1
|
Ravindran S, Pai B S, Shetty VM. Risk of cutaneous carcinogenesis with phototherapy in Indian subpopulation: A ten‐year analysis and a review of literature. Dermatol Ther 2022; 35:e15536. [DOI: 10.1111/dth.15536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/19/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Surya Ravindran
- Consultant Dermatologist Artes skin and hair clinic Palakkad India
| | - Sathish Pai B
- Department of Dermatology Kasturba Medical College, Manipal, Manipal Academy of Higher Education Manipal 576104 India
| | - Varsha M. Shetty
- Department of Dermatology Kasturba Medical College, Manipal, Manipal Academy of Higher Education Manipal 576104 India
| |
Collapse
|
2
|
Zhu S, Sun C, Zhang L, Du X, Tan X, Peng S. Incidence Trends and Survival Prediction of Malignant Skin Cancer: A SEER-Based Study. Int J Gen Med 2022; 15:2945-2956. [PMID: 35313550 PMCID: PMC8934145 DOI: 10.2147/ijgm.s340620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/24/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusion
Collapse
Affiliation(s)
- Sirong Zhu
- School of Public Health, Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Chao Sun
- School of Public Health, Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Longjiang Zhang
- School of Public Health, Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Xiaoan Du
- School of Public Health, Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Xiaodong Tan
- School of Public Health, Wuhan University, Wuhan, Hubei, People’s Republic of China
- School of Nursing, Wuchang University of Technology, Wuhan, Hubei, People’s Republic of China
- Correspondence: Xiaodong Tan; Shuzhen Peng, Email ;
| | - Shuzhen Peng
- The People’s Hospital of Huangpi, Wuhan, Hubei, People’s Republic of China
| |
Collapse
|
3
|
Kamijo H, Miyagaki T. Mycosis Fungoides and Sézary Syndrome: Updates and Review of Current Therapy. Curr Treat Options Oncol 2021; 22:10. [PMID: 33415447 DOI: 10.1007/s11864-020-00809-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 12/12/2022]
Abstract
OPINION STATEMENT While most patients with early-stage mycosis fungoides (MF) follow an indolent course, patients with advanced-stage MF/Sézary syndrome (SS) have a poor prognosis with a median survival of less than 5 years. Although there are a number of treatments currently available, achieving and maintaining a durable response remain challenging, especially in advanced-stage MF/SS. The choice of frontline therapy is dependent on the stage of disease. For early-stage MF, the treatment concept is to control skin lesions mainly by skin-directed therapies, such as topical therapies, phototherapies, and radiotherapies. For advanced-stage MF/SS, systemic treatments by biological or targeted therapies including bexarotene and interferon either alone or in combination are tried first, with more immunosuppressive chemotherapies being reserved for refractory or rapidly progressive disease. Recent improvements in biological or targeted therapies include brentuximab vedotin and mogamulizumab. When biopsy samples have 10% or more CD30-positive malignant cells, brentuximab vedotin, an anti-CD30 antibody conjugated to monomethyl auristin E, can be a desirable treatment option. For cases with blood involvement, mogamulizumab, an antibody binding to C-C chemokine receptor 4, is effective with high response rates. In the refractory setting, alemtuzumab, histone deacetylase inhibitors, pralatrexate, gemcitabine, and doxorubicin are considered as the treatment option. Because only allogeneic hematopoietic stem cell transplantation can offer a chance of cure with durable complete remission, advanced-stage patients with a markedly short life expectancy should be evaluated for eligibility. Given that there are few randomized controlled studies in the literature, it is necessary to investigate which therapy is preferable for each patient with MF/SS by comparative prospective trials.
Collapse
Affiliation(s)
- Hiroaki Kamijo
- Department of Dermatology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Tomomitsu Miyagaki
- Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
| |
Collapse
|
4
|
Park JB, Jang JY, Kwon DI, Seong SH, Suh KS, Jang MS. The effectiveness of high-dose ultraviolet A-1 phototherapy for acute exacerbation of atopic dermatitis in Asians. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2020; 36:263-270. [PMID: 32141113 DOI: 10.1111/phpp.12546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/23/2020] [Accepted: 02/28/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND/PURPOSE Atopic dermatitis (AD) is an inflammatory skin disease characterized by a chronic course of exacerbations and remissions. High-dose ultraviolet A-1 (UVA-1) phototherapy has been effective in the treatment of acute exacerbations of AD. However, there have been no case studies in Asian patients to date. We investigated the effectiveness of high-dose UVA-1 phototherapy for treating acute exacerbation of AD in Asian patients. METHOD This study included 16 patients with acute exacerbation of AD. High-dose (100 J/cm2 ) regimens of UVA-1 therapy were employed. Therapeutic effectiveness was assessed based on the findings of clinical examinations and scoring of AD (SCORAD) index before treatment and after the 5th and 10th sessions of treatment. Additionally, side effects and recurrence during follow-up were retrospectively evaluated. RESULTS The patients were between 7 and 50 years of age, with a mean age of 25.8 years. The SCORAD index was between 41 and 89.5, with a mean score of 64.9. Among the 16 patients, two patients discontinued treatment due to the aggravation of erythema and pruritus. Of the 14 patients who completed the 10 sessions of high-dose UVA-1 phototherapy, nine patients (64.3%) showed complete remission and five patients (35.7%) showed partial remission. The mean SCORAD index reduced from 64.9 (before treatment) to 23.3 (after the 10th session of treatment). CONCLUSION This is the first case study of high-dose UVA-1 phototherapy for acute exacerbation of AD in Asian patients, suggesting that high-dose UVA-1 phototherapy can be a well-tolerated and effective treatment for acute exacerbated AD. Future large-scale prospective studies are needed.
Collapse
Affiliation(s)
- Jong Bin Park
- Department of Dermatology, Kosin University College of Medicine, Busan, South Korea
| | - Ji Yun Jang
- Department of Dermatology, Kosin University College of Medicine, Busan, South Korea
| | - Do Ik Kwon
- Department of Dermatology, Kosin University College of Medicine, Busan, South Korea
| | - Seol Hwa Seong
- Department of Dermatology, Kosin University College of Medicine, Busan, South Korea
| | - Kee Suck Suh
- Department of Dermatology, Kosin University College of Medicine, Busan, South Korea
| | - Min Soo Jang
- Department of Dermatology, Kosin University College of Medicine, Busan, South Korea
| |
Collapse
|
5
|
|
6
|
Abstract
Ultraviolet (UV) radiation contributes to the development of skin cancer through direct and indirect DNA damage, production of reactive oxygen species, and local immunomodulation. The association between UV radiation and skin cancer has raised concern for the risk of carcinogenesis following phototherapy. The photocarcinogenic impact of psoralen and UVA radiation (PUVA) has been extensively studied, whereas limited safety studies exist for other phototherapy modalities, such as broadband and narrowband UVB and UVA1. Because of the as of yet unclear risk, patients who have undergone any type of phototherapy should be followed for age-appropriate skin cancer screening.
Collapse
|
7
|
Elmets CA, Lim HW, Stoff B, Connor C, Cordoro KM, Lebwohl M, Armstrong AW, Davis DMR, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kiselica M, Kivelevitch D, Korman NJ, Kroshinsky D, Leonardi CL, Lichten J, Mehta NN, Paller AS, Parra SL, Pathy AL, Farley Prater EA, Rupani RN, Siegel M, Strober BE, Wong EB, Wu JJ, Hariharan V, Menter A. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis with phototherapy. J Am Acad Dermatol 2019; 81:775-804. [PMID: 31351884 DOI: 10.1016/j.jaad.2019.04.042] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/11/2019] [Indexed: 01/12/2023]
Abstract
Psoriasis is a chronic inflammatory disease involving multiple organ systems and affecting approximately 3.2% of the world's population. In this section of the guidelines of care for psoriasis, we will focus the discussion on ultraviolet (UV) light-based therapies, which include narrowband and broadband UVB, UVA in conjunction with photosensitizing agents, targeted UVB treatments such as with an excimer laser, and several other modalities and variations of these core phototherapies, including newer applications of pulsed dye lasers, intense pulse light, and light-emitting electrodes. We will provide an in-depth, evidence-based discussion of efficacy and safety for each treatment modality and provide recommendations and guidance for the use of these therapies alone or in conjunction with other topical and/or systemic psoriasis treatments.
Collapse
Affiliation(s)
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | | | | | - Kelly M Cordoro
- University of California, San Francisco School of Medicine, Department of Dermatology, San Francisco, California
| | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | | | | | | | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | | | | | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | | | - Reena N Rupani
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Bruce E Strober
- University of Connecticut, Farmington, Connecticut; Probidity Medical Research, Waterloo, Ontario, Canada
| | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, San Antonio, Texas
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
| | | | | |
Collapse
|
8
|
Ostadhossein F, Misra SK, Schwartz-Duval AS, Sharma BK, Pan D. Nanosalina: A Tale of Saline-Loving Algae from the Lake's Agony to Cancer Therapy. ACS APPLIED MATERIALS & INTERFACES 2017; 9:11528-11536. [PMID: 28291324 DOI: 10.1021/acsami.7b01483] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The nanoparticles (NPs) that contain the therapeutic agent within themselves without further modifications can be coined as "self-therapeutic" NPs. The development of these agents especially when derived from natural resources can lead to a paradigm shift in the field of cancer nanotechnology as they can immensely facilitate the complex chemistry procedures and the follow up biological complications. Herein, we demonstrate that inherently therapeutic NPs "integrating" β-carotene can be synthesized from Dunaliella salina microalgae in a single step without complicated chemistry. The facile synthesis involved microwave irradiation of aqueous suspension of algae which resulted in water dispersible NPs with hydrodynamic diameter of ∼80 nm. Subsequently, extensive physiochemical characterizations were performed to confirm the integrity of the particles. The pro-oxidant activities of the integrated β-carotene were triggered by photoexcitation under UV lamp (362 nm). It was demonstrated that after UV exposure, the C32 human melanoma cells incubated with NPs experienced extensive cell death as opposed to nonilluminated samples. Further cellular analysis revealed that the significant reactive oxygen species (ROS) and in particular singlet oxygen were responsible for the cells' damage while the mode of cell death was dominated by apoptosis. Moreover, detailed endocytic inhibition studies specified that UV exposure affected NPs' cellular uptake mechanism. These inherently therapeutic NPs can open new avenues for melanoma cancer treatment via ROS generation in vitro.
Collapse
Affiliation(s)
- Fatemeh Ostadhossein
- Department of Bioengineering,, University of Illinois at Urbana-Champaign , Urbana, Illinois 61801, United States
| | - Santosh K Misra
- Department of Bioengineering,, University of Illinois at Urbana-Champaign , Urbana, Illinois 61801, United States
| | - Aaron S Schwartz-Duval
- Department of Bioengineering,, University of Illinois at Urbana-Champaign , Urbana, Illinois 61801, United States
| | - Brajendra K Sharma
- Illinois Sustainability Technology Center, Prairie Research Institute, University of Illinois at Urbana-Champaign , Urbana, Illinois 61801, United States
| | - Dipanjan Pan
- Department of Bioengineering,, University of Illinois at Urbana-Champaign , Urbana, Illinois 61801, United States
| |
Collapse
|
9
|
DeCoster E, Alves de Medeiros A, Bostoen J, Stockman A, van Geel N, Lapeere H, Lambert J. A multileveled approach in psoriasis assessment and follow-up: A proposal for a tailored guide for the dermatological practice. J DERMATOL TREAT 2015; 27:298-310. [PMID: 26671313 DOI: 10.3109/09546634.2015.1117566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Psoriasis is a complex and heterogeneous disease resulting from interactions between genetic, immunological, and environmental factors. To make the most optimal treatment decision, the dermatologist must therefore have a detailed overview of the patient's history and lifestyle. OBJECTIVES We sought to offer an overview of the various relevant aspects in clinical dermatological assessment of psoriasis patients, emphasizing the importance of a multidisciplinary and integrated clinical approach. METHODS We gathered information on psoriasis management and developed a tailored checklist covering all health-related aspects associated with psoriasis. RESULTS Demographics, personal and family history were elaborately described as well as drug history to discuss how they affect psoriasis management. Relevant patient information such as the vaccination status or cardiovascular profile were included in the checklist as well and treatment recommendations were adapted and updated in accordance with evidence-based literature. This checklist also emphasizes the importance of drug surveillance, proper follow-up and specialist referral, and why the dermatologist needs to address these health-related aspects when assessing psoriasis patients, going beyond optimal skin care. CONCLUSIONS Our comprehensive overview can be used as a consultation checklist for good clinical practice in psoriasis patient management and aid in treatment decision.
Collapse
Affiliation(s)
- Eveline DeCoster
- a Department of Dermatology , Ghent University Hospital , Ghent , Belgium and
| | | | - Jessica Bostoen
- a Department of Dermatology , Ghent University Hospital , Ghent , Belgium and
| | - Annelies Stockman
- b Department of Dermatology , AZ Sint Rembert Hospital , Torhout , Belgium
| | - Nanja van Geel
- a Department of Dermatology , Ghent University Hospital , Ghent , Belgium and
| | - Hilde Lapeere
- a Department of Dermatology , Ghent University Hospital , Ghent , Belgium and
| | - Jo Lambert
- a Department of Dermatology , Ghent University Hospital , Ghent , Belgium and
| |
Collapse
|
10
|
Wang E, Sasaki J, Nakamura M, Koo J. Cutaneous Carcinogenic Risk of Phototherapy: An Updated Comprehensive Review. ACTA ACUST UNITED AC 2015. [DOI: 10.1177/247553031500100107] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Phototherapy is among the oldest and most highly effective treatment modalities available for moderate-to-severe psoriasis. However, concern regarding the potential carcinogenic risk associated with ultraviolet B (UVB) phototherapy and/or psoralen with ultraviolet A (PUVA) has been expressed by both providers and patients. The purpose of this review is to assess the cutaneous malignancy risks of UVB phototherapy and/or PUVA in all skin types, including Caucasian and non-Caucasian patients. We searched the MEDLINE database for original research articles regarding the skin cancer risk of phototherapy. A total of 61 articles were included. In Caucasians, an increased risk of squamous cell carcinoma with PUVA therapy was reported after >250 sessions, whereas studies among non-Caucasians did not show any increased risk. There was no convincing evidence of increased skin cancer risk associated with UVB phototherapy among all skin types. In view of the continued validation of its safety, phototherapy remains a valuable treatment option for patients with moderate-to-severe psoriasis.
Collapse
Affiliation(s)
- Erica Wang
- University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii
| | - Jodie Sasaki
- University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii
| | - Mio Nakamura
- Department of Dermatology, University of California-San Francisco, San Francisco, California
| | - John Koo
- Department of Dermatology, University of California-San Francisco, San Francisco, California
| |
Collapse
|
11
|
Abstract
UV phototherapy has a long history of use for the treatment of select diseases in dermatology. Its use has evolved into more effective and targeted modalities, including psoralen + UV-A photochemotherapy, narrowband UV-B, excimer laser, and UV-A1 phototherapy. With its proven record of efficacy and safety, UV phototherapy is an excellent option in the treatment of an ever-growing number of skin conditions.
Collapse
Affiliation(s)
- Mariam B Totonchy
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Melvin W Chiu
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, 52-121 Center for the Health Sciences, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
| |
Collapse
|
12
|
Kim YS, Park YL, Lee JS, Whang KU. Multiple actinic keratosis, squamous cell carcinoma and basal cell carcinoma occurred after PUVA therapy in a Korean patient. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2014; 30:277-9. [PMID: 24456558 DOI: 10.1111/phpp.12114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/19/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Ye Seul Kim
- Department of Dermatology, Soonchunhyang University Hospital, Bucheon, Korea
| | | | | | | |
Collapse
|
13
|
Verma SB, Wollina U. Accidental PUVA burns, vitiligo and atopic diathesis resulting in prurigo nodularis: a logical but undocumented rarity. An Bras Dermatol 2013. [PMID: 23197209 PMCID: PMC3699928 DOI: 10.1590/s0365-05962012000600011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Vitiligo is a dreaded disease in India due to its social and cultural consequences.
PUVA and PUVAsol are the main treatment modalities for vitiligo vulgaris. To the best
of our knowledge, this is the first case of accidental PUVA burns eventuating in
prurigo nodularis lesions to be reported in a female patient who was undergoing home
PUVA therapy. The itch is so prominent and disabling that the focus of the patient
has shifted from treating her vitiligo to ameliorating the pruritus.
Collapse
|
14
|
Abstract
Phototherapy is a mainstay of vitiligo treatment and has varying rates of efficacy. Narrowband ultraviolet (UV) B (NB-UVB) and UVA have been used for decades, but it is only recently that monochromatic excimer light (MEL) was developed for use in dermatology and adapted for the treatment of vitiligo. The specific 308-nm radiation wavelength is delivered in a targeted form by the xenon-chloride excimer laser and is also available in an incoherent form that is commonly referred to as the excimer lamp. MEL administered by both laser and lamp has shown efficacy superior to NB-UVB for the treatment of vitiligo and induces more changes at the cellular level than conventional UVB modalities. The excimer laser is effective in adults and children with vitiligo in all skin types as monotherapy or in combination with other established vitiligo therapeutics. Treatment regimens studied included excimer laser two to three times weekly for up to 36 weeks. Patients commonly achieved > 75% repigmentation. The laser has also been used in combination with topical corticosteroids, calcineurin inhibitors and vitamin D analogues, as well as surgery, thus further expanding treatment options for patients with vitiligo. The excimer lamp has been used for treatments one to three times a week for up to 24 weeks and was found to be equal to excimer laser in a head-to-head comparison. It has also been used in combination with topical corticosteroids and oral vitamin E. Both MEL modalities have a limited adverse side-effect profile. Long-term effects are yet to be determined; however, based on available data on UVB phototherapy as well as the properties of MEL devices, there is probably only a minimal increased malignancy risk.
Collapse
Affiliation(s)
- K K Park
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA 94118, USA.
| | | | | |
Collapse
|
15
|
Park KK, Murase JE, Koo J. Long-term prognosis of vitiligo patients on narrowband UVB phototherapy. J Am Acad Dermatol 2012; 66:326-7. [DOI: 10.1016/j.jaad.2011.10.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 10/04/2011] [Indexed: 11/15/2022]
|
16
|
Walker D, Jacobe H. Phototherapy in the Age of Biologics. ACTA ACUST UNITED AC 2011; 30:190-8. [DOI: 10.1016/j.sder.2011.08.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 08/07/2011] [Indexed: 11/29/2022]
|
17
|
Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb A, Koo JYM, Lebwohl M, Leonardi CL, Lim HW, Van Voorhees AS, Beutner KR, Ryan C, Bhushan R. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions. J Am Acad Dermatol 2011; 65:137-74. [PMID: 21306785 DOI: 10.1016/j.jaad.2010.11.055] [Citation(s) in RCA: 310] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 11/21/2010] [Accepted: 11/26/2010] [Indexed: 12/13/2022]
Abstract
Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In the first 5 parts of the American Academy of Dermatology Psoriasis Guidelines of Care, we have presented evidence supporting the use of topical treatments, phototherapy, traditional systemic agents, and biological therapies for patients with psoriasis and psoriatic arthritis. In this sixth and final section of the Psoriasis Guidelines of Care, we will present cases to illustrate how to practically use these guidelines in specific clinical scenarios. We will describe the approach to treating patients with psoriasis across the entire spectrum of this fascinating disease from mild to moderate to severe, with and without psoriatic arthritis, based on the 5 prior published guidelines. Although specific therapeutic recommendations are given for each of the cases presented, it is important that treatment be tailored to meet individual patients' needs. In addition, we will update the prior 5 guidelines and address gaps in research and care that currently exist, while making suggestions for further studies that could be performed to help address these limitations in our knowledge base.
Collapse
Affiliation(s)
-
- Psoriasis Research Center, Baylor University Medical Center, Dallas, Texas, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Pugashetti R, Koo J. Phototherapy in pediatric patients: choosing the appropriate treatment option. ACTA ACUST UNITED AC 2010; 29:115-20. [PMID: 20579600 DOI: 10.1016/j.sder.2010.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Phototherapeutic modalities, including narrowband-UVB, broadband-UVB, PUVA photochemotherapy, and excimer laser therapy are valuable tools that can be used for photoresponsive dermatoses in children. As a systematically safer alternative compared with internal agents, including the prebiologic and biological therapies, phototherapy should be considered a possible treatment option for children with diseases including psoriasis, atopic dermatitis, pityriasis lichenoides chronica, and vitiligo.
Collapse
Affiliation(s)
- Rupa Pugashetti
- University of California, School of Medicine, Irvine, CA, USA.
| | | |
Collapse
|
19
|
Abstract
The ultraviolet (UV) light spectrum has long been known to induce biologic effect on the skin. For a large number of cutaneous disorders, phototherapy and photochemotherapy are effective therapeutic options with excellent safety profiles and well-documented side effects. Despite their ease of administration and benefits, phototherapeutic treatment modalities require appropriate space for the equipment, trained staff, and patient education prior to initiating treatment. However, when the initial barriers to treatment can be overcome, UV therapy can offer patients significant relief from their cutaneous disease. Furthermore, UVB-based phototherapy can produce significant alteration to vitamin D levels. With the recent research implicating association of low vitamin D levels with a variety of health conditions, whether patients receiving phototherapy or, more specifically, those getting vitamin D supplement may be protected from these diseases remains to be established.
Collapse
Affiliation(s)
- Robert J Sage
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan 48202, USA
| | | |
Collapse
|
20
|
Abstract
BACKGROUND Acitretin is an oral retinoid that is approved for the treatment of psoriasis. It is unique compared to other systemic therapies for psoriasis such as methotrexate and cyclosporine in that it is not immunosuppressive. It is, therefore, safe for use in psoriasis patients with a history of chronic infection such as HIV, hepatitis B, hepatitis C or malignancy who have a contraindication to systemic immunosuppressive therapy and require systemic therapy because topical therapy is inadequate and they are unable to commit to phototherapy. Acitretin is one of the treatments of choice for pustular psoriasis. Even though acitretin is less effective as a monotherapy for chronic plaque psoriasis, combination therapy with other agents, especially UVB or psoralen plus UVA phototherapy, can enhance efficacy. OBJECTIVE To provide an updated review of the safety and efficacy of acitretin in the treatment for psoriasis. METHODS Literature review of journal articles from 2008 to 2009 since the last review of acitretin evaluated medical literature from 2005 to 2008. RESULTS/CONCLUSION Acitretin is an effective systemic therapy for psoriasis and is generally well tolerated at low doses for long-term use. If monotherapy with acitretin is inadequate, it can be used in combination with other treatments, particularly UVB phototherapy, to increase efficacy.
Collapse
Affiliation(s)
- Chai Sue Lee
- University of California Davis Medical Center, Department of Dermatology, Sacramento, 95816, USA.
| | | |
Collapse
|
21
|
Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb A, Koo JY, Lebwohl M, Lim HW, Van Voorhees AS, Beutner KR, Bhushan R. Guidelines of care for the management of psoriasis and psoriatic arthritis. J Am Acad Dermatol 2010; 62:114-135. [DOI: 10.1016/j.jaad.2009.08.026] [Citation(s) in RCA: 245] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 08/07/2009] [Accepted: 08/12/2009] [Indexed: 11/26/2022]
|
22
|
Sivanesan SP, Gattu S, Hong J, Chavez-Frazier A, Bandow GD, Malick F, Kricorian G, Koo J. Randomized, double-blind, placebo-controlled evaluation of the efficacy of oral psoralen plus ultraviolet A for the treatment of plaque-type psoriasis using the Psoriasis Area Severity Index score (improvement of 75% or greater) at 12 weeks. J Am Acad Dermatol 2009; 61:793-8. [PMID: 19766350 DOI: 10.1016/j.jaad.2009.04.053] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 04/16/2009] [Accepted: 04/22/2009] [Indexed: 11/17/2022]
Affiliation(s)
- S Priya Sivanesan
- Department of Dermatology, Pittsburgh University, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Ho SGY, Chan HHL. The Asian dermatologic patient: review of common pigmentary disorders and cutaneous diseases. Am J Clin Dermatol 2009; 10:153-68. [PMID: 19354330 DOI: 10.2165/00128071-200910030-00002] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The Asian patient with Fitzpatrick skin types III-V is rarely highlighted in publications on cutaneous disorders or cutaneous laser surgery. However, with changing demographics, Asians will become an increasingly important group in this context. Although high melanin content confers better photoprotection, photodamage in the form of pigmentary disorders is common. Melasma, freckles, and lentigines are the epidermal disorders commonly seen, whilst nevus of Ota and acquired bilateral nevus of Ota-like macules are common dermal pigmentary disorders. Post-inflammatory hyperpigmentation (PIH) occurring after cutaneous injury remains a hallmark of skin of color. With increasing use of lasers and light sources in Asians, prevention and management of PIH is of great research interest. Bleaching agents, chemical peels, intense pulsed light (IPL) treatments, and fractional skin resurfacing have all been used with some success for the management of melasma. Q-switched (QS) lasers are effective for the management of epidermal pigmentation but are associated with a high risk of PIH. Long-pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers and IPL sources pose less of a PIH risk but require a greater number of treatment sessions. Dermal pigmentary disorders are better targeted by QS ruby, QS alexandrite, and QS 1064-nm Nd:YAG lasers, but hyper- and hypopigmentation may occur. Non-ablative skin rejuvenation using a combination approach with different lasers and light sources in conjunction with cooling devices allows different skin chromophores to be targeted and optimal results to be achieved, even in skin of color. Deep-tissue heating using radiofrequency and infra-red light sources affects the deep dermis and achieves enhanced skin tightening, resulting in eyebrow elevation, rhytide reduction, and contouring of the lower face and jawline. For management of severe degrees of photoaging, fractional resurfacing is useful for wrinkle and pigment reduction, as well as acne scarring. Acne, which is common in Asians, can be treated with topical and oral antibacterials, hormonal treatments, and isotretinoin. Infra-red diode lasers used with a low-fluence, multiple-pass approach have also been shown to be effective with few complications. Fractional skin resurfacing is very useful for improving the appearance of acne scarring. Hypertrophic and keloid scarring, another common condition seen in Asians, can be treated with the combined used of intralesional triamcinolone and fluorouracil, followed by pulsed-dye laser. Esthetic enhancement procedures such as botulinum toxin type A and fillers are becoming increasingly popular. These are effective for rhytide improvement and facial or body contouring. We highlight the differences between Asian skin and other skin types and review conditions common in skin of color together with treatment strategies.
Collapse
Affiliation(s)
- Stephanie G Y Ho
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | | |
Collapse
|
24
|
Pang ML, Murase JE, Koo J. An updated review of acitretin--a systemic retinoid for the treatment of psoriasis. Expert Opin Drug Metab Toxicol 2008; 4:953-64. [PMID: 18624682 DOI: 10.1517/17425255.4.7.953] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Acitretin is a systemic retinoid used for psoriasis. It normalizes cellular differentiation and maturation and is also used as a chemopreventive agent against cutaneous malignancies. However, it is not used frequently because of its side-effect profile. OBJECTIVE Safety and efficacy of acitretin was evaluated as monotherapy, as well as in combination with other systemic agents. METHODS Medical literature from 2005 to 2008 was reviewed. The most scientifically rigorous clinical trials were selected for Psoriasis Area and Severity Index. Articles were limited to case reports or clinical trials, human subjects and English language journals. RESULTS/CONCLUSION Acitretin is effective as monotherapy for pustular and erythrodermic psoriasis and for plaque psoriasis (with other systemic agents). Side effects of acitretin use occur more commonly with high doses. Hence, acitretin is safe and effective for psoriasis.
Collapse
Affiliation(s)
- Mei-Lin Pang
- University of California, San Francisco, Department of Dermatology, San Francisco, CA, USA.
| | | | | |
Collapse
|
25
|
Abstract
BACKGROUND Little data exist about the efficacy of phototherapy in childhood dermatoses. OBJECTIVE To report our experience with pediatric patients treated with phototherapy. METHODS The study included children <or=17 years of age, who were treated in our phototherapy unit between 1985 and 2005. Data were retrospectively collected. RESULTS The study included 113 patients (50 boys, 63 girls) with a median of age of 13 years (range: 3-17 yrs). Narrow-band ultraviolet-B (34.6%), and ultraviolet-B (33.1%) were the most common treatments administered to the patients. Indications for phototherapy were psoriasis in 53.5%, vitiligo in 20.5%, pityriasis lichenoides in 14.2%, alopecia areata in 7.9%. Response was achieved in 92.9% of the psoriasis patients treated with narrow-band ultraviolet-B, in 83.3% treated with psoralen plus ultraviolet-A, and in 93.3% with ultraviolet-B. All the pityriasis lichenoides chronica patients who received narrow-band ultraviolet-B responded to the treatment and seven of nine treated with ultraviolet-B had a response. Response was achieved in 57% of the vitiligo patients treated with psoralen plus ultraviolet-A and in 50% of vitiligo patients treated with narrow-band ultraviolet-B. Of the 10 alopecia areata patients, two responded to psoralen plus ultraviolet-A. Among all the patients, erythema was the most common adverse effect. CONCLUSION Phototherapy is a well-tolerated treatment for childhood dermatoses, and is especially efficacious in psoriasis and pityriasis lichenoides chronica patients.
Collapse
Affiliation(s)
- Sibel Ersoy-Evans
- Department of Dermatology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | | | | | | |
Collapse
|