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Minh PPT, Minh TT, Thi PH, Ha GQT, Thi TB, Tirant M, Huu DL. New-insight UVB Treatment for Psoriasis Vulgaris in Vietnamese Patients. Indian J Dermatol 2024; 69:32-37. [PMID: 38572050 PMCID: PMC10986872 DOI: 10.4103/ijd.ijd_134_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Background Narrowband UVB (NBUVB) has recently been used in Vietnam for the treatment of psoriasis. However, there are no data on Vietnamese patients to adopt a uniform national protocol. Objectives This study aimed to establish an optimal NBUVB therapy for the treatment of psoriasis in Vietnamese patients. Materials and Methods One hundred and twenty-two patients with psoriasis vulgaris were included. They were randomly allocated to two groups: the percentage dose (group 1, 62 patients) and the fixed dose (group 2, 60 patients). In group 1, the starting dose was 50% of the minimal erythema dose (MED) and the 10% increment dose adjusted in the next sessions. In group 2, the starting dose was based on Fitzpatrick skin types (fixed dose). Psoriasis area and severity index (PASI) was used to evaluate efficacy. Results More than 68% of the patients get PASI75 at session 36. Group 2 had significantly fewer sessions (20 ± 5 vs 25 ± 7, P- value = 0.0004) and lower cumulative dose than group 1 (14.1 ± 4.3 J/cm2 vs 18.0 ± 8.0 J/cm2, P- value = 0.0075) to achieve PASI75. Adverse effects were more common in group 2 than group 1, including burning sensation/erythema (43.33% vs 14.52%, P- value = 0.0009) and pruritus (75.00% vs 22.58%, P- value <0.0001). Conclusion NBUVB therapy was safe and effective for Vietnamese psoriasis patients. Fixed doses produced a quicker clinical response with fewer sessions and lower cumulative doses. Adverse effects were mild in both groups and less noted for the MED-based dose. For the recommendation, a fixed dose should be applied for patients who have less concern about side effects, while a MED-based dose can be suitable for patients having conditions related to light sensitivity.
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Affiliation(s)
| | - Trang Trinh Minh
- Department of International Cooperation and Scientific Research, UV Clinic, Hanoi, Vietnam
| | | | - Giang Quach Thi Ha
- Out-patient Department, Vietnam National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Tra Bui Thi
- National Cancer Center Graduate School of Cancer Science and Policy, Republic of Korea
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2
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Park EJ, Yadav H, Singh TP. Editorial: Microbiota in skin inflammatory diseases. Front Immunol 2023; 14:1235314. [PMID: 37398670 PMCID: PMC10311210 DOI: 10.3389/fimmu.2023.1235314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 07/04/2023] Open
Affiliation(s)
- Eun Jeong Park
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hariom Yadav
- Center for Microbiome Research, Microbiomes Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Tej Pratap Singh
- Department of Pathobiology, University of Pennsylvania, Philadelphia, PA, United States
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3
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Youssef YE, Eldegla HEA, Elmekkawy RSM, Gaballah MA. Evaluation of vitamin D receptor gene polymorphisms (ApaI and TaqI) as risk factors of vitiligo and predictors of response to narrowband UVB phototherapy. Arch Dermatol Res 2023; 315:379-386. [PMID: 35318513 PMCID: PMC10020320 DOI: 10.1007/s00403-022-02348-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 02/08/2022] [Accepted: 03/02/2022] [Indexed: 11/28/2022]
Abstract
Vitiligo is acquired depigmentation due to multiple factors. Vitamin D in skin, through its receptors (VDR), regulates cell growth, differentiation, immune response and exerts both stimulatory and protective effects on melanocytes. The gene sequence encoding VDR has polymorphic forms such as ApaI and TaqI that may affect vitamin D actions. Narrowband ultraviolet B (NB-UVB) phototherapy became the mainstay of vitiligo treatment because of its efficacy and little side effects. The current work aimed at evaluating the possible association between VDR gene polymorphisms (TaqI and ApaI) and susceptibility of vitiligo and if they could be predictors of response to NB-UVB phototherapy in Egyptian vitiligo patients. 100 vitiligo patients indicated for NB-UVB phototherapy and 100 healthy age and sex matched controls were included. All participants were subjected to history taking, general and dermatological examinations, and VDR ApaI and TaqI gene polymorphisms analysis by PCR-RFLP. The patients received NB-UVB 3times per week for 6 months then revaluated. There was significant increase in Aa genotype of ApaI polymorphism in patients associated with significant increase in vitiligo activity. 66% of patient showed variable degrees of response to NB-UVB. The responders significantly had AA genotype of ApaI polymorphism. TaqI polymorphism showed nonsignificant effects on vitiligo susceptibility and response to NB-UVB. A allele of ApaI was significant independent predictor of NB-UVB phototherapy responders. VDR gene polymorphism (ApaI) may share in vitiligo pathogenesis and response to NB-UVB. Knowing the genetic background of the patient helps individualization of treatment to get better results.
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Affiliation(s)
- Youssef Elbayoumy Youssef
- Department of Dermatology, Andrology and STDs, Faculty of Medicine, Mansoura University, El-Gomhoria St., Mansoura, Egypt
| | - Heba Elsayed Abdelmoneim Eldegla
- Department of Dermatology, Andrology and STDs, Faculty of Medicine, Mansoura University, El-Gomhoria St., Mansoura, Egypt
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Mohammad Ali Gaballah
- Department of Dermatology, Andrology and STDs, Faculty of Medicine, Mansoura University, El-Gomhoria St., Mansoura, Egypt
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4
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Goulden V, Ling TC, Babakinejad P, Dawe R, Eadie E, Fassihi H, Fityan A, Garibaldinos T, Ibbotson SH, Novakovic L, Rush E, Weatherhead SC, Whitehouse H, Hashme M, Mustapa MFM, Exton LS. British Association of Dermatologists and British Photodermatology Group guidelines for Narrowband Ultraviolet B Phototherapy 2022. Br J Dermatol 2022; 187:295-308. [DOI: 10.1111/bjd.21669] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | - Tsui C. Ling
- Photobiology Unit, Dermatology Centre University of Manchester and Salford Royal NHS Foundation Trust Manchester M6 8HD UK
| | | | - Robert Dawe
- Scottish Photobiology Service, Photobiology Unit University of Dundee & NHS Tayside Ninewells Hospital & Medical School, Dundee DD1 9SY UK
| | - Ewan Eadie
- Scottish Photobiology Service, Photobiology Unit University of Dundee & NHS Tayside Ninewells Hospital & Medical School, Dundee DD1 9SY UK
| | - Hiva Fassihi
- Department of Photodermatology, St John's Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust London SE1 9RT UK
| | - Adam Fityan
- University Hospital Southampton NHS Foundation Trust Southampton SO10 6YD UK
| | - Trish Garibaldinos
- Department of Photodermatology, St John's Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust London SE1 9RT UK
| | - Sally H. Ibbotson
- Scottish Photobiology Service, Photobiology Unit University of Dundee & NHS Tayside Ninewells Hospital & Medical School, Dundee DD1 9SY UK
| | - Ljuba Novakovic
- Department of Photodermatology, St John's Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust London SE1 9RT UK
- Queen Elizabeth Hospital, Lewisham & Greenwich NHS Trust London SE18 4QH UK
| | | | | | | | - Maria Hashme
- Clinical Standards Unit, British Association of Dermatologists, Willan House London W1T 5HQ UK
| | - M. Firouz Mohd Mustapa
- Clinical Standards Unit, British Association of Dermatologists, Willan House London W1T 5HQ UK
| | - Lesley S. Exton
- Clinical Standards Unit, British Association of Dermatologists, Willan House London W1T 5HQ UK
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5
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Leighton P, Chalmers JR, Batchelor JM, Rogers A, Perways A, Haines RH, Meakin GD, White J, Ravenscroft JC, Sach TH, Santer M, Whitton ME, Eleftheriadou V, Thomas KS. Prescribing and using vitiligo treatments - lessons from a nested Process Evaluation within the HI-Light Vitiligo Randomised Controlled Trial. Clin Exp Dermatol 2022; 47:1480-1489. [PMID: 35340044 PMCID: PMC9544377 DOI: 10.1111/ced.15193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/20/2022] [Accepted: 03/23/2022] [Indexed: 12/01/2022]
Abstract
Background The HI‐Light Trial demonstrated that for active, limited vitiligo, combination treatment with potent topical corticosteroid (TCS) and handheld narrowband ultraviolet B offers a better treatment response than potent TCS alone. However, it is unclear how to implement these findings. Aim We sought to answer three questions: (i) Can combination treatment be used safely and effectively by people with vitiligo?; (ii) Should combination treatment be made available as routine clinical care?; and (iii) Can combination treatment be integrated within current healthcare provision? Methods This was a mixed‐methods process evaluation, including semi‐structured interviews with a purposive sample of trial participants, structured interviews with commissioners, and an online survey and focus groups with trial staff. Transcripts were coded by framework analysis, with thematic development by multiple researchers. Results Participants found individual treatments easy to use, but the combination treatment was complicated and required nurse support. Both participants and site investigators felt that combination treatment should be made available, although commissioners were less certain. There was support for the development of services offering combination treatment, although this might not be prioritized above treatment for other conditions. A ‘mixed economy’ model was suggested, involving patients purchasing their own devices, although concerns regarding the safe use of treatments mean that training, monitoring and ongoing support are essential. The need for medical physics support may mean that a regional service is more practical. Conclusion Combination treatment should be made available for people seeking treatment for vitiligo, but services require partnership with medical physics and ongoing training and support for patients.
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Affiliation(s)
- Paul Leighton
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, UK
| | - Joanne R Chalmers
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, UK
| | - Jonathan M Batchelor
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, UK
| | - Andy Rogers
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Akram Perways
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rachel H Haines
- Nottingham Clinical Trials Unit, University of Nottingham, UK
| | - Garry D Meakin
- Nottingham Clinical Trials Unit, University of Nottingham, UK
| | - Jennifer White
- Nottingham Clinical Trials Unit, University of Nottingham, UK
| | - Jane C Ravenscroft
- Department of Paediatric Dermatology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Tracey H Sach
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Miriam Santer
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Maxine E Whitton
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, UK
| | | | - Kim S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, UK
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6
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Zhilova MB, Gorodnichev PV. Narrow-band phototherapy in the treatment of atopic dermatitis: mechanisms of action, methodology of implementation. VESTNIK DERMATOLOGII I VENEROLOGII 2021. [DOI: 10.25208/vdv1293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Phototherapy is widely used to treat various chronic skin diseases. One of the most effective methods of treatment is narrow-band medium-wave ultraviolet radiation with a wavelength of 311 nm (UVB-311). UVB-311 is used for such immune-mediated diseases as atopic dermatitis, psoriasis, vitiligo, mycosis fungoides and others. Despite the fact that the method was developed more than 30 years ago, the exact mechanism of its therapeutic action remains insufficiently studied. To date, most of the effects of UVB-311 are explained by its effect on the immune cells of the skin. This review examines data on the effects on the main molecular targets, including T-lymphocytes, keratinocytes, Langerhans cells, cytokine profile, epidermal barrier proteins. Data on the features of the pathogenetic effect of UVB-311 on the immune mechanisms of pathogenesis in atopic dermatitis were obtained. The issues of dosing by determining the minimum erythemic dose (MED) or skin phototype, methodology of procedures are discussed. Prospects for further study of photobiological aspects of UVB-311 action are determined.
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7
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Musters AH, Mashayekhi S, Harvey J, Axon E, Lax SJ, Flohr C, Drucker AM, Gerbens L, Ferguson J, Ibbotson S, Dawe RS, Garritsen F, Brouwer M, Limpens J, Prescott LE, Boyle RJ, Spuls PI. Phototherapy for atopic eczema. Cochrane Database Syst Rev 2021; 10:CD013870. [PMID: 34709669 PMCID: PMC8552896 DOI: 10.1002/14651858.cd013870.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Atopic eczema (AE), also known as atopic dermatitis, is a chronic inflammatory skin condition that causes significant burden. Phototherapy is sometimes used to treat AE when topical treatments, such as corticosteroids, are insufficient or poorly tolerated. OBJECTIVES To assess the effects of phototherapy for treating AE. SEARCH METHODS We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and ClinicalTrials.gov to January 2021. SELECTION CRITERIA We included randomised controlled trials in adults or children with any subtype or severity of clinically diagnosed AE. Eligible comparisons were any type of phototherapy versus other forms of phototherapy or any other treatment, including placebo or no treatment. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology. For key findings, we used RoB 2.0 to assess bias, and GRADE to assess certainty of the evidence. Primary outcomes were physician-assessed signs and patient-reported symptoms. Secondary outcomes were Investigator Global Assessment (IGA), health-related quality of life (HRQoL), safety (measured as withdrawals due to adverse events), and long-term control. MAIN RESULTS We included 32 trials with 1219 randomised participants, aged 5 to 83 years (mean: 28 years), with an equal number of males and females. Participants were recruited mainly from secondary care dermatology clinics, and study duration was, on average, 13 weeks (range: 10 days to one year). We assessed risk of bias for all key outcomes as having some concerns or high risk, due to missing data, inappropriate analysis, or insufficient information to assess selective reporting. Assessed interventions included: narrowband ultraviolet B (NB-UVB; 13 trials), ultraviolet A1 (UVA1; 6 trials), broadband ultraviolet B (BB-UVB; 5 trials), ultraviolet AB (UVAB; 2 trials), psoralen plus ultraviolet A (PUVA; 2 trials), ultraviolet A (UVA; 1 trial), unspecified ultraviolet B (UVB; 1 trial), full spectrum light (1 trial), Saalmann selective ultraviolet phototherapy (SUP) cabin (1 trial), saltwater bath plus UVB (balneophototherapy; 1 trial), and excimer laser (1 trial). Comparators included placebo, no treatment, another phototherapy, topical treatment, or alternative doses of the same treatment. Results for key comparisons are summarised (for scales, lower scores are better): NB-UVB versus placebo/no treatment There may be a larger reduction in physician-assessed signs with NB-UVB compared to placebo after 12 weeks of treatment (mean difference (MD) -9.4, 95% confidence interval (CI) -3.62 to -15.18; 1 trial, 41 participants; scale: 0 to 90). Two trials reported little difference between NB-UVB and no treatment (37 participants, four to six weeks of treatment); another reported improved signs with NB-UVB versus no treatment (11 participants, nine weeks of treatment). NB-UVB may increase the number of people reporting reduced itch after 12 weeks of treatment compared to placebo (risk ratio (RR) 1.72, 95% CI 1.10 to 2.69; 1 trial, 40 participants). Another trial reported very little difference in itch severity with NB-UVB (25 participants, four weeks of treatment). The number of participants with moderate to greater global improvement may be higher with NB-UVB than placebo after 12 weeks of treatment (RR 2.81, 95% CI 1.10 to 7.17; 1 trial, 41 participants). NB-UVB may not affect rates of withdrawal due to adverse events. No withdrawals were reported in one trial of NB-UVB versus placebo (18 participants, nine weeks of treatment). In two trials of NB-UVB versus no treatment, each reported one withdrawal per group (71 participants, 8 to 12 weeks of treatment). We judged that all reported outcomes were supported with low-certainty evidence, due to risk of bias and imprecision. No trials reported HRQoL. NB-UVB versus UVA1 We judged the evidence for NB-UVB compared to UVA1 to be very low certainty for all outcomes, due to risk of bias and imprecision. There was no evidence of a difference in physician-assessed signs after six weeks (MD -2.00, 95% CI -8.41 to 4.41; 1 trial, 46 participants; scale: 0 to 108), or patient-reported itch after six weeks (MD 0.3, 95% CI -1.07 to 1.67; 1 trial, 46 participants; scale: 0 to 10). Two split-body trials (20 participants, 40 sides) also measured these outcomes, using different scales at seven to eight weeks; they reported lower scores with NB-UVB. One trial reported HRQoL at six weeks (MD 2.9, 95% CI -9.57 to 15.37; 1 trial, 46 participants; scale: 30 to 150). One split-body trial reported no withdrawals due to adverse events over 12 weeks (13 participants). No trials reported IGA. NB-UVB versus PUVA We judged the evidence for NB-UVB compared to PUVA (8-methoxypsoralen in bath plus UVA) to be very low certainty for all reported outcomes, due to risk of bias and imprecision. There was no evidence of a difference in physician-assessed signs after six weeks (64.1% reduction with NB-UVB versus 65.7% reduction with PUVA; 1 trial, 10 participants, 20 sides). There was no evidence of a difference in marked improvement or complete remission after six weeks (odds ratio (OR) 1.00, 95% CI 0.13 to 7.89; 1 trial, 9/10 participants with both treatments). One split-body trial reported no withdrawals due to adverse events in 10 participants over six weeks. The trials did not report patient-reported symptoms or HRQoL. UVA1 versus PUVA There was very low-certainty evidence, due to serious risk of bias and imprecision, that PUVA (oral 5-methoxypsoralen plus UVA) reduced physician-assessed signs more than UVA1 after three weeks (MD 11.3, 95% CI -0.21 to 22.81; 1 trial, 40 participants; scale: 0 to 103). The trial did not report patient-reported symptoms, IGA, HRQoL, or withdrawals due to adverse events. There were no eligible trials for the key comparisons of UVA1 or PUVA compared with no treatment. Adverse events Reported adverse events included low rates of phototoxic reaction, severe irritation, UV burn, bacterial superinfection, disease exacerbation, and eczema herpeticum. AUTHORS' CONCLUSIONS Compared to placebo or no treatment, NB-UVB may improve physician-rated signs, patient-reported symptoms, and IGA after 12 weeks, without a difference in withdrawal due to adverse events. Evidence for UVA1 compared to NB-UVB or PUVA, and NB-UVB compared to PUVA was very low certainty. More information is needed on the safety and effectiveness of all aspects of phototherapy for treating AE.
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Affiliation(s)
- Annelie H Musters
- Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Soudeh Mashayekhi
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jane Harvey
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Emma Axon
- Cochrane Skin, Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Stephanie J Lax
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Carsten Flohr
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Aaron M Drucker
- Department of Medicine, University of Toronto, Toronto, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Louise Gerbens
- Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - John Ferguson
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sally Ibbotson
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Robert S Dawe
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Floor Garritsen
- Department of Dermatology, HagaZiekenhuis van Den Haag, Den Haag, Netherlands
| | - Marijke Brouwer
- Department of Dermatology, Antonius Ziekenhuis, Sneek/Emmeloord, Netherlands
| | - Jacqueline Limpens
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Laura E Prescott
- Cochrane Skin, Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Robert J Boyle
- Cochrane Skin, Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
- National Heart & Lung Institute, Section of Inflammation and Repair, Imperial College London, London, UK
| | - Phyllis I Spuls
- Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
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Watson N, Wilson N, Shmarov F, Zuliani P, Reynolds NJ, Weatherhead SC. The use of psoriasis biomarkers, including trajectory of clinical response, to predict clearance and remission duration to UVB phototherapy. J Eur Acad Dermatol Venereol 2021; 35:2250-2258. [PMID: 34255884 DOI: 10.1111/jdv.17519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Remission duration and treatment response following phototherapy for psoriasis are highly variable and factors influencing these are poorly understood. OBJECTIVES Our primary outcome was to investigate whether selected clinical/serum biomarkers were associated with remission duration, and secondly with psoriasis clearance at the end of phototherapy. In addition, we looked at whether early trajectory of UVB clearance was associated with final clearance outcome. METHODS We performed a prospective cohort study of 100 psoriasis patients, routinely prescribed Narrowband UVB and measured selected clinical and biochemical biomarkers, including weekly PASI (psoriasis area and severity index) scores. Patients were followed up for 18 months. RESULTS The median time to relapse was 6 months (95% CI 5-18) if PASI90 was achieved, and 4 months (95% CI 3-9) if less than PASI90 was achieved. Achieving PASI100 did not result in prolonged remission. On UVB completion, the median final PASI (n = 96) was 1.0 (IQR 0.5, 1.6) with 78 (81%) achieving PASI75 and 39 (41%) achieving PASI90. Improved PASI90 response was significantly associated with lower BMI, higher baseline PASI, non-smoking status and lower cumulative NbUVB. Serum levels of C-reactive protein (CRP) and vitamin D were not associated with clearance or remission duration. Early treatment response from weeks 2-3 was predictive of final outcome. For example, achieving PASI30 at week 3 was significantly associated with PASI90 at the end of the course [36/77 (51%) vs. 2/24 (8%), P < 0.001]. CONCLUSIONS Raised BMI and positive smoking status predicted poorer phototherapy response. For the first time, we have shown that PASI clearance trajectory over the first 2-3 weeks of UVB, can predict psoriasis clearance. This is an important new step towards developing psoriasis personalized prescribing, which can now be formally tested in clinical trials. These simple clinical measures can be used to inform patient treatment expectations; allowing treatment modifications and/or switching to alternative therapies.
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Affiliation(s)
- N Watson
- Department of Dermatology, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - N Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - F Shmarov
- School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | - P Zuliani
- School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | - N J Reynolds
- Department of Dermatology, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - S C Weatherhead
- Department of Dermatology, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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9
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Musters AH, Mashayekhi S, Flohr C, Drucker AM, Gerbens L, Ferguson J, Ibbotson S, Dawe RS, Garritsen F, Brouwer M, Limpens J, Lax SJ, Harvey J, Spuls PI. Phototherapy for atopic eczema. Hippokratia 2021. [DOI: 10.1002/14651858.cd013870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Annelie H Musters
- Department of Dermatology; Amsterdam University Medical Centers, University of Amsterdam; Amsterdam Netherlands
| | - Soudeh Mashayekhi
- St John's Institute of Dermatology; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - Carsten Flohr
- St John's Institute of Dermatology; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - Aaron M Drucker
- Department of Medicine; University of Toronto; Toronto Canada
- Women's College Research Institute; Women's College Hospital; Toronto Canada
| | - Louise Gerbens
- Department of Dermatology; Amsterdam University Medical Centers, University of Amsterdam; Amsterdam Netherlands
| | - John Ferguson
- St John's Institute of Dermatology; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - Sally Ibbotson
- Photobiology Unit, Dermatology Department; University of Dundee, Ninewells Hospital and Medical School; Dundee UK
| | - Robert S Dawe
- Photobiology Unit, Dermatology Department; University of Dundee, Ninewells Hospital and Medical School; Dundee UK
| | - Floor Garritsen
- Department of Dermatology; HagaZiekenhuis van Den Haag; Den Haag Netherlands
| | - Marijke Brouwer
- Department of Dermatology; Antonius Ziekenhuis; Sneek/Emmeloord Netherlands
| | - Jacqueline Limpens
- Dutch Cochrane Centre/Medical Library; Academic Medical Center; AMSTERDAM Netherlands
| | - Stephanie J Lax
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
| | - Jane Harvey
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
| | - Phyllis I Spuls
- Department of Dermatology; Amsterdam University Medical Centers, University of Amsterdam; Amsterdam Netherlands
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10
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Thomas KS, Batchelor JM, Akram P, Chalmers JR, Haines RH, Meakin GD, Duley L, Ravenscroft JC, Rogers A, Sach TH, Santer M, Tan W, White J, Whitton ME, Williams HC, Cheung ST, Hamad H, Wright A, Ingram JR, Levell NJ, Goulding JMR, Makrygeorgou A, Bewley A, Ogboli M, Stainforth J, Ferguson A, Laguda B, Wahie S, Ellis R, Azad J, Rajasekaran A, Eleftheriadou V, Montgomery AA. Randomized controlled trial of topical corticosteroid and home-based narrowband ultraviolet B for active and limited vitiligo: results of the HI-Light Vitiligo Trial. Br J Dermatol 2020; 184:828-839. [PMID: 33006767 DOI: 10.1111/bjd.19592] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Evidence for the effectiveness of vitiligo treatments is limited. OBJECTIVES To determine the effectiveness of (i) handheld narrowband UVB (NB-UVB) and (ii) a combination of potent topical corticosteroid (TCS) and NB-UVB, compared with TCS alone, for localized vitiligo. METHODS A pragmatic, three-arm, placebo-controlled randomized controlled trial (9-month treatment, 12-month follow-up). Adults and children, recruited from secondary care and the community, aged ≥ 5 years and with active vitiligo affecting < 10% of skin, were randomized 1 : 1 : 1 to receive TCS (mometasone furoate 0·1% ointment + dummy NB-UVB), NB-UVB (NB-UVB + placebo TCS) or a combination (TCS + NB-UVB). TCS was applied once daily on alternating weeks; NB-UVB was administered on alternate days in escalating doses, adjusted for erythema. The primary outcome was treatment success at 9 months at a target patch assessed using the participant-reported Vitiligo Noticeability Scale, with multiple imputation for missing data. The trial was registered with number ISRCTN17160087 on 8 January 2015. RESULTS In total 517 participants were randomized to TCS (n = 173), NB-UVB (n = 169) and combination (n = 175). Primary outcome data were available for 370 (72%) participants. The proportions with target patch treatment success were 17% (TCS), 22% (NB-UVB) and 27% (combination). Combination treatment was superior to TCS: adjusted between-group difference 10·9% (95% confidence interval 1·0%-20·9%; P = 0·032; number needed to treat = 10). NB-UVB alone was not superior to TCS: adjusted between-group difference 5·2% (95% CI - 4·4% to 14·9%; P = 0·29; number needed to treat = 19). Participants using interventions with ≥ 75% expected adherence were more likely to achieve treatment success, but the effects were lost once treatment stopped. Localized grade 3 or 4 erythema was reported in 62 (12%) participants (including three with dummy light). Skin thinning was reported in 13 (2·5%) participants (including one with placebo ointment). CONCLUSIONS Combination treatment with home-based handheld NB-UVB plus TCS is likely to be superior to TCS alone for treatment of localized vitiligo. Combination treatment was relatively safe and well tolerated but was successful in only around one-quarter of participants.
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Affiliation(s)
- K S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - J M Batchelor
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - P Akram
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - R H Haines
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - G D Meakin
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - L Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - J C Ravenscroft
- Department of Paediatric Dermatology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A Rogers
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - T H Sach
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - M Santer
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - W Tan
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - J White
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - M E Whitton
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - H C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - S T Cheung
- Cannock Chase Hospital and New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - H Hamad
- Cannock Chase Hospital and New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - A Wright
- St Luke's Hospital, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - J R Ingram
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - N J Levell
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - J M R Goulding
- Solihull Hospital, University Hospitals of Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Makrygeorgou
- West Glasgow Ambulatory Care Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - A Bewley
- Barts Health NHS Trust and Queen Mary University London, London, UK
| | - M Ogboli
- Birmingham Children's Hospital, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - J Stainforth
- York Hospital, York Teaching Hospital NHS Foundation Trust, York, UK
| | - A Ferguson
- Royal Derby Hospital and the London Road Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - B Laguda
- Chelsea and Westminster Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - S Wahie
- University Hospital of North Durham, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - R Ellis
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - J Azad
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - A Rajasekaran
- Birmingham City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | - A A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
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11
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Vieyra-Garcia PA, Wolf P. A deep dive into UV-based phototherapy: Mechanisms of action and emerging molecular targets in inflammation and cancer. Pharmacol Ther 2020; 222:107784. [PMID: 33316286 DOI: 10.1016/j.pharmthera.2020.107784] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/25/2020] [Indexed: 02/07/2023]
Abstract
UV-based phototherapy (including psoralen plus UVA (PUVA), UVB and UVA1) has a long, successful history in the management of numerous cutaneous disorders. Photoresponsive diseases are etiologically diverse, but most involve disturbances in local (and occasionally systemic) inflammatory cells and/or abnormalities in keratinocytes that trigger inflammation. UV-based phototherapy works by regulating the inflammatory component and inducing apoptosis of pathogenic cells. This results in a fascinating and complex network of simultaneous events-immediate transcriptional changes in keratinocytes, immune cells, and pigment cells; the emergence of apoptotic bodies; and the trafficking of antigen-presenting cells in skin-that quickly transform the microenvironment of UV-exposed skin. Molecular elements in this system of UV recognition and response include chromophores, metabolic byproducts, innate immune receptors, neurotransmitters and mediators such as chemokines and cytokines, antimicrobial peptides, and platelet activating factor (PAF) and PAF-like molecules that simultaneously shape the immunomodulatory effects of UV and their interplay with the microbiota of the skin and beyond. Phototherapy's key effects-proapoptotic, immunomodulatory, antipruritic, antifibrotic, propigmentary, and pro-prebiotic-promote clinical improvement in various skin diseases such as psoriasis, atopic dermatitis (AD), graft-versus-host disease (GvHD), vitiligo, scleroderma, and cutaneous T-cell lymphoma (CTCL) as well as prevention of polymorphic light eruption (PLE). As understanding of phototherapy improves, new therapies (UV- and non-UV-based) are being developed that will modify regulatory T-cells (Treg), interact with (resident) memory T-cells and /or utilize agonists and antagonists as well as antibodies targeting soluble molecules such as cytokines and chemokines, transcription factors, and a variety of membrane-associated receptors.
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Affiliation(s)
- Pablo A Vieyra-Garcia
- Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, Graz A-8036, Austria.
| | - Peter Wolf
- Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, Graz A-8036, Austria.
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12
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Cork MJ, Danby SG, Ogg GS. Atopic dermatitis epidemiology and unmet need in the United Kingdom. J DERMATOL TREAT 2020; 31:801-809. [PMID: 31631717 PMCID: PMC7573657 DOI: 10.1080/09546634.2019.1655137] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/31/2019] [Indexed: 01/17/2023]
Abstract
Atopic dermatitis (AD), also known as atopic eczema, is a chronic inflammatory skin condition associated with a significant health-related and socioeconomic burden, and is characterized by intense itch, disruption of the skin barrier, and upregulation of type 2-mediated immune responses. The United Kingdom (UK) has a high prevalence of AD, affecting 11-20% of children and 5-10% of adults. Approximately 2% of all cases of childhood AD in the UK are severe. Despite this, most AD treatments are performed at home, with little contact with healthcare providers or services. Here, we discuss the course of AD, treatment practices, and unmet need in the UK. Although the underlying etiology of the disease is still emerging, AD is currently attributed to skin barrier dysfunction and altered inflammatory responses. Management of AD focuses on avoiding triggers, improving skin hydration, managing exacerbating factors, and reducing inflammation through topical and systemic immunosuppressants. However, there is a significant unmet need to improve the overall management of AD and help patients gain control of their disease through safe and effective treatments. Approaches that target individual inflammatory pathways (e.g. dupilumab, anti-interleukin (IL)-4 receptor α) are emerging and likely to provide further therapeutic opportunities for patient benefit.
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Affiliation(s)
- Michael J. Cork
- Sheffield Dermatology Research, Department of Infection, Immunity & Cardiovascular Disease, Faculty of Medicine, Dentistry & Health, The University of Sheffield, Sheffield, UK
- Sheffield Children’s Hospital and Sheffield Teaching Hospitals Clinical Research Facilities, Sheffield, UK
| | - Simon G. Danby
- Sheffield Dermatology Research, Department of Infection, Immunity & Cardiovascular Disease, Faculty of Medicine, Dentistry & Health, The University of Sheffield, Sheffield, UK
- Sheffield Children’s Hospital and Sheffield Teaching Hospitals Clinical Research Facilities, Sheffield, UK
| | - Graham S. Ogg
- MRC Human Immunology Unit, NIHR Biomedical Research Centre, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
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13
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Batchelor JM, Thomas KS, Akram P, Azad J, Bewley A, Chalmers JR, Cheung ST, Duley L, Eleftheriadou V, Ellis R, Ferguson A, Goulding JM, Haines RH, Hamad H, Ingram JR, Laguda B, Leighton P, Levell N, Makrygeorgou A, Meakin GD, Millington A, Ogboli M, Rajasekaran A, Ravenscroft JC, Rogers A, Sach TH, Santer M, Stainforth J, Tan W, Wahie S, White J, Whitton ME, Williams HC, Wright A, Montgomery AA. Home-based narrowband UVB, topical corticosteroid or combination for children and adults with vitiligo: HI-Light Vitiligo three-arm RCT. Health Technol Assess 2020; 24:1-128. [PMID: 33245043 PMCID: PMC7750863 DOI: 10.3310/hta24640] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Systematic reviews suggest that narrowband ultraviolet B light combined with treatments such as topical corticosteroids may be more effective than monotherapy for vitiligo. OBJECTIVE To explore the clinical effectiveness and cost-effectiveness of topical corticosteroid monotherapy compared with (1) hand-held narrowband ultraviolet B light monotherapy and (2) hand-held narrowband ultraviolet B light/topical corticosteroid combination treatment for localised vitiligo. DESIGN Pragmatic, three-arm, randomised controlled trial with 9 months of treatment and a 12-month follow-up. SETTING Sixteen UK hospitals - participants were recruited from primary and secondary care and the community. PARTICIPANTS Adults and children (aged ≥ 5 years) with active non-segmental vitiligo affecting ≤ 10% of their body area. INTERVENTIONS Topical corticosteroids [mometasone furoate 0.1% (Elocon®, Merck Sharp & Dohme Corp., Merck & Co., Inc., Whitehouse Station, NJ, USA) plus dummy narrowband ultraviolet B light]; narrowband ultraviolet B light (narrowband ultraviolet B light plus placebo topical corticosteroids); or combination (topical corticosteroids plus narrowband ultraviolet B light). Topical corticosteroids were applied once daily on alternate weeks and narrowband ultraviolet B light was administered every other day in escalating doses, with a dose adjustment for erythema. All treatments were home based. MAIN OUTCOME MEASURES The primary outcome was self-assessed treatment success for a chosen target patch after 9 months of treatment ('a lot less noticeable' or 'no longer noticeable' on the Vitiligo Noticeability Scale). Secondary outcomes included blinded assessment of primary outcome and percentage repigmentation, onset and maintenance of treatment response, quality of life, side effects, treatment burden and cost-effectiveness (cost per additional successful treatment). RESULTS In total, 517 participants were randomised (adults, n = 398; and children, n = 119; 52% male; 57% paler skin types I-III, 43% darker skin types IV-VI). At the end of 9 months of treatment, 370 (72%) participants provided primary outcome data. The median percentage of narrowband ultraviolet B light treatment-days (actual/allocated) was 81% for topical corticosteroids, 77% for narrowband ultraviolet B light and 74% for combination groups; and for ointment was 79% for topical corticosteroids, 83% for narrowband ultraviolet B light and 77% for combination. Target patch location was head and neck (31%), hands and feet (32%), and rest of the body (37%). Target patch treatment 'success' was 20 out of 119 (17%) for topical corticosteroids, 27 out of 123 (22%) for narrowband ultraviolet B light and 34 out of 128 (27%) for combination. Combination treatment was superior to topical corticosteroids (adjusted risk difference 10.9%, 95% confidence interval 1.0% to 20.9%; p = 0.032; number needed to treat = 10). Narrowband ultraviolet B light was not superior to topical corticosteroids (adjusted risk difference 5.2%, 95% confidence interval -4.4% to 14.9%; p = 0.290; number needed to treat = 19). The secondary outcomes supported the primary analysis. Quality of life did not differ between the groups. Participants who adhered to the interventions for > 75% of the expected treatment protocol were more likely to achieve treatment success. Over 40% of participants had lost treatment response after 1 year with no treatment. Grade 3 or 4 erythema was experienced by 62 participants (12%) (three of whom were using the dummy) and transient skin thinning by 13 participants (2.5%) (two of whom were using the placebo). We observed no serious adverse treatment effects. For combination treatment compared with topical corticosteroids, the unadjusted incremental cost-effectiveness ratio was £2328.56 (adjusted £1932) per additional successful treatment (from an NHS perspective). LIMITATIONS Relatively high loss to follow-up limits the interpretation of the trial findings, especially during the post-intervention follow-up phase. CONCLUSION Hand-held narrowband ultraviolet B light plus topical corticosteroid combination treatment is superior to topical corticosteroids alone for treatment of localised vitiligo. Combination treatment was relatively safe and well tolerated, but was effective in around one-quarter of participants only. Whether or not combination treatment is cost-effective depends on how much decision-makers are willing to pay for the benefits observed. FUTURE WORK Development and testing of new vitiligo treatments with a greater treatment response and longer-lasting effects are needed. TRIAL REGISTRATION Current Controlled Trials ISRCTN17160087. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 64. See the NIHR Journals Library website for further project information.
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14
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Barolet AC, Litvinov IV, Barolet D. Beneficial Effects of Near-Infrared Light Photobiomodulation in Linear Morphea: A Case Report. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2020; 38:679-682. [PMID: 33103949 DOI: 10.1089/photob.2020.4840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Linear morphea is a variant of scleroderma limited to the skin and underlying tissues secondary to an autoimmune inflammation leading to excess collagen deposition and fibrosis. Apart from topical or oral medications, successful light-based treatments have been reported using phototherapy including Psoralen plus ultraviolet A, photodynamic therapy, carbon dioxide laser, pulsed dye laser, and visible/infrared light. Methods: We report a patient with biopsy-proven infraorbital linear morphea responding to 940 nm near-infrared light photobiomodulation treatments. Results: The patient had excellent cosmesis without textural changes or hypopigmentation despite her darker skin complexion (Fitzpatrick phototype III) after tri-weekly treatments for 8 months. Conclusions: Linear morphea, therefore, may be potentially amenable to home use light-based therapy by using nonthermal nonablative 940 nm photons. To our knowledge, this home-based treatment approach has not been previously reported.
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Affiliation(s)
- Augustin C Barolet
- Department of Surgery, Experimental Surgery Graduate Training Program, McGill University Health Centre, Montreal, Canada.,Division of Dermatology, McGill University Health Centre, Montreal, Canada
| | - Ivan V Litvinov
- Department of Surgery, Experimental Surgery Graduate Training Program, McGill University Health Centre, Montreal, Canada.,Division of Dermatology, McGill University Health Centre, Montreal, Canada
| | - Daniel Barolet
- Division of Dermatology, McGill University Health Centre, Montreal, Canada.,RoseLab Skin Optics Research Laboratory, Laval, Canada
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15
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Kutlu O, Ozdemir Cetinkaya P, Karaosmanoglu N, Karaaslan E, Kiratli Nalbant E, Eksioglu M. The effect of narrowband ultraviolet B phototherapy on antinuclear antibody status: A case-control study. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2020; 36:470-475. [PMID: 32810337 DOI: 10.1111/phpp.12601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/10/2020] [Accepted: 08/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Narrowband ultraviolet B (NB-UVB) phototherapy has become a widely used, standard treatment modality in dermatology. The effect of 8-methoxypsoralen plus ultraviolet A on antinuclear antibody (ANA) formation has been investigated extensively, but there are very scarce data about the potential risk of NB-UVB phototherapy inducing production of ANAs. The aims of this study were evaluation of ANA status before and after NB-UVB treatment and comparison of ANA status with the healthy control group. METHODS Phototherapy unit database was used to identify patients who had received whole body NB-UVB treatment. Analyses of ANA were performed twice in the study group that were before initiation of the NB-UVB phototherapy and after cessation of the therapy. Also, ANAs were screened in the control group. RESULTS A total of 95 patients (50 males and 45 females; mean age: 43.03 ± 13.40) treated with NB-UVB radiation and 90 age- and sex-matched controls were included in the study. Thirteen patients (13.7%) were found to develop ANAs at the end of the treatment. ANA positivity was significantly more common in patients after phototherapy than in patients before phototherapy and than in the control group. None of the patients in the positive ANA group was diagnosed with any connective tissue diseases. CONCLUSION This study revealed that ANA positivity increased after NB-UVB phototherapy. However, it did not provide evidence for increased connective tissue disease risk. Therefore, ANA might not need to be routinely checked before treatment unless the patients have signs and symptoms indicating autoimmune diseases.
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Affiliation(s)
- Omer Kutlu
- Department of Dermatology and Venereology, Uşak University Medical Faculty, Uşak, Turkey
| | | | - Nermin Karaosmanoglu
- Department of Dermatology and Venereology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Engin Karaaslan
- Department of Dermatology and Venereology, Nusaybin State Hospital, Mardin, Turkey
| | - Esra Kiratli Nalbant
- Department of Dermatology and Venereology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Meral Eksioglu
- Department of Dermatology and Venereology, Ankara Training and Research Hospital, Ankara, Turkey
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16
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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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17
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Wang A, Liu Y, Wang XJ, Liu F. White-light flashlight activated up-conversion luminescence for ultraviolet-B tagging. OPTICS LETTERS 2020; 45:2720-2723. [PMID: 32412450 DOI: 10.1364/ol.393770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
Optical tagging technology with emission in the ultraviolet region upon visible-light excitation is promising for objects identified in visually bright environments, while the relevant research is absent. Here we put forward a covert tagging concept, which is based on up-converting phosphors (e.g., Lu3Al5O12:Pr3+) with emission peaking in the ultraviolet-B region (UV-B, 290-320 nm). A white-light flashlight serves as excitation source to make the up-converter emit, and an ultraviolet camera is applied to see such an emission wavelength range. This Letter expands the excitation source for an up-conversion process to a convenient flashlight for the first time, to the best of our knowledge. Moreover, such a flashlight-pumped UV-B tagging technology is generally applicable for many other phosphors, which can be utilized to mark and differentiate objects in commercial, civilian, or military applications.
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18
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Wang G, Bai F, Tian Z, Fan L, Lei M. Balneotherapy with Chinese herbal medicine prolongs the remission period in patients with psoriasis vulgaris. Dermatol Ther 2020; 33:e13351. [PMID: 32232885 DOI: 10.1111/dth.13351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/22/2020] [Accepted: 03/25/2020] [Indexed: 11/29/2022]
Abstract
This study aimed to evaluate whether the supplementary balneotherapy with Chinese herbal medicine (CHM) could facilitate the treatment of psoriasis vulgaris and thus be beneficial for long-term remission from the symptoms. Two hundred psoriasis vulgaris patients with moderate-to-severe plaque psoriasis from January 2013 to June 2014 were evenly divided into two groups: the consolidated therapy group (CTG) and unconsolidated therapy group (UTG); the remission period of the two groups was compared. There was no significant difference in Psoriasis Area Severity Index (PASI) score between the two groups at the beginning and the end of the treatment. However, the average remission time in CTG was 10.99 months, which was significantly longer than that of 7.94 months in UTG (P = .001). After a correction of age, course of disease, skin type as well as PASI baseline value using a COX model, we found that the risk of recurrence of psoriasis vulgaris in UTG was higher than that in the CTG (P < .001). No adverse reactions were discovered when combing the two treatments together. The combined treatment of CHM balneotherapy and narrowband ultraviolet B could significantly prolong the remission time in patients with psoriasis vulgaris.
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Affiliation(s)
- Genhui Wang
- Department of Dermatology, Hebei Traditional Chinese Medical Hospital, Shijiazhuang City, Hebei, China
| | - Fan Bai
- Department of Dermatology, Hebei Traditional Chinese Medical Hospital, Shijiazhuang City, Hebei, China
| | - Zan Tian
- Department of Dermatology, Hebei Traditional Chinese Medical Hospital, Shijiazhuang City, Hebei, China
| | - Lifang Fan
- Department of Dermatology, Hebei Traditional Chinese Medical Hospital, Shijiazhuang City, Hebei, China
| | - Mingjun Lei
- Department of Dermatology, Hebei Traditional Chinese Medical Hospital, Shijiazhuang City, Hebei, China
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19
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Sun X, Zhou X, Wei Y, Yang W, Huang N, Ding Y, Hu R, Guo S, Yang C, Weng H, Zhang Y, Chen X, Ding X, Liu L, Yin Q, Wang R, Li X, Li B. Our Choice: study protocol for a randomized controlled trial for optimal implementation of psoriasis treatment by the integration of Chinese and western medicine. Trials 2020; 21:299. [PMID: 32228720 PMCID: PMC7106809 DOI: 10.1186/s13063-020-4209-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 02/25/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Plaque psoriasis is a refractory inflammatory skin disease. The common therapies used to treat plaque psoriasis in traditional Chinese medicine (TCM) and western medicine (WM) have distinct characteristics and advantages. Although a combination of TCM and WM therapies, adjusted to the clinical situation, is widely used, there are no systematic studies on the hierarchical selection of this treatment combination based on the severity of skin lesions. We therefore designed a randomized clinical trial to focus on the sequence of internal and external treatments of TCM in patients with mild-to-moderate plaque psoriasis and to optimize the integration of Chinese and western medicine for the treatment of patients with severe plaque psoriasis, thereby achieving high-level clinical evidence and establish treatment norms for the integrated use of Chinese and western medicines. METHODS In this proposed multicenter, single-blinded, randomized controlled trial, 108 patients with mild-to-moderate plaque psoriasis will be randomly assigned to two groups in a 1:1 ratio to receive either internal or external TCM treatment, and 270 patients with severe plaque psoriasis will be randomly assigned to three groups in a 1:1:1 ratio to receive treatment with TCM or WM, or TCM + WM. All enrolled patients will receive 8 weeks of treatment. Follow-up assessments will be done 8 weeks after the treatment. The primary outcome of this study is the evaluation of efficacy and relapse rate, based on the Psoriasis Area and Severity Index, and the secondary outcome measures include determination of the affected body surface area, physician's global assessment, pruritus scores (determined using a visual analog scale), TCM symptom score, Dermatology Life Quality Index, patient-reported quality of life score and incidence of serious adverse events. DISCUSSION This study will provide high-level clinical evidence for internal and external TCM treatment optimization and will contribute to establishing norms for the integration of Chinese and western Medicines. TRIAL REGISTRATION ClinicalTrials.gov, NCT03941431. Registered on 8 May 2019.
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Affiliation(s)
- Xiaoying Sun
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Xiaoyong Zhou
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, 430022, China
| | - Yuegang Wei
- Department of Dermatology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
| | - Wenxin Yang
- Department of Dermatology, Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Ning Huang
- Department of Dermatology, The Second Affiliated Hospital of Fujian Traditional Chinese Medical University, Fuzhou, 350001, China
| | - Yangfeng Ding
- Department of Dermatology, Shanghai Dermatology Hospital, Shanghai, 200443, China
| | - Rongyi Hu
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, 430022, China
| | - Shun Guo
- Department of Dermatology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
| | - Chunyan Yang
- Department of Dermatology, Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Huilan Weng
- Department of Dermatology, The Second Affiliated Hospital of Fujian Traditional Chinese Medical University, Fuzhou, 350001, China
| | - Ying Zhang
- Department of Dermatology, Shanghai Dermatology Hospital, Shanghai, 200443, China
| | - Xi Chen
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Xiaojie Ding
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Liu Liu
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Qingfeng Yin
- Jiangsu Famous Medical Technology Co. Ltd., Nanjing University of Traditional Chinese Medicine, Floor 2, Building 19, Nanjing, 210029, China
| | - Ruiping Wang
- Office of Clinical Medical Research Center, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Xin Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China. .,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, 201203, China.
| | - Bin Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China. .,Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, 201203, China.
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20
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Kerkhof P, Gruijl F. Phototherapy in the perspective of the chronicity of psoriasis. J Eur Acad Dermatol Venereol 2020; 34:926-931. [DOI: 10.1111/jdv.16245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 01/21/2020] [Indexed: 12/14/2022]
Affiliation(s)
- P.C.M. Kerkhof
- Department of Dermatology Radboud University Nijmegen Medical Centre Nijmegen The Netherlands
| | - F.R. Gruijl
- Department of Dermatology Leids Universitair Medisch Centrum Nijmegen The Netherlands
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21
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Phan K, Ramachandran V, Fassihi H, Sebaratnam DF. Comparison of Narrowband UV-B With Psoralen-UV-A Phototherapy for Patients With Early-Stage Mycosis Fungoides: A Systematic Review and Meta-analysis. JAMA Dermatol 2020; 155:335-341. [PMID: 30698622 DOI: 10.1001/jamadermatol.2018.5204] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Phototherapy is one of the mainstays of treatment for early mycosis fungoides (MF). The most common modalities are psoralen-UV-A (PUVA) and narrowband UV-B (NBUVB). Objective To compare the efficacy and adverse effects of PUVA vs NBUVB in early-stage MF. Data Sources A systematic review was performed by searching Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Ovid Medline, PubMed, Cochrane Library, American College of Physicians ACP Journal Club, and Database of Abstracts of Review of Effectiveness from inception to March 30, 2018. UV A, PUVA, mycosis fungoides, Sézary syndrome, cutaneous T-cell lymphoma, UV B, and UVB were used as either key words or MeSH terms. Study Selection Studies of cohorts with histologically confirmed early-stage MF, defined as stages IA, IB, and IIA, that compared PUVA vs NBUVB, had at least 10 patients in each comparator group, and reported outcomes of response to therapy. Exclusion criteria were studies with patients with stage IIB or higher MF, pediatric patients, fewer than 10 in each comparator group, noncomparative studies, case reports, and abstract studies. Data Extraction and Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. Data were pooled using a random-effects model with odds ratio (OR) as effect size. Main Outcomes and Measures Main outcomes were complete response rate, partial response rate, disease recurrence, and adverse effects, including erythema, nausea, pruritus, phototoxic effects, dyspepsia, and pain. Results Seven studies were included with a total of 778 patients (405 of 724 [55.9%] men; mean age, 52 years); 527 were treated with PUVA and 251 with NBUVB. Most of the included studies were of poor to moderate quality. Any response was found in 479 of the 527 (90.9%) patients treated with PUVA vs 220 of 251 (87.6%) treated with NBUVB (OR, 1.40; 95% CI, 0.84-2.34; P = .20). Complete response was found in 389 of 527 (73.8%) patients who received PUVA vs 156 of 251 (62.2%) who received NBUVB, which was statistically significant (OR, 1.68; 95% CI, 1.02-2.76; P = .04). Partial response was similar (90 of 501 [18.0%] vs 64 of 233 [27.5%]; OR, 0.58; 95% CI, 0.33-1.04; P = .07). No significant difference was found between PUVA and NBUVB in terms of adverse effects of erythema (38 of 527 [7.2%] vs 17 of 251 [6.7%]; P = .54), nausea (10 of 527 [1.9%] vs 3 of 251 [1.2%]; P = .72), pruritus (2 of 527 [0.4%] vs 4 of 251 [1.7%]; P = .26), phototoxic effects (7 of 527 [1.4%] vs 2 of 251 [0.9%]; P = .72), dyspepsia (6 of 527 [1.2%] vs 0 of 251 [0%]; P = .59), or pain (0 of 527 [0%] vs 2 of 251 [0.9%]; P = .50). Conclusions and Relevance The findings suggest that PUVA is a potential alternative to NBUVB in the management of early-stage MF. These findings have implications for clinicians involved in the management of early-stage MF.
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Affiliation(s)
- Kevin Phan
- Department of Dermatology, Liverpool Hospital, Liverpool, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Kensington, Sydney, Australia
| | | | - Hiva Fassihi
- St John's Institute for Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Deshan F Sebaratnam
- Department of Dermatology, Liverpool Hospital, Liverpool, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Kensington, Sydney, Australia
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22
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Yanovsky RL, Huang KP, Buzney EA. Optimizing Narrowband UVB Phototherapy Regimens for Psoriasis. Dermatol Clin 2020; 38:1-10. [DOI: 10.1016/j.det.2019.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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23
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Smith MP, Ly K, Thibodeaux Q, Bhutani T, Nakamura M. Home phototherapy for patients with vitiligo: challenges and solutions. Clin Cosmet Investig Dermatol 2019; 12:451-459. [PMID: 31388308 PMCID: PMC6607222 DOI: 10.2147/ccid.s185798] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/07/2019] [Indexed: 12/31/2022]
Abstract
Vitiligo is a chronic autoimmune condition involving selective dysfunction and destruction of melanocytes in the skin, hair, or both. The typical presentation is well-demarcated depigmented skin patches. Given vitiligo is the most common cause of depigmentation worldwide and early disease responds best to treatment, prompt diagnosis and proactive management of vitiligo are critical. While a wide variety of treatments has demonstrated variable effectiveness in treating vitiligo, phototherapy remains standard of care because of its proven efficacy and favorable side effect profile. However, many patients with vitiligo are unable to access affordable, consistent, or convenient phototherapy. To address these issues, home-based phototherapy has emerged as a patient-centered alternative. The purpose of this review is to discuss management of vitiligo with a specific focus on access to home-based phototherapy (HBPT) for patients with this condition. Key challenges to HBPT include misperceptions around safety and efficacy, inadequate physician education and training, insurance and financial barriers, and appropriate patient selection. Solutions to these challenges are presented, such as approaches to improve physician education and increasing the evidence surrounding the effectiveness and safety of this treatment for vitiligo. In addition, various practical considerations are discussed to guide dermatologists on how to approach HBPT as a treatment option for patients with vitiligo.
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Affiliation(s)
- Mary Patricia Smith
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Karen Ly
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Quinn Thibodeaux
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Mio Nakamura
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
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24
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Affiliation(s)
- A Tanew
- Phototherapy Unit, Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - H W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, U.S.A
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25
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Britton J, Eadie E, Turner D. An investigation of different types of eyewear and face shields in protecting patients and operators from the harmful effects of ultraviolet radiation. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2019; 35:246-254. [PMID: 30932222 DOI: 10.1111/phpp.12459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/25/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Phototherapy and photochemotherapy are commonly used treatment modalities for a range of chronic skin conditions. Whilst undergoing ultraviolet radiation exposure, patients can wear personal protective equipment. Face shields in combination with other forms of skin cover may be worn to provide both skin and eye protection. There are a number of different types of eyewear and face shields available for purchase. Some of these have clear identifications that show the levels of protection provided whilst others may not have any. METHODS A series of similar experiments has been undertaken independently at two phototherapy treatment centres-Chapel Allerton Hospital, Leeds and Ninewells Hospital, Dundee-to investigate the effectiveness of different face shields and eye protection that are available for purchase in the United Kingdom (UK). Two similar examples of one face shield were tested at both centres, and another was transferred between the units. RESULTS Not all examples of the face shields and protective eyewear provided the wearer full protection between 300 nanometres and 400 nanometres (nm). Cost and conformance to different standards was not always a good indicator. Some inexpensive examples tested also met British Association of Dermatology protective sunglasses guidelines. CONCLUSIONS It is incumbent on all centres to check the properties of protective face shields and eyewear provided to patients and operators to guard against the effects from ultraviolet radiation. There is no correlation between price of the protective equipment and level of protection offered, and there may be opportunity for cost savings.
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Affiliation(s)
- Jason Britton
- Medical Physics Department, Leeds General Infirmary, Leeds, UK
| | - Ewan Eadie
- Photobiology unit, Ninewells Hospital, Dundee, UK
| | - David Turner
- Dermatology Department, Chapel Allerton Hospital, Leeds, UK
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26
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Naasan H, Dawe RS, Ibbotson SH. Efficacy of localized hand and foot phototherapy: a review of patients treated in a teaching hospital setting. Clin Exp Dermatol 2019; 44:356-358. [DOI: 10.1111/ced.13776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2018] [Indexed: 12/01/2022]
Affiliation(s)
- H. Naasan
- Photobiology Unit; Department of Dermatology; University of Dundee; Ninewells Hospital and Medical School; Dundee UK
| | - R. S. Dawe
- Photobiology Unit; Department of Dermatology; University of Dundee; Ninewells Hospital and Medical School; Dundee UK
| | - S. H. Ibbotson
- Photobiology Unit; Department of Dermatology; University of Dundee; Ninewells Hospital and Medical School; Dundee UK
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27
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Relke N, Gooderham M. The Use of Janus Kinase Inhibitors in Vitiligo: A Review of the Literature. J Cutan Med Surg 2019; 23:298-306. [PMID: 30902022 DOI: 10.1177/1203475419833609] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Vitiligo is a common acquired depigmenting disorder characterized by the development of white macules and patches due to the loss of melanocytes. Patients with vitiligo can be stigmatized by society, making the disease a source of psychological stress that can considerably affect quality of life. The goal of vitiligo treatment is to obtain skin repigmentation in the majority of cases, and less commonly to depigment the remaining normal skin. There is no consistent, long-term, durable therapy for vitiligo for all patients, highlighting the unmet need for new safe and effective therapies to control this disease. Recently, JAK inhibitors have been explored as a promising novel treatment option in vitiligo. The JAK and signal transducers and activators of transcription (STAT) pathway is an attractive therapeutic target because IFN-γ-dependent cytokines produced through this pathway have been implicated in the pathogenesis of disease. This literature review describes vitiligo pathophysiology, explains the usefulness of the JAK inhibitors for treatment, and summarizes published case reports, case series, and open-label studies. Research outlined here shows JAK inhibitors in patients with vitiligo have a favorable safety profile and effectively produce repigmentation of lesions, especially with concomitant ultraviolet exposure. Additional studies are required to confirm efficacy, establish safety, and investigate durability of repigmentation.
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Affiliation(s)
| | - Melinda Gooderham
- 1 Queen's University, Kingston, ON, Canada.,2 SKiN Centre for Dermatology, Peterborough, ON, Canada.,3 Probity Medical Research, Waterloo, ON, Canada
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28
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Abstract
Cutaneous T-cell lymphomas (CTCL) are a heterogenous group of non-Hodgkin lymphomas arising in the skin. Mycosis fungoides (MF), the most common variant, is characterised by clonal proliferation of skin residing malignant T-cells. Initially appearing with erythematous patches and plaques it follows a chronic course with progression to cutaneous tumours and extracutaneous involvement in some patients. Phototherapy with ultraviolet A radiation combined with 8-methoxypsoralen (PUVA) and with narrow-band ultraviolet B radiation (NB-UVB) are among the first line options for the treatment of MF and can induce remission in most patients. Sézary syndrome (SS) is a rare and more aggressive CTCL variant with generalized skin involvement. Patients with SS and with erythroderma from MF can benefit from treatment with extracorporeal photochemotherapy (ECP) where peripheral blood is exposed to PUVA. Phototherapy can be safely combined with systemic agents, most notably interferon-alpha and retinoids. Another photoresponsive CTCL variant is lymphomatoid papulosis (LP), a CD30+ lymphoproliferative disease characterised by chronically recurring papules. The disease responds favourably to PUVA but low dose methotrexate might be preferred for long term disease control. Recently updated treatment guidelines have been published to provide evidence-based algorithms for the stage-oriented treatment of MF, SS and LP. Areas of uncertainty are treatment schedules that are currently not optimised for CTCL, the use of phototherapy for maintenance, and the value of ultraviolet A1 radiation, excimer lasers, and photodynamic therapy.
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Affiliation(s)
- Franz Trautinger
- Department of Dermatology and Venereology, Karl Landsteiner University of Health Sciences, University Hospital of St. Pölten, Austria.
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29
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Russo F, Vispi M, Sirna R, Mancini V, Bagnoni G, Bartoli L, Bellini M, Brandini L, Caproni M, Castelli A, Cecchi R, Cuccia A, Fimiani M, Grazzini M, Marsili F, Mazzatenta C, Niccoli MC, Panduri S, Peccianti C, Pecenco S, Pimpinelli N, Prignano F, Ricceri F, Romanelli M, Rossari S, Taviti F, Volpi W, Pellegrino M. Tuscan consensus on the use of UVBnb phototherapy in the treatment of psoriasis. GIORN ITAL DERMAT V 2018; 154:99-105. [PMID: 30375219 DOI: 10.23736/s0392-0488.18.06223-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Psoriasis (PSO) is traditionally defined as an immune-mediated, inflammatory dermatological disease characterized by a chronic-relapsing course and associated with multifactorial inheritance (genetic predisposition and influence of various environmental factors). Considered until recently a dermatological disease only, today PSO is correctly known as a systemic one because of the involvement of multiple organs with important impact on social life and relationships. PSO is found in the 0.3-4.6% of the world's population, while its prevalence in the Italian population is estimated at 2.8%. Therefore, if we consider that in Tuscany more than 100,000 people out of 3,672,202 suffer of psoriasis, it is of paramount importance to focus on a shared clinical and therapeutic protocol to manage the disease. With the aim of ensuring diagnostic-therapeutic suitability, high levels of care and standardization of treatment, a unique clinical-therapeutic management model has been developed and validated in Tuscany, involving all accredited regional dermatological centers. Among the possible alternatives to be implemented in the treatment of patients with mild, moderate-severe psoriasis, UVBnb phototherapy is widely used alone or in association with other systemic and non-systemic devices. Despite this, there is still no universally shared therapeutic protocol. In this context the CO.FO.TO working group (Consensus Fototerapia Toscana) is born with the aim of defining and validating the main guidelines in the use of phototherapy with UVBnb in psoriasis; the guidelines are based both on the real-life experience of the different centers of reference in the region and on the revision of the recent literature.
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Affiliation(s)
- Filomena Russo
- Section of Dermatology, Department of Clinical Medicine and Immunological Science, University of Siena, Siena, Italy -
| | - Martina Vispi
- Section of Dermatology, Department of Dermatology, Misericordia Hospital, Grosseto, Italy
| | - Riccardo Sirna
- Section of Dermatology, Department of Dermatology, Misericordia Hospital, Grosseto, Italy
| | - Virginia Mancini
- Section of Pathology, Department of Medical Biotechnology, University of Siena, Siena, Italy
| | | | - Laura Bartoli
- Unit of Dermatology, San Jacopo Hospital, Pistoia, Italy
| | - Mauro Bellini
- Unit of Dermatology, Carrara Hospital, Carrara, Italy
| | - Luca Brandini
- Unit of Dermatology, San Giuseppe Hospital, Empoli, Italy
| | - Marzia Caproni
- Unit of Dermatologic Rare Disease and Skin Immunopathology, Department of Dermatology, University of Florence, Florence, Italy
| | | | - Roberto Cecchi
- Unit of Dermatology, San Jacopo Hospital, Pistoia, Italy
| | - Aldo Cuccia
- Unit of Dermatology, San Donato Hospital, Arezzo, Italy
| | - Michele Fimiani
- Section of Dermatology, Department of Clinical Medicine and Immunological Science, University of Siena, Siena, Italy
| | - Marta Grazzini
- Unit of Dermatology, Campo di Marte Hospital, Lucca, Italy
| | - Franco Marsili
- Unit of Dermatology, Versilia Hospital, Lido di Camaiore, Lucca, Italy
| | | | | | | | - Camilla Peccianti
- Section of Dermatology, Department of Dermatology, Misericordia Hospital, Grosseto, Italy
| | | | - Nicola Pimpinelli
- Department of Surgery and Translational Medicine, Dermatology Clinic, University of Florence, Florence, Italy
| | - Francesca Prignano
- Department of Surgery and Translational Medicine, Dermatology Clinic, University of Florence, Florence, Italy
| | - Federica Ricceri
- Department of Surgery and Translational Medicine, Dermatology Clinic, University of Florence, Florence, Italy
| | | | - Susanna Rossari
- Unit of Dermatology, Versilia Hospital, Lido di Camaiore, Lucca, Italy
| | | | - Walter Volpi
- Unit of Dermatologic Rare Disease and Skin Immunopathology, Department of Dermatology, University of Florence, Florence, Italy
| | - Michele Pellegrino
- Section of Dermatology, Department of Clinical Medicine and Immunological Science, University of Siena, Siena, Italy
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30
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Holroyd CR, Seth R, Bukhari M, Malaviya A, Holmes C, Curtis E, Chan C, Yusuf MA, Litwic A, Smolen S, Topliffe J, Bennett S, Humphreys J, Green M, Ledingham J. The British Society for Rheumatology biologic DMARD safety guidelines in inflammatory arthritis. Rheumatology (Oxford) 2018; 58:e3-e42. [DOI: 10.1093/rheumatology/key208] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- Christopher R Holroyd
- Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rakhi Seth
- Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Marwan Bukhari
- Rheumatology Department, University Hospitals of Morecombe Bay NHS Foundation Trust, Lancaster, UK
| | - Anshuman Malaviya
- Rheumatology Department, Mid Essex hospitals NHS Trust, Chelmsford, UK
| | - Claire Holmes
- Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Elizabeth Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Christopher Chan
- Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mohammed A Yusuf
- Rheumatology Department, Mid Essex hospitals NHS Trust, Chelmsford, UK
| | - Anna Litwic
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Rheumatology Department, Salisbury District Hospital, Salisbury, UK
| | - Susan Smolen
- Rheumatology Department, Mid Essex hospitals NHS Trust, Chelmsford, UK
| | - Joanne Topliffe
- Rheumatology Department, Mid Essex hospitals NHS Trust, Chelmsford, UK
| | - Sarah Bennett
- Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jennifer Humphreys
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Muriel Green
- National Rheumatoid Arthritis Society, Queen Alexandra Hospital, Portsmouth, UK
| | - Jo Ledingham
- Rheumatology Department, Queen Alexandra Hospital, Portsmouth, UK
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31
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Polańska A, Gaura T, Bowszyc‐Dmochowska M, Osmola‐Mańkowska A, Olek‐Hrab K, Adamski Z, Żaba R, Dańczak‐Pazdrowska A. Calcipotriol/betamethasone ointment compared to narrow‐band UVB in plaque psoriasis: first clinical and ultrasonographic study. Int J Dermatol 2018; 58:108-113. [DOI: 10.1111/ijd.14150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/17/2018] [Accepted: 06/20/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Adriana Polańska
- Department of Dermatology and Venereology University of Medical Sciences Poznań Poland
| | - Tomasz Gaura
- Department of Dermatology University of Medical Sciences Poznań Poland
| | | | | | | | - Zygmunt Adamski
- Department of Dermatology University of Medical Sciences Poznań Poland
| | - Ryszard Żaba
- Department of Dermatology and Venereology University of Medical Sciences Poznań Poland
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32
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Ungureanu S, Arzpayma P, Edwards C, Anstey AV. Home phototherapy in the U.K.'s National Health Service: time to reach out. Br J Dermatol 2018; 176:1339-1340. [PMID: 28504385 DOI: 10.1111/bjd.14993] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S Ungureanu
- Heart of England NHS Foundation Trust, Birmingham, U.K
| | - P Arzpayma
- Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, Gwynedd, North Wales
| | - C Edwards
- Aneurin Bevan University Health Board, Newport, South Wales
| | - A V Anstey
- Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, Gwynedd, North Wales
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33
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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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34
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Youssef R, Abdel-Halim MRE, Kamel M, Khorshid M, Fahim A. Effect of polymorphisms in IL-12B p40, IL-17A and IL-23 A/G genes on the response of psoriatic patients to narrowband UVB. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2018; 34:347-349. [PMID: 29763989 DOI: 10.1111/phpp.12395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/04/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Randa Youssef
- Dermatology Department, Cairo University, Cairo, Egypt
| | | | - Marwa Kamel
- Dermatology Department, Cairo University, Cairo, Egypt
| | - Mervat Khorshid
- Clinical Pathology Department, Cairo University, Cairo, Egypt
| | - Aya Fahim
- Dermatology Department, Cairo University, Cairo, Egypt
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35
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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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Raone B, Patrizi A, Gurioli C, Gazzola A, Ravaioli GM. Cutaneous carcinogenic risk evaluation in 375 patients treated with narrowband-UVB phototherapy: A 15-year experience from our Institute. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2018. [PMID: 29533483 DOI: 10.1111/phpp.12382] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Narrowband-ultraviolet B (NB-UVB) is widely used for the treatment of several dermatological diseases. A cutaneous carcinogenic effect has been hypothesized, but not proved. METHODS We retrospectively reviewed the data of patients treated with NB-UVB between January 1998 and December 2013 at the Dermatology Unit of our University Hospital, to evaluate the cutaneous carcinogenic risk of NB-UVB. RESULTS In all, 375 patients were included, each receiving a mean follow-up of 6.9 years. Vitiligo and psoriasis were the most common diseases. In total, 19 non-melanoma skin cancers (NMSCs) were diagnosed in eight patients, after a mean latency of 5.2 years after the first radiation. No malignant melanoma (MM) was observed. The incidence rates of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) were 620.2/100 ̇000 p/y and 116.3/100 ̇000 p/y. NMSCs were more frequent in patients affected by psoriasis (P = .0232), with older age at the first radiation (mean = 68.8 years, P = .0001). CONCLUSION Despite the small number of patients and limited follow-up, our data suggest that NB-UVB may trigger cutaneous carcinogenesis, mainly in patients at risk for NMSCs, increasing their personal risk for single and multiple neoplasms, usually superficial BCCs. MM risk does not seem to be enhanced.
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Affiliation(s)
- Beatrice Raone
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Carlotta Gurioli
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Andrea Gazzola
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Giulia Maria Ravaioli
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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van Santen S, Vermeer MH, Willemze R. Classification and recommended treatment options for folliculotropic mycosis fungoides. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2018.1406796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Suzanne van Santen
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten H. Vermeer
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rein Willemze
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
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Patra V, Mayer G, Gruber-Wackernagel A, Horn M, Lembo S, Wolf P. Unique profile of antimicrobial peptide expression in polymorphic light eruption lesions compared to healthy skin, atopic dermatitis, and psoriasis. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2017; 34:137-144. [PMID: 29044786 PMCID: PMC5888155 DOI: 10.1111/phpp.12355] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 12/01/2022]
Abstract
Background Polymorphic light eruption (PLE) has been attributed to type IV, most likely delayed‐type hypersensitivity response (adaptive immunity) but little is known on innate immunity, especially antimicrobial peptides (AMPs) in the disease. Abnormalities in AMP expression have been linked to pathological skin conditions such as atopic dermatitis (AD) and psoriasis. Methods Antimicrobial peptide profiling was carried out in PLE skin samples (n,12) compared with that of healthy (n,13), atopic (n,6), and psoriatic skin (n,6). Results Compared to healthy skin, we observed increased expression of psoriasin and RNAse7 (both mostly in stratum granulosum of the epidermis), HBD‐2 (in the cellular infiltrate of the dermis), and LL37 (mostly in and around blood vessels and glands) in PLE lesional skin, a similar expression profile as present in psoriatic skin and different to that of AD (with little or no expression of psoriasin, RNAse7, HBD‐2, and LL37). HBD‐3 was downregulated in PLE compared to its high expression in the epidermis and dermis of healthy skin, AD, and psoriasis. Conclusion The unique profile of differentially expressed AMPs in PLE implies a role in the pathophysiology of the disease, possibly directly or indirectly linked to the microbiome of the skin.
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Affiliation(s)
- VijayKumar Patra
- Research Unit for Photodermatology, Medical University of Graz, Graz, Austria.,Center for Medical Research, Medical University of Graz, Graz, Austria
| | - Gerlinde Mayer
- Research Unit for Photodermatology, Medical University of Graz, Graz, Austria.,Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Alexandra Gruber-Wackernagel
- Research Unit for Photodermatology, Medical University of Graz, Graz, Austria.,Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Michael Horn
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Serena Lembo
- Department of Medicine, Surgery, and Dentistry, Scuola Medica Salernitana, University of Salerno, Fisciano, Italy
| | - Peter Wolf
- Research Unit for Photodermatology, Medical University of Graz, Graz, Austria.,Department of Dermatology, Medical University of Graz, Graz, Austria
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Rodríguez-Granados M, Estany-Gestal A, Pousa-Martínez M, Labandeira J, Gato Otero R, Fernández-Redondo V. Is it Useful to Calculate Minimal Erythema Dose Before Narrowband UV-B Phototherapy? ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ma L, Zhang Q, Hu Y, Luo X. Evaluation of narrow band ultraviolet B phototherapy in the treatment of chronic actinic dermatitis in Chinese patients. Dermatol Ther 2017; 30. [PMID: 29047198 DOI: 10.1111/dth.12528] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 06/11/2017] [Accepted: 06/29/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Li Ma
- Department of Dermatology; Huashan Hospital, Fudan University; Shanghai 200040 China
| | - Qiaoan Zhang
- Department of Dermatology; Huashan Hospital, Fudan University; Shanghai 200040 China
| | - Yue Hu
- Department of Dermatology; Huashan Hospital, Fudan University; Shanghai 200040 China
| | - Xiaoqun Luo
- Department of Dermatology; Huashan Hospital, Fudan University; Shanghai 200040 China
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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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Successful short desensitization treatment protocol with narrowband UVB phototherapy (TL-01) in polymorphic light eruption. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.04.009] [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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Pacifico A, Leone G, Damiani G, Ferraro C, Iacovelli P, Paro Vidolin A, Muscardin L. Indeterminate cell histiocytosis: A case treated with ultraviolet B narrow band phototherapy (NB UVB). PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2017; 33:329-333. [DOI: 10.1111/phpp.12327] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/23/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - Giovanni Leone
- San Gallicano Dermatological Institute; IRCCS; Rome Italy
| | - Giovanni Damiani
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti; Unità Operativa di Dermatologia; IRCCS Fondazione Cà Granda; Ospedale Maggiore Policlinico; Università degli Studi di Milano; Milano Italy
| | | | | | | | - Luca Muscardin
- San Gallicano Dermatological Institute; IRCCS; Rome Italy
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Rodríguez-Granados MT, Estany-Gestal A, Pousa-Martínez M, Labandeira J, Gato Otero R, Fernández-Redondo V. Is it Useful to Calculate Minimal Erythema Dose Before Narrowband UV-B Phototherapy? ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:852-858. [PMID: 28687116 DOI: 10.1016/j.ad.2017.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 05/19/2017] [Accepted: 05/25/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The starting dose for narrowband UV-B phototherapy is determined by a patient's skin phototype or minimal erythema dose (MED). Calculation of MED identifies patients with unsuspected photosensitivity. The aim of this study was to investigate the influence of factors such as concomitant use of photosensitizing agents, diagnosis, and combination with acitretin in patients with psoriasis on the frequency and severity of adverse effects in patients with a low MED to narrowband UV-B phototherapy. MATERIAL AND METHODS We undertook a retrospective observational cohort study between February 1, 2009 and March 31, 2015. MED values were classified as normal or low. RESULTS In total, 302 patients with different skin conditions started narrowband UV-B phototherapy at a dose determined by their MED. No differences were found between patients with a low MED and those with a normal MED for number of drugs taken (P=.071) or use of photosensitizing agents (P=0.806). Following adjustment for age, sex, and phototype, the multivariate analysis showed that psoriasis exerted a protective effect against a low MED (OR=0.31 [95% CI, 0.16-0.58]). No significant risk of erythema or pruritus was detected in patients with a low MED (OR=1.68; 95% CI, 0.91-3.29 and OR=2.04; 95% CI, 0.99-4.22, respectively). CONCLUSIONS Psoriasis protects against a low MED. Although erythema and pruritus were more common in patients with a low MED, the differences were not significant.
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Affiliation(s)
- M T Rodríguez-Granados
- Servicio de Dermatología, Hospital Clínico Universitario, Santiago de Compostela, España.
| | - A Estany-Gestal
- Unidad de Epidemiología e Investigación Clínica, Fundación I+D+i Ramón Domínguez, Santiago de Compostela, España
| | - M Pousa-Martínez
- Servicio de Dermatología, Hospital Clínico Universitario, Santiago de Compostela, España
| | - J Labandeira
- Servicio de Dermatología, Hospital Clínico Universitario, Santiago de Compostela, España
| | - R Gato Otero
- Servicio de Dermatología, Hospital Clínico Universitario, Santiago de Compostela, España
| | - V Fernández-Redondo
- Servicio de Dermatología, Hospital Clínico Universitario, Santiago de Compostela, España
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Successful Short Desensitization Treatment Protocol with Narrowband UVB Phototherapy (TL-01) in Polymorphic Light Eruption. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:752-757. [PMID: 28549611 DOI: 10.1016/j.ad.2017.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/15/2017] [Accepted: 04/14/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Polymorphic light eruption (PLE) is a common idiopathic photodermatosis that typically presents with pruritic papular or papulovesicular lesions on sun-exposed skin between spring and autumn. In many subjects PLE is mild, and can usually be prevented by the use of broad-spectrum topical sunscreens and a gradual increase in sunlight exposure. However, in some individuals, sunlight exposure results in florid PLE and they often benefit from prophylactic desensitization treatment using phototherapy in early spring, an artificial method that induces a "hardening" phenomenon. OBJECTIVE To describe and evaluate the efficacy of a short desensitization protocol, based on a one-month-treatment, administered twice a week with narrow band UVB in subjects with severe polymorphic light eruption (PLE). METHODS A retrospective, open planned and non-randomized study to assess the efficacy of UVB phototherapy in prevention of polymorphic light eruption. RESULTS Fifteen subjects diagnosed with severe PLE were treated with the standard protocol in our Photobiology Unit between 2014 and 2015. The effect of hardening was sustained during follow up in 87.5% of desensitization treatments. A statistically significant association (p<0.05) between the years of duration of the PLE and the response to treatment was found. CONCLUSIONS The effect of hardening was maintained in the vast majority of subjects, obtaining a good benefit with no PLE episodes during all the summer. We demonstrate that our standard protocol is effective, and produces a successful outcome for the majority of PLE subjects. Our protocol is shorter than those currently applied, being favourable both for the patient and the physician.
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Mijušković ŽP, Kandolf-Sekulović L, Tiodorović D, Nikolić M, Jovanović M, Škiljević D, Gajinov Z, Zečević RD. Serbian Association of Dermatovenereologists’ Guidelines for the Diagnosis and Treatment of Psoriasis. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2017. [DOI: 10.1515/sjdv-2016-0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Željko P. Mijušković
- Clinic of Dermatovenereology, School of Medicine, Military Medical Academy, Belgrade, Republic of Serbia
| | - Lidija Kandolf-Sekulović
- Clinic of Dermatovenereology, School of Medicine, Military Medical Academy, Belgrade, Republic of Serbia
| | - Danica Tiodorović
- Clinic of Dermatovenereology, Clinical Center of Niš, Faculty of Medicine, University of Niš, Republic of Serbia
| | - Miloš Nikolić
- Clinic of Dermatovenereology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Republic of Serbia
| | - Marina Jovanović
- Clinic of Dermatovenereology, Clinical Center of Vojvodina, Faculty of Medicine, University of Novi Sad, Republic of Serbia
| | - Dušan Škiljević
- Clinic of Dermatovenereology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Republic of Serbia
| | - Zorica Gajinov
- Clinic of Dermatovenereology, Clinical Center of Vojvodina, Faculty of Medicine, University of Novi Sad, Republic of Serbia
| | - Radoš D. Zečević
- Clinic of Dermatovenereology, School of Medicine, Military Medical Academy, Belgrade, Republic of Serbia
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Thomas KS, Batchelor JM, Bath-Hextall F, Chalmers JR, Clarke T, Crowe S, Delamere FM, Eleftheriadou V, Evans N, Firkins L, Greenlaw N, Lansbury L, Lawton S, Layfield C, Leonardi-Bee J, Mason J, Mitchell E, Nankervis H, Norrie J, Nunn A, Ormerod AD, Patel R, Perkins W, Ravenscroft JC, Schmitt J, Simpson E, Whitton ME, Williams HC. A programme of research to set priorities and reduce uncertainties for the prevention and treatment of skin disease. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BackgroundSkin diseases are very common and can have a large impact on the quality of life of patients and caregivers. This programme addressed four diseases: (1) eczema, (2) vitiligo, (3) squamous cell skin cancer (SCC) and (4) pyoderma gangrenosum (PG).ObjectiveTo set priorities and reduce uncertainties for the treatment and prevention of skin disease in our four chosen diseases.DesignMixed methods including eight systematic reviews, three prioritisation exercises, two pilot randomised controlled trials (RCTs), three feasibility studies, two core outcome initiatives, four funding proposals for national RCTs and one completed national RCT.SettingSecondary care, primary care and the general population.ParticipantsPatients (and their caregivers) with eczema, vitiligo, SCC and PG, plus health-care professionals with an interest in skin disease.InterventionsOur three intervention studies included (1) barrier enhancement using emollients from birth to prevent eczema (pilot RCT); (2) handheld narrowband ultraviolet light B therapy for treating vitiligo (pilot RCT); and (3) oral ciclosporin (Neoral®, Novartis Pharmaceuticals) compared with oral prednisolone for managing PG (pragmatic national RCT).ResultsSystematic reviews included two overarching systematic reviews of RCTs of treatments for eczema and vitiligo, an umbrella review of systematic reviews of interventions for the prevention of eczema, two reviews of treatments for SCC (one included RCTs and the second included observational studies), and three reviews of outcome measures and outcome reporting. Three prioritisation partnership exercises identified 26 priority areas for future research in eczema, vitiligo and SCC. Two international consensus initiatives identified four core domains for future eczema trials and seven core domains for vitiligo trials. Two pilot RCTs and three feasibility studies critically informed development of four trial proposals for external funding, three of which are now funded and one is pending consideration by funders. Our pragmatic RCT tested the two commonly used systemic treatments for PG (prednisolone vs. ciclosporin) and found no difference in their clinical effectiveness or cost-effectiveness. Both drugs showed limited benefit. Only half of the participants’ ulcers had healed by 6 months. For those with healed ulcers, recurrence was common (30%). Different side effect profiles were noted for each drug, which can inform clinical decisions on an individual patient basis. Three researchers were trained to PhD level and a dermatology patient panel was established to ensure patient involvement in all aspects of the programme.ConclusionsFindings from this programme of work have already informed clinical guidelines and patient information resources. Feasibility studies have ensured that large national pragmatic trials will now be conducted on important areas of treatment uncertainty that address the needs of patients and the NHS. There is scope for considerable improvement in terms of trial design, conduct and reporting for RCTs of skin disease, which can be improved through wider collaboration, registration of trial protocols and complete reporting and international consensus over core outcome sets. Three national trials have now been funded as a result of this work. Two international initiatives to establish how best to measure the core outcome domains for eczema and vitiligo are ongoing.Trial registrationCurrent Controlled Trials Barrier Enhancement for Eczema Prevention (BEEP) (ISRCTN84854178 and NCT01142999), Study of Treatments fOr Pyoderma GAngrenosum Patients (STOP GAP) (ISRCTN35898459) and Hand Held NB-UVB for Early or Focal Vitiligo at Home (HI-Light Pilot Trial) (NCT01478945).FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 18. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kim S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | | | | | - Joanne R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Tessa Clarke
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | | | - Finola M Delamere
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | | | - Nicholas Evans
- Trust Headquarters, West Hertfordshire Hospital NHS Trust, Hemel Hempstead, UK
| | - Lester Firkins
- Strategy and Development Group, James Lind Alliance, Oxford, UK
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Louise Lansbury
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Sandra Lawton
- Dermatology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Carron Layfield
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - James Mason
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | - Eleanor Mitchell
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Helen Nankervis
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - John Norrie
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Andrew Nunn
- Medical Research Council (MRC) Clinical Trials Unit, University College London, London, UK
| | | | - Ramesh Patel
- Radcliffe-on-Trent Health Centre, Nottingham, UK
| | - William Perkins
- Dermatology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jane C Ravenscroft
- Dermatology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jochen Schmitt
- Centre for Evidence-based Healthcare, Medical Faculty Carl Gustav Carus, Dresden, Germany
| | - Eric Simpson
- Oregon Health and Science University, Portland, OR, USA
| | - Maxine E Whitton
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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Phototherapy for Pityriasis Lichenoides in the Pediatric Population: A Review of the Published Literature. Am J Clin Dermatol 2016; 17:583-591. [PMID: 27502793 DOI: 10.1007/s40257-016-0216-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Pityriasis lichenoides (PL) is a dermatologic disorder that manifests in either the acute (pityriasis lichenoides et varioliformis acuta) or the chronic form (pityriasis lichenoides chronica, also known as parapsoriasis chronica). Traditional first-line therapy consists of corticosteroids or antibiotics; however, these treatments are often accompanied with multiple side effects and may be ineffective. OBJECTIVE The goal of this study was to review the use of phototherapy for treating PL in the pediatric population. MATERIALS AND METHODS We performed a systematic review of the literature in the National Library of Medicine's PubMed database and the SCOPUS database discussing phototherapy for treatment of PL in the pediatric population. The following search terms were used: 'pityriasis lichenoides', 'pityriasis lichenoides chronica', 'pityriasis lichenoides et varioliformis acuta', and 'febrile ulceronecrotic Mucha-Habermann disease'. RESULTS The systematic search and screening of articles resulted in 14 articles including a total of 64 patients with PL treated with phototherapy. Three different modalities were utilized, with five studies using broadband ultraviolet B (BB-UVB) radiation, nine studies utilizing narrowband UVB (NB-UVB), and two studies employing psoralen with ultraviolet A (PUVA) therapy. Overall, the use of BB-UVB had an initial clearance rate of 89.6 % with 23.1 % recurrence, whereas NB-UVB cleared 73 % of the lesions with no recurrence, and PUVA therapy initially cleared 83 % of the lesions with 60 % recurrence. The side-effect profiles were similar and revealed limited toxicity. CONCLUSION Phototherapy shows promising results and a favorable side-effect profile in the treatment of PL. Ultimately, large randomized controlled trials are needed to determine optimal treatments.
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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] [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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Matos TR, Ling TC, Sheth V. Ultraviolet B radiation therapy for psoriasis: Pursuing the optimal regime. Clin Dermatol 2016; 34:587-93. [DOI: 10.1016/j.clindermatol.2016.05.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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