2010; 163:167-73. [DOI: 10.1111/j.1365-2133.2010.09763.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gattu S, Pang ML, Pugashetti R, Malick F, Hong J, Bowers E, Levatter JI, Koo J. Pilot evaluation of supra-erythemogenic phototherapy with excimer laser in the treatment of patients with moderate to severe plaque psoriasis. J DERMATOL TREAT 2010; 21:54-60. [DOI: 10.3109/09546630903203756] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb A, Koo JY, Lebwohl M, Lim HW, Van Voorhees AS, Beutner KR, Bhushan R. Guidelines of care for the management of psoriasis and psoriatic arthritis. J Am Acad Dermatol 2010; 62:114-135. [DOI: 10.1016/j.jaad.2009.08.026] [Citation(s) in RCA: 245] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 08/07/2009] [Accepted: 08/12/2009] [Indexed: 11/26/2022]
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Wollenschläger I, Hermann J, Ockenfels H. UVB-308-nm- (NUVB-)Therapie mittels Excimer-Laser bei atopischer Dermatitis und weiteren inflammatorischen Dermatosen. Hautarzt 2009; 60:898-906. [DOI: 10.1007/s00105-009-1828-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Toll A, Vélez-González M, Gallardo F, Gilaberte M, Pujol RM. Treatment of localized persistent plaque psoriasis with incoherent narrowband ultraviolet B phototherapy. J DERMATOL TREAT 2009; 16:165-8. [PMID: 16096183 DOI: 10.1080/09546630510043211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE This study evaluated the efficacy of targeted UVB phototherapy treatment of chronic persistent psoratic plaques with localized incoherent UVB phototherapy. METHODS Sixteen subjects were enrolled. The final group was composed of eight men and seven women, each having one to seven chronic, stable psoriatic plaques. Each plaque was treated with fluences ranging from 3 to 7 MED using a fibre-coupled incoherent phototherapy device twice weekly for a maximum of 13 sessions. Assessments with a combination of three scores, each on a scale from 0 to 4, for scaling, erythema and induration (SEI score) were performed. RESULTS The patients received from 6 to 13 sessions (mean 9.6). The SEI score decreased by 3.3 (p = 0.01). This reduction was equally detected in all subscores. In a few patients, blistering and burning sensation after some sessions were noted. CONCLUSION Localized UVB phototherapy is an effective treatment option for persistent plaques of psoriasis. Compared with conventional UVB, localized phototherapy has the added safety benefit of virtually eliminating unwanted exposure of the healthy tissue to UVB.
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Affiliation(s)
- Agustí Toll
- Department of Dermatology, Hospital del Mar, IMAS, Barcelona, Spain.
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Gattu S, Rashid RM, Wu JJ. 308-nm excimer laser in psoriasis vulgaris, scalp psoriasis, and palmoplantar psoriasis. J Eur Acad Dermatol Venereol 2009; 23:36-41. [DOI: 10.1111/j.1468-3083.2008.02942.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Brozyna A, Wasilewska K, Wesierska K, Chwirot BW. Porcine skin as a model system for studies of adverse effects of narrow-band UVB pulses on human skin. J Toxicol Environ Health A 2009; 72:789-795. [PMID: 19557606 DOI: 10.1080/15287390902800363] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Ultraviolet (UV) radiation has been widely used in medicine, and in recent years there has been a growing interest in narrow-band UVB therapies, especially those employing pulses of the 308-nm line of XeCl excimer lasers. Comparative studies in several skin pathologies showed that narrow-band UVB was more effective than classical broad-band UVB radiation. Simultaneously, UVB is carcinogenic and there is a need for data to establish the risk associated with phototherapies involving irradiations of human skin with different doses of narrow- and broad-band UVA and/or UVB radiation. Relevant data are sparse predominantly due to a lack of suitable model systems for study of this phenomenon. Our comparative study of human and porcine skin responses to pulses of narrow-band UVB radiation demonstrated that for doses ranging from 5 to 10,000 mJ/cm(2) both skin types have similar susceptibility to UVB-induced breaking of nuclear DNA, indicating that pig skin might serve as good model for studies of sensitivity of human skin to UVB radiation.
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Affiliation(s)
- Anna Brozyna
- Department of Medical Biology, Institute of General and Molecular Biology, Nicolaus Copernicus University, Toruń, Poland
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He YL, Zhang XY, Dong J, Xu JZ, Wang J. Clinical efficacy of a 308 nm excimer laser for treatment of psoriasis vulgaris. Photoderm Photoimm Photomed 2007; 23:238-41. [DOI: 10.1111/j.1600-0781.2007.00317.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Millions of people have at least one tattoo. Complex and light absorbing molecules are implanted in the skin. When tattooed skin receives UV radiation or natural sunlight, photochemical cleavage of the pigments may occur. As a first step, we dissolved pigments in a suitable solvent and analyzed them after light irradiation. METHODS The widespread Pigment Red 22 was dissolved in different solvents. The solutions were irradiated with either UVB radiation (up to 8 h) or with natural sunlight (110 days). After irradiation, the solutions were analyzed by means of liquid chromatography and mass spectrometry. RESULTS A clear cleavage of the pigment was detected in all solvents and the primary decomposition products were identified. In tetrahydrofuran and dioxane, the pigment concentration decreased significantly during UVB irradiation, whereas the pigment was completely destroyed during sunlight exposure. In chloroform and dichloromethane, the pigment concentration decreased slightly during UVB irradiation, whereas the pigment was almost completely destroyed during sunlight exposure. CONCLUSION Since chloroform and dichloromethane do not affect the cleavage process, these solvents are optimal for such in vitro experiments. We have shown the cleavage of the tattoo pigment Red 22 when exposed to UVB radiation or natural sunlight. The decomposition products are hazardous showing a potential risk of being toxic or even carcinogenic. At present, a risk assessment is not feasible since the concentration of pigments and their decomposition products in skin are unknown.
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Affiliation(s)
- Eva Engel
- Department of Dermatology, University of Regensburg, Germany
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Goldinger SM, Dummer R, Schmid P, Prinz Vavricka M, Burg G, Lauchli S. Excimer Laser versus Narrow-Band UVB (311 nm) in the Treatment of Psoriasis Vulgaris. Dermatology 2006; 213:134-9. [PMID: 16902290 DOI: 10.1159/000093852] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Accepted: 02/18/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The excimer laser is a new therapeutic option in the treatment of psoriasis vulgaris. OBJECTIVE The purpose of this study was to determine the response of psoriasis lesions to the 308-nm excimer laser compared to 311-nm UVB phototherapy. METHODS In this prospective right/left comparative, open, single-blinded trial, selected psoriasis plaques of 16 patients were treated with the excimer laser whereas the rest of the body was treated with UVB narrow-band phototherapy. A modified PASI score was used to evaluate the results. RESULTS After 12 treatments, 15 patients were evaluated. In 2 patients no difference between the two body sides was observed. In 9 patients the laser-treated lesions showed better results, whereas in 4 patients the side treated with 311-nm UVB showed more clearing. The mean reduction in PASI score was 5.6 and 4.9, respectively (difference not significant). CONCLUSION The use of the 308-nm xenon chloride excimer laser is an additional effective therapeutic option for the treatment of psoriasis vulgaris.
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Abstract
The range of diagnostic and therapeutic applications of ultraviolet A (UVA) radiation has been continuously expanding. UVA radiation is a well-known mutagenic factor capable of damaging both cells and tissues. At the same time there is a very limited information on long-term consequences of irradiating the skin with different doses of UVA and long-wavelength ultraviolet B (UVB) radiation used in therapies of skin disorders. It was demonstrated that for UVA doses of 0.1 to 1000 mJ/cm2 the sensitivity of the porcine skin to the UVA-induced breaking of nuclear DNA is similar to that of the human skin. Results indicate that porcine skin may serve as a model system for population studies of the deleterious effects of UVA irradiation of the skin cells.
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Affiliation(s)
- Anna Brozyna
- Department of Medical Biology, Institute of General and Molecular Biology, Nicolaus Copernicus University, Torun, Poland
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Abstract
The 308-nm excimer laser represents the latest advance in the concept of selective phototherapy. It emits a wavelength in the UV-B spectrum and thus shares the same indications as conventional phototherapy. Like other laser devices, the 308-nm excimer laser emits a monochromatic and coherent beam of light, can selectively treat a lesion while sparing surrounding healthy skin, and can deliver high fluencies. Clinicians have taken advantage of these properties to treat dermatologic disorders since 1997, with psoriasis and vitiligo attracting most attention. Initially, high fluencies (minimal erythemal dose, 8-16) were used, with excellent clinical results, to treat psoriasis vulgaris. The significance of side effects and the potential long-term carcinogenic risk associated with such fluencies have resulted in medium doses (about 3 minimal erythemal dose) being recommended, however. Interestingly, taking advantage of the selectivity of the laser, newer treatment protocols adapt the dose to the lesion and not to the minimal erythemal dose, as is the case for conventional phototherapies. Many prospective study series have also shown the efficacy and the good tolerance of the 308-nm excimer laser in the treatment of localized vitiligo. Induced rates of repigmentation seem to be higher than with narrowband UV-B. Moreover, the selectivity of the treatment prevents irradiation of healthy skin and limits unsightly tanning of surrounding skin. Aesthetically pleasing results are usually not achieved in extremities and bony prominences, which are not good indications for this technique. Combining the 308-nm excimer laser with 0.1% tacrolimus ointment has provided very interesting results, which need to be confirmed in larger series. The absence of actual data concerning the long-term risk for skin cancer after this treatment means that it should be considered with caution. Combination with topical steroids appears to be synergistic and potentially reduces long-term side effects; again, prospective data are lacking.
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Affiliation(s)
- Thierry Passeron
- Department of Dermatology. Archet 2 Hospital, 06202 NICE Cedex 3, France.
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Joachim J, François N, Piccerelle P, Kister J, Reynier JP, Humbert P, Aubin F. [Mechanisms and treatment of psoriasis]. Presse Med 2005; 34:1727-36. [PMID: 16374397 DOI: 10.1016/s0755-4982(05)84261-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Psoriasis is a common dermatosis that affects 3-5% of the European population. Current treatments offer considerable clinical benefits, but their use is limited due to tolerance problems. Recent years have seen the development of new treatments, used separately or in combination to improve the chronic lesions caused by this disease. T cells play an important role in the pathogenesis of psoriasis. Various techniques target the T cells and the immunological mechanisms involved in their activation. In 2005, treatment of psoriasis is directed essentially towards immunological pathways.
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Affiliation(s)
- J Joachim
- Service central de la pharmacie et du médicament, Laboratoire de contrôle de la qualité, Hôpital de la Conception, Marseille (13).
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Abstract
THE EFFICACY OF THE 308 NM EXCIMER LASER in the treatment of common psoriasis has been demonstrated. THE DOSES USED have progressively decreased, hence, limiting the adverse events that appear redhibitory with high doses. THE ADAPTATION OF THE DOSES not to the patients themselves but to each of the plaques treated should reduce the number of sessions and the cumulated close necessary to obtain clinical remission. THE 308 NM EXCIMER LASER is effective and tolerance is good in the treatment of vitiligo. It should be proposed for limited vitiligo and essentially of the "UV sensitive" areas, which have shown aesthetically correct percentage of repigmentation. THE PLACE AND INTEREST of its association with other treatments, notably with topical tacrolimus, remains to be defined. Although the results obtained in the treatment of vitiligo are promising, they have to be confirmed in larger cohorts and ensure the absence of median and long term side effects. This therefore limits its use in combined treatments in the context of controlled clinical traits. THE 30 NM EXCIMER LASER IS AN EFFECTIVE AND WELL TOLERATED TREATMENT in localised and non-nodular forms of mycosis fungoid (MF). Although the number of patients treated is limited, the clinical and histological cure observed demonstrates the interest of this new technique in the treatment of MF. These results must be confirmed in a greater number of patients. THE 308 NM EXCIMER LASER is an interesting therapeutic alternative in the treatment of plaques of alopecia areata, erosive oral lichen planus, post-surgical hypopigmentation, vergetures and localised forms of atopic dermatitis. Because of the sparcity of data and in the absence of long term follow-up, it must not be proposed in first intention.
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Affiliation(s)
- Thierry Passeron
- Service de dermatologie, Hôpital Archet, 2, route de Saint-Antoine de Ginestière, 06200 Nice, France.
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