1
|
Sandoval AGW, Mahajan A, Buzney E. Phototherapy for Psoriasis in the Age of Biologics. Dermatol Clin 2024; 42:399-404. [PMID: 38796271 DOI: 10.1016/j.det.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Abstract
Phototherapy has utility as a psoriatic therapy, given its relatively high clinical efficacy, low side effect profile, and lower cost compared to newer effective treatments like biologics and small molecules. Phototherapy has shown Psoriasis Area and Severity Index (PASI)-75 and PASI-90 rates comparable to those of biologics and small molecules, with similarly rapid onsets of action, rates of remission, and quality of life scores. Certain patients may particularly benefit from phototherapy, such as those with localized disease or contraindications to systemic immunomodulatory medication. Phototherapy can be more cost-effective than biologics and conveniently administered at home, making it a valuable therapeutic option for the right patient.
Collapse
Affiliation(s)
| | - Arjun Mahajan
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Elizabeth Buzney
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA.
| |
Collapse
|
2
|
Hernández-Bule ML, Naharro-Rodríguez J, Bacci S, Fernández-Guarino M. Unlocking the Power of Light on the Skin: A Comprehensive Review on Photobiomodulation. Int J Mol Sci 2024; 25:4483. [PMID: 38674067 PMCID: PMC11049838 DOI: 10.3390/ijms25084483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Photobiomodulation (PBM) is a procedure that uses light to modulate cellular functions and biological processes. Over the past decades, PBM has gained considerable attention for its potential in various medical applications due to its non-invasive nature and minimal side effects. We conducted a narrative review including articles about photobiomodulation, LED light therapy or low-level laser therapy and their applications on dermatology published over the last 6 years, encompassing research studies, clinical trials, and technological developments. This review highlights the mechanisms of action underlying PBM, including the interaction with cellular chromophores and the activation of intracellular signaling pathways. The evidence from clinical trials and experimental studies to evaluate the efficacy of PBM in clinical practice is summarized with a special emphasis on dermatology. Furthermore, advancements in PBM technology, such as novel light sources and treatment protocols, are discussed in the context of optimizing therapeutic outcomes and improving patient care. This narrative review underscores the promising role of PBM as a non-invasive therapeutic approach with broad clinical applicability. Despite the need for further research to develop standard protocols, PBM holds great potential for addressing a wide range of medical conditions and enhancing patient outcomes in modern healthcare practice.
Collapse
Affiliation(s)
| | | | - Stefano Bacci
- Research Unit of Histology and Embriology, Department of Biology, University of Florence, 50139 Florence, Italy;
| | | |
Collapse
|
3
|
Slominski RM, Chen JY, Raman C, Slominski AT. Photo-neuro-immuno-endocrinology: How the ultraviolet radiation regulates the body, brain, and immune system. Proc Natl Acad Sci U S A 2024; 121:e2308374121. [PMID: 38489380 PMCID: PMC10998607 DOI: 10.1073/pnas.2308374121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
Ultraviolet radiation (UVR) is primarily recognized for its detrimental effects such as cancerogenesis, skin aging, eye damage, and autoimmune disorders. With exception of ultraviolet B (UVB) requirement in the production of vitamin D3, the positive role of UVR in modulation of homeostasis is underappreciated. Skin exposure to UVR triggers local responses secondary to the induction of chemical, hormonal, immune, and neural signals that are defined by the chromophores and extent of UVR penetration into skin compartments. These responses are not random and are coordinated by the cutaneous neuro-immuno-endocrine system, which counteracts the action of external stressors and accommodates local homeostasis to the changing environment. The UVR induces electrical, chemical, and biological signals to be sent to the brain, endocrine and immune systems, as well as other central organs, which in concert regulate body homeostasis. To achieve its central homeostatic goal, the UVR-induced signals are precisely computed locally with transmission through nerves or humoral signals release into the circulation to activate and/or modulate coordinating central centers or organs. Such modulatory effects will be dependent on UVA and UVB wavelengths. This leads to immunosuppression, the activation of brain and endocrine coordinating centers, and the modification of different organ functions. Therefore, it is imperative to understand the underlying mechanisms of UVR electromagnetic energy penetration deep into the body, with its impact on the brain and internal organs. Photo-neuro-immuno-endocrinology can offer novel therapeutic approaches in addiction and mood disorders; autoimmune, neurodegenerative, and chronic pain-generating disorders; or pathologies involving endocrine, cardiovascular, gastrointestinal, or reproductive systems.
Collapse
Affiliation(s)
- Radomir M. Slominski
- Departments of Genetics, the University of Alabama at Birmingham, Birmingham, AL35294
| | - Jake Y. Chen
- Department of Biomedical Informatics and Data Science, the University of Alabama at Birmingham, Birmingham, AL35294
- Comprehensive Cancer Center, Cancer Chemoprevention Program, University of Alabama at Birmingham, Birmingham, AL35294
| | - Chander Raman
- Department of Dermatology, the University of Alabama at Birmingham, Birmingham, AL35294
| | - Andrzej T. Slominski
- Comprehensive Cancer Center, Cancer Chemoprevention Program, University of Alabama at Birmingham, Birmingham, AL35294
- Department of Dermatology, the University of Alabama at Birmingham, Birmingham, AL35294
- Veteran Administration Medical Center, Birmingham, AL35294
| |
Collapse
|
4
|
Sarda A, Vaidyanathan V, Das S, De A. Laser and Lights in Psoriasis. Indian J Dermatol 2024; 69:159-164. [PMID: 38841222 PMCID: PMC11149792 DOI: 10.4103/ijd.ijd_423_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Psoriasis is a chronic inflammatory skin condition affecting millions of individuals worldwide. Over the years, various treatment modalities have been explored to alleviate the symptoms and improve the quality of life for patients with psoriasis. Among these treatment options, lasers and lights have emerged as promising non-invasive approaches with significant efficacy. This review aims to provide an overview of the current understanding and clinical applications of lasers and lights in the management of psoriasis. We have discussed the mechanisms of action behind different laser and light therapies and their impact on psoriatic plaques. Additionally, we discuss the various types of lasers and lights utilized, including excimer lasers, pulsed dye lasers, and narrowband ultraviolet B (NB-UVB) phototherapy, highlighting their unique properties and clinical outcomes. Moreover, we have addressed important considerations related to patient selection, treatment protocols, and potential side effects associated with lasers and lights. We emphasize the need for proper evaluation, monitoring, and customization of treatment plans to ensure optimal outcomes and minimize adverse events.
Collapse
Affiliation(s)
- Aarti Sarda
- From the Consultant Dermatologist, Wizderm Speciality Skin and Hair Clinic, New Delhi, India
| | | | - Sudip Das
- Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Abhishek De
- Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| |
Collapse
|
5
|
Semele R, Grewal S, Jeengar MK, Singh TG, Swami R. From Traditional Medicine to Advanced Therapeutics: The Renaissance of Phyto-nano Interventions in Psoriasis. RECENT ADVANCES IN INFLAMMATION & ALLERGY DRUG DISCOVERY 2024; 18:27-42. [PMID: 37921124 DOI: 10.2174/0127722708265612231012080047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/26/2023] [Accepted: 08/11/2023] [Indexed: 11/04/2023]
Abstract
Psoriasis is an autoimmune systemic chronic inflammatory disease that exhibits characteristic detrimental effects on the skin, often leading to infections or comorbid conditions. The multifaceted nature of psoriasis has made it very challenging to treat, especially with current chemotherapy options. Therefore, it is essential to consider phytoconstituents as novel alternatives. However, despite demonstrating higher anti-inflammatory, anti-psoriasis, and immunomodulatory potential, their clinical usage is hindered due to their poor physicochemical properties. To address these drawbacks, nanoparticulate drug delivery systems have been developed, helping to achieve better permeation of phytoconstituents through topical administration. This has breathed new life into traditional systems of medicine, particularly in the context of treating psoriasis. In this current review, we present a detailed, comprehensive, and up-to-date analysis of the literature, which will contribute to affirming the clinical role of phyto-nano interventions against psoriasis.
Collapse
Affiliation(s)
- Rajneesh Semele
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Sonam Grewal
- Maharishi Markandeshwar College of Pharmacy, MMDU, Mullana, Haryana, India
| | - Manish Kumar Jeengar
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India
| | | | - Rajan Swami
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| |
Collapse
|
6
|
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.
Collapse
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
| | | | | |
Collapse
|
7
|
Guo J, Zhang H, Lin W, Lu L, Su J, Chen X. Signaling pathways and targeted therapies for psoriasis. Signal Transduct Target Ther 2023; 8:437. [PMID: 38008779 PMCID: PMC10679229 DOI: 10.1038/s41392-023-01655-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/10/2023] [Accepted: 09/14/2023] [Indexed: 11/28/2023] Open
Abstract
Psoriasis is a common, chronic, and inflammatory skin disease with a high burden on individuals, health systems, and society worldwide. With the immunological pathologies and pathogenesis of psoriasis becoming gradually revealed, the therapeutic approaches for this disease have gained revolutionary progress. Nevertheless, the mechanisms of less common forms of psoriasis remain elusive. Furthermore, severe adverse effects and the recurrence of disease upon treatment cessation should be noted and addressed during the treatment, which, however, has been rarely explored with the integration of preliminary findings. Therefore, it is crucial to have a comprehensive understanding of the mechanisms behind psoriasis pathogenesis, which might offer new insights for research and lead to more substantive progress in therapeutic approaches and expand clinical options for psoriasis treatment. In this review, we looked to briefly introduce the epidemiology, clinical subtypes, pathophysiology, and comorbidities of psoriasis and systematically discuss the signaling pathways involving extracellular cytokines and intracellular transmission, as well as the cross-talk between them. In the discussion, we also paid more attention to the potential metabolic and epigenetic mechanisms of psoriasis and the molecular mechanistic cascades related to its comorbidities. This review also outlined current treatment for psoriasis, especially targeted therapies and novel therapeutic strategies, as well as the potential mechanism of disease recurrence.
Collapse
Affiliation(s)
- Jia Guo
- Department of Dermatology, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, 410008, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, 410008, Hunan, China
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, 410008, Hunan, China
| | - Hanyi Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, 410008, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, 410008, Hunan, China
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, 410008, Hunan, China
| | - Wenrui Lin
- Department of Dermatology, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, 410008, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, 410008, Hunan, China
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, 410008, Hunan, China
| | - Lixia Lu
- Department of Dermatology, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, 410008, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, 410008, Hunan, China
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, 410008, Hunan, China
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China.
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, 410008, Hunan, China.
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, 410008, Hunan, China.
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, 410008, Hunan, China.
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China.
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, 410008, Hunan, China.
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Changsha, 410008, Hunan, China.
- Hunan Engineering Research Center of Skin Health and Disease, Changsha, 410008, Hunan, China.
| |
Collapse
|
8
|
Li Y, Cao Z, Guo J, Li Q, Zhu W, Kuang Y, Chen X. Assessment of efficacy and safety of UV-based therapy for psoriasis: a network meta-analysis of randomized controlled trials. Ann Med 2022; 54:159-169. [PMID: 34989291 PMCID: PMC8741237 DOI: 10.1080/07853890.2021.2022187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Previous studies have proven that ultraviolet (UV)-based phototherapy, including UVB or psoralen UVA (PUVA), and their combination therapies, is effective for psoriasis treatment. OBJECTIVE To compare the clinical efficacy and adverse events (AEs) of different UV-based phototherapy in psoriasis. METHODS PubMed, Cochrane Library, Scopus and Embase were systematically searched. A random-effect model network meta-analysis with frequentist framework was performed, and results were reported as risk ratios (RRs) with 95% CI. The main variable for assessing effectiveness and safety are PASI 75 response and withdrawal due to AEs. Ranking effects were calculated by surface under the cumulative ranking analysis (SUCRA). RESULTS Thirty-two studies involving a total of 2120 psoriasis patients were included in this network meta-analysis. Overall, no significant difference was reported with respect to withdrawal due to AEs or incidence of erythema. The relatively safest strategy was combined adjuvant therapy with PUVA (cPUVA), especially PUVA combined with calcium/vitamin D derivatives (RR 0.98, 95% CI [0.30-3.17], SUCRA = 80.8%). Both cPUVA (RR 1.39, 95% CI [1.00- 1.94]) and combined adjuvant therapy with UVB (cUVB) (RR 1.27, 95% CI [1.03-1.57]) showed a superior effect than the monotherapy of UVA or UVB, respectively. PUVA combined with vitamin D and its derivatives (PAVD) ranked highest concerning clinical effect and safety (clusterank value = 7393.2). CONCLUSIONS The efficacy of all the combination therapy regimens was significantly superior to that of UV monotherapy, without significant differences in tolerability and safety. cUVB and cPUVA, and particularly the combination of UVA with calcium/vitamin D derivatives, was ranked as the overall safest and most effective phototherapy method.
Collapse
Affiliation(s)
- Yajia Li
- Department of Dermatology, Hunan Key Laboratory of Skin Cancer and Psoriasis; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
| | - Ziqin Cao
- Department of Spine Surgery, the Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jia Guo
- Department of Dermatology, Hunan Key Laboratory of Skin Cancer and Psoriasis; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
| | - Qiangxiang Li
- National Clinical Research Center for Geriatric Disorders of Xiangya hospital, Central South University (Sub-center of Ningxia), Yinchuan, Ningxia Hui Autonomous Region 750001, China.,Ningxia Geriatric Disease Clinical Research Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia Hui Autonomous Region 750001, China.,Hunan People's Hospital, Geriatrics Institute of Hunan Province, Changsha, China, Changsha 410002, China
| | - Wu Zhu
- Department of Dermatology, Hunan Key Laboratory of Skin Cancer and Psoriasis; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yehong Kuang
- Department of Dermatology, Hunan Key Laboratory of Skin Cancer and Psoriasis; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Chen
- Department of Dermatology, Hunan Key Laboratory of Skin Cancer and Psoriasis; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
9
|
Lei L, Jiang L, Hu Y, Chen M, Huang J, Chen J, Zeng Q. The comprehensive assessment of epigenetics changes during skin development. FUNDAMENTAL RESEARCH 2022. [DOI: 10.1016/j.fmre.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
10
|
Repurposing approved therapeutics for new indication: Addressing unmet needs in psoriasis treatment. CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2021; 2:100041. [PMID: 34909670 PMCID: PMC8663928 DOI: 10.1016/j.crphar.2021.100041] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/04/2021] [Accepted: 06/04/2021] [Indexed: 02/06/2023] Open
Abstract
Psoriasis is a chronic inflammatory autoimmune condition manifested by the hyperproliferation of keratinocytes with buildup of inflammatory red patches and scales on skin surfaces. The available treatment options for the management of psoriasis have various drawbacks, and the clinical need for effective therapeutics for this disease remain unmet; therefore, the approaches of drug repurposing or drug repositioning could potentially be used for treating indications of psoriasis. The undiscovered potential of drug repurposing or repositioning compensates for the limitations and hurdles in drug discovery and drug development processes. Drugs initially approved for other indications, including anticancer, antidiabetic, antihypertensive, and anti-arthritic activities, are being investigated for their potential in psoriasis management as a new therapeutic indication by using repurposing strategies. This article envisages the potential of various therapeutics for the management of psoriasis. Psoriasis is an autoimmune inflammatory skin disorder with complex physiology. Conventional treatments for psoriasis cause severe adverse effects; therefore an unmet need remains for safer and more effective therapies for psoriasis. Various drugs that effectively decrease the inflammation and proliferation of skin cells can be repurposed for the management of psoriasis. Repurposed drugs provide various incentives to the pharmaceutical industry.
Collapse
|
11
|
Myers E, Kheradmand S, Miller R. An Update on Narrowband Ultraviolet B Therapy for the Treatment of Skin Diseases. Cureus 2021; 13:e19182. [PMID: 34873522 PMCID: PMC8634827 DOI: 10.7759/cureus.19182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 12/25/2022] Open
Abstract
The objective of this review is to provide an update on narrowband ultraviolet B (NB-UVB) as a treatment for various skin conditions. NB-UVB works by suppressing the cutaneous cell-mediated immune response and has been shown to be an efficacious and clinically tolerable treatment for a range of inflammatory dermatoses. A literature search was conducted by advanced searches of PubMed for NB-UVB treatment of dermatologic skin diseases with a focus on reports from 2010 to 2021, including both office-based and home-based phototherapy (HBPT). Data were prioritized based on studies with a high level of evidence using the Oxford Evidence-Based Medicine guidance. We found that NB-UVB continues to serve as an effective form of therapy for several cutaneous conditions, including vitiligo, psoriasis, atopic dermatitis, mycosis fungoides, and other inflammatory dermatoses. The recent introduction of Janus kinase inhibitors in combination with NB-UVB suggests future promise in the treatment of vitiligo. Despite its rise in popularity, a decline was seen in office-based NB-UVB treatment during the coronavirus disease 2019 pandemic. Options are available to deliver NB-UVB at home with comparable efficacy to office-based treatments. In conclusion, for a select group of patients and conditions, NB-UVB continues to serve as an effective treatment modality with minimal side effects, with HBPT serving as an option to improve patient compliance.
Collapse
Affiliation(s)
- Elisha Myers
- Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Shiva Kheradmand
- Dermatology, Hospital Corporation of America/University of South Florida Morsani College of Medicine: Largo Medical Center, Largo, USA
| | - Richard Miller
- Dermatology, Hospital Corporation of America/University of South Florida Morsani College of Medicine: Largo Medical Center, Largo, USA
| |
Collapse
|
12
|
Banerjee S, Das S, Roy AK, Ghoshal L. Comparative Effectiveness and Safety of Methotrexate Versus PUVA in Severe Chronic Stable Plaque Psoriasis. Indian J Dermatol 2021; 66:371-377. [PMID: 34759395 PMCID: PMC8530075 DOI: 10.4103/ijd.ijd_492_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Psoriasis is a chronic, inflammatory, immune-mediated, debilitating skin disease affecting approximately 2%–3% of the global population. Various treatment modalities are available for extensive psoriasis which include methotrexate, cyclosporine, retinoids, oral PUVA therapy, and biologic agents. Aims and Objectives: The aim of this study was to compare the effectiveness and safety of methotrexate vs. PUVA in severe chronic plaque psoriasis with BSA >20%. Materials and Methods: A randomized open-label clinical study was performed. Sixty patients with extensive stable plaque psoriasis were recruited in the study. Thirty patients received methotrexate at a dose of 0.4 mg/kg up to a maximum of 15 mg/week and the rest 30 were treated by PUVA, 8-methoxy psoralen tablet (20 mg) followed by UVA started at the dose of 1 j/cm2 thrice weekly with an increment of 20% dose every third sitting until 2.5 j/cm2 is reached. Both forms of treatment were continued for 10 weeks or until PASI 90 achieved, which-ever was earlier. Clinical examination, blood investigation, PASI scoring, and photograph were repeated in serial intervals during the study. At the end of study, the data were compiled, tabulated, and analyzed. Result: In the PUVA group, 90% achieved PASI-50 and 63.33% achieved PASI-90, in the methotrexate group all patients achieved both PASI-50 and PASI-90. Methotrexate acted significantly faster than PUVA in disease clearance. In the methotrexate group decreased platelet count in 13.33% patients, decreased hemoglobin (<10 gm/dl), elevated liver enzyme, each of these developed in 10% of patients. In the PUVA group, no serious side effects were observed. Conclusions: Methotrexate is more efficacious with lesser incidence of subjective complications and more incidence of laboratory complications compared to PUVA in extensive plaque psoriasis.
Collapse
Affiliation(s)
- Saikat Banerjee
- Department of Dermatology, Venereology and Leprosy, NRS Medical College, Kolkata, India
| | - Suchibrata Das
- Department of Dermatology, Venereology and Leprosy, NRS Medical College, Kolkata, India
| | - Alok K Roy
- Department of Dermatology, Venereology and Leprosy, NRS Medical College, Kolkata, India
| | - Loknath Ghoshal
- Associate Professor and Head of the Department, Department of Dermatology, Malda Medical College and Hospital, Malda, West Bengal, India
| |
Collapse
|
13
|
Kamimura S, Kitamura Y, Fujii T, Okamoto K, Sanada N, Okajima N, Wakugawa T, Fukui H, Mizuguchi H, Takeda N. Effects of narrow-band UVB on nasal symptom and upregulation of histamine H 1 receptor mRNA in allergic rhinitis model rats. Laryngoscope Investig Otolaryngol 2021; 6:34-41. [PMID: 33614927 PMCID: PMC7883611 DOI: 10.1002/lio2.518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/14/2020] [Accepted: 12/26/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Phototherapy with narrow-band ultraviolet B (narrow-band UVB) is clinically effective treatment for atopic dermatitis. In the present study, we examined the effects of intranasal irradiation with narrow-band UVB on nasal symptom, upregulation of histamine H1 receptor (H1R) gene expression and induction of DNA damage in the nasal mucosa of allergic rhinitis (AR) model rat. METHODS AR model rats were intranasally irradiated with 310 nm of narrow-band UVB. Nasal mucosal levels of H1R mRNA were measured using real-time quantitative reverse transcriptase (RT)-PCR. DNA damage was evaluated using cyclobutane pyrimidine dimer (CPD) immunostaining. RESULTS In toluene 2,4-diisocyanate (TDI)-sensitized rats, TDI provoked sneezes and H1R gene expression in the nasal mucosa. Intranasal pre-irradiation with 310 nm narrow-band UVB at doses of 600 and 1400, but not 200 mJ/cm2 significantly inhibited the number of sneezes and upregulation of H1R gene expression provoked by TDI. CPD-positive cells appeared in the nasal mucosa after intranasal narrow-band UVB irradiation at a dose of 1400, but not 200 and 600 mJ/cm2. The suppression of TDI-provoked sneezes and upregulation of H1R gene expression lasted 24 hours, but not 48 hours, after narrow-band UVB irradiation with a dose of 600 mJ/cm2. CONCLUSIONS Intranasal pre-irradiation with narrow-band UVB dose-dependently inhibited sneezes and upregulation of H1R gene expression of the nasal mucosa in AR model rats, suggesting that the inhibition of nasal upregulation of H1R gene expression suppressed nasal symptom. The suppression after narrow-band UVB irradiation at a dose of 600 mJ/cm2 was reversible without induction of DNA damage. These findings indicated that low-dose narrow-band UVB phototherapy could be effectively and safely used for AR treatment in a clinical setting. LEVEL OF EVIDENCE NA.
Collapse
Affiliation(s)
- Seiichiro Kamimura
- Department of OtolaryngologyInstitute of Biomedical Sciences, Tokushima University Graduate SchoolTokushimaJapan
| | - Yoshiaki Kitamura
- Department of OtolaryngologyInstitute of Biomedical Sciences, Tokushima University Graduate SchoolTokushimaJapan
| | - Tatsuya Fujii
- Department of OtolaryngologyInstitute of Biomedical Sciences, Tokushima University Graduate SchoolTokushimaJapan
| | - Kentaro Okamoto
- Department of Molecular PharmacologyInstitute of Biomedical Sciences, Tokushima University Graduate SchoolTokushimaJapan
| | - Nanae Sanada
- Department of Molecular PharmacologyInstitute of Biomedical Sciences, Tokushima University Graduate SchoolTokushimaJapan
| | - Natsuki Okajima
- Department of Molecular PharmacologyInstitute of Biomedical Sciences, Tokushima University Graduate SchoolTokushimaJapan
| | - Tomoharu Wakugawa
- Department of Molecular PharmacologyInstitute of Biomedical Sciences, Tokushima University Graduate SchoolTokushimaJapan
| | - Hiroyuki Fukui
- Department of OtolaryngologyInstitute of Biomedical Sciences, Tokushima University Graduate SchoolTokushimaJapan
| | - Hiroyuki Mizuguchi
- Laboratory of Pharmacology, Faculty of PharmacyOsaka Ohtani UniversityOsakaJapan
| | - Noriaki Takeda
- Department of OtolaryngologyInstitute of Biomedical Sciences, Tokushima University Graduate SchoolTokushimaJapan
| |
Collapse
|
14
|
Gnaneshwar Rao A, Jagadevapuram K. Comparative study of PUVA and NB-UVB in the management of chronic plaque psoriasis. INDIAN JOURNAL OF DRUGS IN DERMATOLOGY 2021. [DOI: 10.4103/ijdd.ijdd_26_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
15
|
Hartman CJ, Mester JC, Hare PM, Cohen AI. Novel inactivation of the causative fungal pathogen of white-nose syndrome with methoxsalen plus ultraviolet A or B radiation. PLoS One 2020; 15:e0239001. [PMID: 32915896 PMCID: PMC7485863 DOI: 10.1371/journal.pone.0239001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/27/2020] [Indexed: 12/03/2022] Open
Abstract
White-nose syndrome is a fungal disease responsible for the rapid decline of North American bat populations. This study addressed a novel method for inactivating Pseudogymnoascus destructans, the causative agent of WNS, using ultraviolet A (UVA) or B (UVB) radiation in combination with methoxsalen, a photosensitizer from the furanocoumarin family of compounds. Fungal spore suspensions were diluted in micromolar concentrations of methoxsalen (50–500 μM), then exposed to fixed doses of UVA radiation (500–5000 mJ/cm2), followed by plating on germination media. These plates were examined for two to four weeks for evidence of spore germination or inactivation, along with resultant growth or inhibition of P. destructans colonies. Pretreatment of fungal spores with low doses of methoxsalen resulted in a UVA dose-dependent inactivation of the P. destructans spores. All doses of methoxsalen paired with 500 mJ/cm2 of UVA led to an approximate two-log10 (~99%) reduction in spore viability, and when paired with 1000 mJ/cm2, a four-log10 or greater (>99.99%) reduction in spore viability was observed. Additionally, actively growing P. destructans colonies treated directly with methoxsalen and either UVA or UVB radiation demonstrated UV dose-dependent inhibition and termination of colony growth. This novel approach of using a photosensitizer in combination with UV radiation to control fungal growth may have broad, practical application in the future.
Collapse
Affiliation(s)
- Colin J. Hartman
- Department of Biological Sciences, Northern Kentucky University, Highland Heights, Kentucky, United States of America
| | - Joseph C. Mester
- Department of Biological Sciences, Northern Kentucky University, Highland Heights, Kentucky, United States of America
- * E-mail:
| | - Patrick M. Hare
- Department of Chemistry and Biochemistry, Northern Kentucky University, Highland Heights, Kentucky, United States of America
| | - Alan I. Cohen
- Department of Biological Sciences, Northern Kentucky University, Highland Heights, Kentucky, United States of America
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Ostrowska K. Coumarin-piperazine derivatives as biologically active compounds. Saudi Pharm J 2020; 28:220-232. [PMID: 32042262 PMCID: PMC7000312 DOI: 10.1016/j.jsps.2019.11.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/29/2019] [Indexed: 11/06/2022] Open
Abstract
A number of psychiatric disorders, including anxiety, schizophrenia, Parkinson's disease, depression and others CNS diseases are known to induce defects in the function of neural pathways sustained by the neurotransmitters, like dopamine and serotonin. N-arylpiperazine moiety is important for CNS-activity, particularly for serotonergic and dopaminergic activity. In the scientific literature there are many examples of coumarin-piperazine derivatives, particularly with arylpiperazines linked to a coumarin system via an alkyl liner, which can modulate serotonin, dopamine and adrenergic receptors. Numerous studies have revealed that the inclusion of a piperazine moiety could occasionally provide unexpected improvements in the bioactivity of various biologically active compounds. The piperazine analogs have been shown to have a potent antimicrobial activity and they can also act as BACE-1 inhibitors. On the other hand, arylpiperazines linked to coumarin derivatives have been shown to have antiproliferative activity against leukemia, lung, colon, breast, and prostate tumors. Recently, it has been reported that coumarin-piperazine derivatives exhibit a Fneuroprotective effect by their antioxidant and anti-inflammatory activities and they also show activity as acetylcholinesterase inhibitors and antifilarial activity. In this work we provide a summary of the latest advances in coumarin-related chemistry relevant for biological activity.
Collapse
|
18
|
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]
|
19
|
Khater MH, AbdallaAlhabib S, Elkshishy KA, Khattab FM. Evaluation of Galectin3 levels in psoriatic patients treated by narrow-band UVB phototherapy. J DERMATOL TREAT 2019; 31:758-762. [DOI: 10.1080/09546634.2019.1670778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Mohamed H. Khater
- Assistant Professor of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Kamal A. Elkshishy
- Professor of Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Fathia M. Khattab
- Assistant Professor of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
20
|
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
|
21
|
Abu El-Hamd M, Adam El Taieb M, Mahmoud AA, Mahmoud Samy O. Serum YKL-40 in patients with psoriasis vulgaris treated by narrow-band UVB phototherapy. J DERMATOL TREAT 2018; 30:545-548. [DOI: 10.1080/09546634.2018.1543848] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Mohammed Abu El-Hamd
- Department of Dermatology, Venereology and Andrology, Sohag University, Sohag, Egypt
| | | | | | - Ola Mahmoud Samy
- Department of Dermatology, Venereology and Andrology, Aswan University, Aswan, Egypt
| |
Collapse
|
22
|
Hum M, Kalia S, Gniadecki R. Prescribing Home Narrowband UVB Phototherapy: A Review of Current Approaches. J Cutan Med Surg 2018; 23:91-96. [PMID: 30221998 DOI: 10.1177/1203475418800947] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Conventional, full-body phototherapy equipment is costly and therefore patients are usually treated in dermatology centres. Such office-based therapy is often not feasible for those patients who live far away from a phototherapy centre due to lost time and wages, inability to travel because of extensive skin disease, or prohibitive travel costs. Home phototherapy has emerged as a modality that meets the needs of those patients. Our aim was to review available studies on UV sources, treatment protocols, efficacy, and safety of home phototherapy. A literature review was conducted on PubMed using the terms "home" AND "phototherapy" AND ("guide" OR "approach" OR "review" OR "protocol"). From the data extracted, narrowband UVB (311 nm) offers the best balance between safety and efficacy and is recommended for home phototherapy by most authors. Treatment is safe and possible adverse effects are related to overexposure (erythema, blistering). The usual treatment protocol was administering treatments on alternating days, including weekends, with dosing based on the patient's Fitzpatrick skin type. We also provide information on the available home phototherapy systems in Canada and their reimbursement. Home phototherapy is underused in Canada. Narrowband UVB phototherapy sources equipped with a 3-dimensional panel provides a practical and safe option.
Collapse
Affiliation(s)
- Matthew Hum
- 1 Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sunil Kalia
- 2 Photomedicine Institute, Vancouver Coastal Health and Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Robert Gniadecki
- 3 Division of Dermatology, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
23
|
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.
Collapse
Affiliation(s)
- Sally H. Ibbotson
- Photobiology Unit, Dermatology Department, Ninewells Hospital, University of Dundee School of Medicine, Dundee, United Kingdom
| |
Collapse
|
24
|
Breuer J, Loser K, Mykicki N, Wiendl H, Schwab N. Does the environment influence multiple sclerosis pathogenesis via UVB light and/or induction of vitamin D? J Neuroimmunol 2018; 329:1-8. [PMID: 29793727 DOI: 10.1016/j.jneuroim.2018.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 05/17/2018] [Indexed: 12/22/2022]
Abstract
Multiple sclerosis (MS) is a disease of presumed auto-immune origin. Long-standing observations such as the correlation between MS incidence and geographical latitude or the levels of Vitamin D (Vit D) in the serum have implicated the environmental factors UVB radiation and diet in the etiology of the disease. Clinical trials have been conducted and are currently underway to elucidate whether a Vit D enriched diet or treatment with UVB can influence MS incidence, -severity, and -progression, as well as the ideal time point for treatment. This review summarizes the current scientific knowledge to the environmental factors UVB-light and Vit D concerning the clinical aspects of MS in epidemiological studies and clinical trials.
Collapse
Affiliation(s)
- Johanna Breuer
- Department of Neurology, University of Münster, Münster, Germany
| | - Karin Loser
- Department of Dermatology, University of Münster, Münster, Germany
| | - Nadine Mykicki
- Department of Dermatology, University of Münster, Münster, Germany
| | - Heinz Wiendl
- Department of Neurology, University of Münster, Münster, Germany
| | - Nicholas Schwab
- Department of Neurology, University of Münster, Münster, Germany.
| |
Collapse
|
25
|
Xu F, Li Y, Ahmad J, Wang Y, Scott DE, Vostal JG. Vitamin K5 is an efficient photosensitizer for ultraviolet A light inactivation of bacteria. FEMS Microbiol Lett 2018; 365:4810545. [DOI: 10.1093/femsle/fny005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 01/12/2018] [Indexed: 12/12/2022] Open
|
26
|
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
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
Hart PH, Lucas RM, Booth DR, Carroll WM, Nolan D, Cole JM, Jones AP, Kermode AG. Narrowband UVB Phototherapy for Clinically Isolated Syndrome: A Trial to Deliver the Benefits of Vitamin D and Other UVB-Induced Molecules. Front Immunol 2017; 8:3. [PMID: 28167940 PMCID: PMC5256075 DOI: 10.3389/fimmu.2017.00003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/03/2017] [Indexed: 01/16/2023] Open
Abstract
Low vitamin D and insufficient sun exposure are additive independent risk factors for the development of multiple sclerosis (MS). The usual measure of vitamin D status, serum 25-hydroxy vitamin D [25(OH)D], is also a marker of recent exposure to the UVB rays of sunshine. The main evidence for a protective effect for MS development of higher 25(OH)D comes from observational studies, but this study design cannot separate out whether 25(OH)D is acting as a marker of vitamin D status, sun exposure, or both. In light of a lack of definitive outcomes in MS patients after trials of vitamin D supplementation and the ability of narrowband UVB to induce vitamin D, as well as other immune-regulatory molecules in skin, the Phototherapy for Clinically Isolated Syndrome (PhoCIS) trial was established to investigate the benefits of narrowband UVB, in addition to supplemented vitamin D, on MS development in individuals with Clinically Isolated Syndrome. We propose that the PhoCIS trial provides a fresh approach to re-defining the reported associations of 25(OH)D levels with MS development and progression.
Collapse
Affiliation(s)
- Prue H Hart
- Telethon Kids Institute, University of Western Australia , Perth, WA , Australia
| | - Robyn M Lucas
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia; National Centre for Epidemiology and Public Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - David R Booth
- The Westmead Institute for Medical Research, University of Sydney , Westmead, NSW , Australia
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, University of Western Australia, Sir Charles Gairdner Hospital , Perth, WA , Australia
| | - David Nolan
- Institute for Immunology and Infectious Disease, Murdoch University, Perth, WA, Australia; Royal Perth Hospital, Immunology Department, Perth, WA, Australia
| | - Judith M Cole
- St John of God Dermatology , Subiaco, WA , Australia
| | - Anderson P Jones
- Telethon Kids Institute, University of Western Australia , Perth, WA , Australia
| | - Allan G Kermode
- Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, University of Western Australia, Sir Charles Gairdner Hospital, Perth, WA, Australia; Institute for Immunology and Infectious Disease, Murdoch University, Perth, WA, Australia
| |
Collapse
|
29
|
Phototherapy of Psoriasis, a Chronic Inflammatory Skin Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 996:287-294. [PMID: 29124709 DOI: 10.1007/978-3-319-56017-5_24] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Phototherapy is an effective treatment modality for several skin diseases which has been in use from the era of the Egyptians. Insight into its mode of action has gradually accumulated over the past decades. A crucial biological effect of ultraviolet radiation is the induction of apoptosis in T lymphocytes and in keratinocytes in the epidermis. Via this mechanism inflammation-induced pathological changes characteristic of psoriasis are counteracted.Phototherapy remains the only therapeutic option for certain patient groups where modification of the systemic immune reactions is contraindicated, such as by HIV, internal malignancy or pregnancy. UVB treatment is highly cost-effective, which is important in this age of increasing health care costs.
Collapse
|
30
|
Kadakol A, Sharma N, Kulkarni YA, Gaikwad AB. Esculetin: A phytochemical endeavor fortifying effect against non-communicable diseases. Biomed Pharmacother 2016; 84:1442-1448. [DOI: 10.1016/j.biopha.2016.10.072] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/18/2016] [Accepted: 10/24/2016] [Indexed: 02/06/2023] Open
|
31
|
Tavolaro P, Martino G, Andò S, Tavolaro A. Zeolite scaffolds for cultures of human breast cancer cells. Part II: Effect of pure and hybrid zeolite membranes on neoplastic and metastatic activity control. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 68:474-481. [DOI: 10.1016/j.msec.2016.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 05/16/2016] [Accepted: 06/05/2016] [Indexed: 11/16/2022]
|
32
|
Zaher H, Bassiouny D, Abdel Hay R, Samir N, Ragab N, Sayed S. Dermoscopic and Immunohistochemical Changes in Acquired Melanocytic Nevi following Narrow-Band Ultraviolet B Therapy. Dermatology 2016; 232:273-8. [PMID: 27193800 DOI: 10.1159/000445780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 03/20/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acquired melanocytic nevi (AMN) have been reported to undergo morphological and dermoscopic changes following exposure to narrow-band ultraviolet B (NB-UVB) radiation. OBJECTIVE To study the morphological, dermoscopic and immunohistochemical changes in AMN following NB-UVB radiation. METHODS Suberythemogenic NB-UVB sessions were delivered to 40 patients with AMN. For each patient, a minimum of 2 nevi were selected. One nevus was surgically removed from each patient prior to sessions as control; for the other nevus, dermoscopic images were captured before and after NB-UVB sessions. The images were evaluated for changes. At the end, another nevus was surgically removed for immunohistochemical assessment of Ki-67 and melan-A. RESULTS Our study showed a statistically significant increase in the size of AMN following NB-UVB radiation. Benign dermoscopic changes were observed. Statistically significant positive correlations were found between some dermoscopic findings and the total cumulative dose of NB-UVB. Immunohistochemical analysis did not show any significant change in the exposed AMN. CONCLUSION AMN irradiated with repeated suberythemogenic doses of NB-UVB showed benign morphological and dermoscopic changes, and this was confirmed by our immunohistochemical study.
Collapse
Affiliation(s)
- Hesham Zaher
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | | | | | | |
Collapse
|
33
|
Sokolova A, Lee A, D Smith S. The Safety and Efficacy of Narrow Band Ultraviolet B Treatment in Dermatology: A Review. Am J Clin Dermatol 2015; 16:501-31. [PMID: 26369540 DOI: 10.1007/s40257-015-0151-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Narrow-band ultraviolet B (NBUVB) phototherapy is an important treatment modality in dermatology. The most common dermatological indications for NBUVB include psoriasis, atopic dermatitis and vitiligo; however, it has been found to be an effective and well-tolerated treatment option in various other dermatoses. The efficacy of NBUVB phototherapy compares favorably with other available photo(chemo)therapy options and its efficacy is further augmented by a number of topical and systemic adjuncts. The long-term safety of NBUVB phototherapy remains to be fully elucidated; however, available data now suggest that it is safe and well-tolerated. The objective of this review was to summarize the current understanding of the safety and efficacy of NBUVB phototherapy in dermatology.
Collapse
Affiliation(s)
- Anna Sokolova
- Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia
| | - Andrew Lee
- Department of Dermatology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia.
- Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.
| | - Saxon D Smith
- Department of Dermatology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
- Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
34
|
Yang L, Zhang CS, May B, Yu J, Guo X, Zhang AL, Xue CC, Lu C. Efficacy of combining oral Chinese herbal medicine and NB-UVB in treating psoriasis vulgaris: a systematic review and meta-analysis. Chin Med 2015; 10:27. [PMID: 26413149 PMCID: PMC4583725 DOI: 10.1186/s13020-015-0060-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/17/2015] [Indexed: 11/22/2022] Open
Abstract
Background The combination of a Chinese herbal medicine (CHM) bath and narrowband ultraviolet B (NB-UVB) improved the efficacy of NB-UVB treatment of psoriasis vulgaris, but bath therapy is inconvenient. Oral CHM plus NB-UVB has been tested in clinical practice. This study aims to evaluate whether adding oral CHM could be beneficial for NB-UVB therapy by a systematic review and meta-analysis. Methods Nine English and Chinese databases were searched from their inception to April 2014. Randomized controlled trials (RCTs) comparing the combination of orally administered CHM and NB-UVB with that of CHM placebo and NB-UVB or NB-UVB alone for treating psoriasis vulgaris and reporting Psoriasis Area Severity Index (PASI) outcomes were included. A systematic review, meta-analysis, risk of bias assessment and the GRADE assessment were conducted in accordance with Cochrane Collaboration methodology to assess the evidence for efficacy outcome. Data were analyzed in RevMan5.2. Results Eighteen eligible RCTs (n = 1416) were included for systematic review, and 17 (n = 1342) of them were included in meta-analysis. Risk of bias in terms of blinding was high and so was in publication bias. Quality of evidence was low according the GRADE assessment. PASI-60 or above [risk ratio (RR) = 1.35, 95 % confidence interval (CI) 1.26–1.45, I2 = 5 %, number needed to treat = 4.27] and PASI-90 or above (RR = 1.71, 95 % CI 1.45–2.01, I2 = 0 %, number needed to treat = 5.92) were higher in the intervention group. The combination treatment conferred a 24 % benefit of PASI-60 or above (83 vs 59 %, RR = 1.35, 95 % CI 1.26–1.45, P < 0.01). The incidence of NB-UVB-induced adverse events was lower in the intervention group (95/464 vs 123/428, RR = 0.66, 95 % CI 0.46–0.96, P < 0.01). Mild gastrointestinal reactions (2.87 %) and liver function impairments (0.68 %) were reported in the intervention group. No serious adverse events were reported. Conclusion The orally administrated CHM combined with NB-UVB in treating psoriasis vulgaris showed improved efficacy but quality of evidence was low. Electronic supplementary material The online version of this article (doi:10.1186/s13020-015-0060-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lihong Yang
- Evidence Based Medicine and Clinical Research Service Group, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China ; The 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China ; Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120 China
| | - Claire Shuiqing Zhang
- China-Australia International Research Centre for Chinese Medicine, School of Health Sciences, RMIT Health Innovations Research Institute, RMIT University, PO Box 71, Bundoora, Melbourne, VIC 3083 Australia
| | - Brian May
- China-Australia International Research Centre for Chinese Medicine, School of Health Sciences, RMIT Health Innovations Research Institute, RMIT University, PO Box 71, Bundoora, Melbourne, VIC 3083 Australia
| | - Jingjie Yu
- Department of Dermatology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Xinfeng Guo
- Evidence Based Medicine and Clinical Research Service Group, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China ; The 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China ; Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120 China
| | - Anthony Lin Zhang
- China-Australia International Research Centre for Chinese Medicine, School of Health Sciences, RMIT Health Innovations Research Institute, RMIT University, PO Box 71, Bundoora, Melbourne, VIC 3083 Australia
| | - Charlie Changli Xue
- The 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China ; Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120 China ; China-Australia International Research Centre for Chinese Medicine, School of Health Sciences, RMIT Health Innovations Research Institute, RMIT University, PO Box 71, Bundoora, Melbourne, VIC 3083 Australia
| | - Chuanjian Lu
- Department of Dermatology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China ; The 2nd Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China ; Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120 China ; China-Australia International Research Centre for Chinese Medicine, School of Health Sciences, RMIT Health Innovations Research Institute, RMIT University, PO Box 71, Bundoora, Melbourne, VIC 3083 Australia
| |
Collapse
|
35
|
Abstract
Phototherapy is a first-line option for the treatment of moderate to severe psoriasis. Systematic reviews indicate near comparable efficacy of the different forms of phototherapy. Localized phototherapy can be an adjunctive treatment of recalcitrant plaques during systemic treatment of psoriasis. More than 200 psoralen-UV-A therapy treatment sessions is associated with an increased risk of keratinocytic cancers, whereas no increased risk has been demonstrated for narrow-band UV-B therapy. The mechanism of action of phototherapy in psoriasis is via inhibition of keratinocyte proliferation; induction of apoptosis in keratinocytes, dendritic, and T cells; and inhibition of Th1 and Th17 pathways, but activation of Th2.
Collapse
Affiliation(s)
- Emoke Racz
- Department of Dermatology, Erasmus University Medical Center Rotterdam, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Errol P Prens
- Department of Dermatology, Erasmus University Medical Center Rotterdam, PO Box 2040, Rotterdam 3000 CA, The Netherlands.
| |
Collapse
|
36
|
Zhilova MB, Chikin VV. Clinical efficacy of the rotation of phototherapy methods (PUVA therapy and mid-wavelength ultraviolet therapy (311 nm)) in patients with moderate to severe forms of psoriasis. VESTNIK DERMATOLOGII I VENEROLOGII 2015. [DOI: 10.25208/0042-4609-2015-91-1-67-75] [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
Goal. To assess the therapeutic efficacy of the rotation of mid-wavelength ultraviolet therapy (311 nm) and PUVA therapy in patients with moderate to severe forms of psoriasis, and to assess the efficacy of mid-wavelength ultraviolet therapy (311 nm) in a multiple-course therapy. Materials and methods. The study involved 66 patients with moderate to severe forms of psoriasis who received multiple courses of treatment by methods of the PUVA therapy and narrowband mid-wavelength phototherapy (311 nm). The patients were divided into three groups: Group 1 (n = 20) - patients who received treatment in the form of mid-wavelength ultraviolet therapy (311 nm) after multiple courses of PUVA therapy; Group 2 (n = 26) - patients who received only multiple courses of PUVA therapy; Group 3 (n = 20) - patients who received only multiple courses of mid-wavelength ultraviolet therapy (311 nm). Results. The authors determined high efficacy (82.8%) of mid-wavelength ultraviolet therapy (311 nm) in patients with moderate to severe forms of psoriasis vulgaris who had previously received multiple courses of PUVA therapy. After multiple courses of long-term treatment by mid-wavelength ultraviolet therapy (311 nm), patients with moderate to severe forms of psoriasis had high efficacy of such multiple courses of treatment (85.78%). Conclusion. Patients with moderate to severe forms of psoriasis who had previously received multiple courses of PUVA therapy can be switched to mid-wavelength ultraviolet therapy (311 nm) with the maintenance of high efficacy of such treatment. The authors observed the absence of any adaptation to the spectral range of mid-wavelength ultraviolet therapy (311 nm) in case of multiple courses of treatment.
Collapse
|
37
|
Werfel T, Holiangu F, Niemann KH, Schmerling O, Lüllau F, Zedler A, Sträter HD, Niebuhr M. Digital ultraviolet therapy: a novel therapeutic approach for the targeted treatment of psoriasis vulgaris. Br J Dermatol 2015; 172:746-53. [DOI: 10.1111/bjd.13464] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2014] [Indexed: 11/30/2022]
Affiliation(s)
- T. Werfel
- Department of Dermatology and Allergy; Division of Immunodermatology and Allergy Research; Hannover Medical School; Carl-Neuberg-Str. 1 D-30625 Hannover Germany
| | - F. Holiangu
- Department of Dermatology and Allergy; Division of Immunodermatology and Allergy Research; Hannover Medical School; Carl-Neuberg-Str. 1 D-30625 Hannover Germany
| | - K.-H. Niemann
- Faculty I ‘Electrical Engineering and Information Technology’; University of Applied Sciences and Arts; Hannover Germany
| | - O. Schmerling
- Faculty I ‘Electrical Engineering and Information Technology’; University of Applied Sciences and Arts; Hannover Germany
| | - F. Lüllau
- Lüllau Engineering GmbH; Lüneburg Germany
| | - A. Zedler
- Institute for Product and Process Innovation (PPI); Leuphana University of Lüneburg; Lüneburg Germany
| | - H.-D. Sträter
- Institute for Product and Process Innovation (PPI); Leuphana University of Lüneburg; Lüneburg Germany
| | - M. Niebuhr
- Department of Dermatology and Allergy; Division of Immunodermatology and Allergy Research; Hannover Medical School; Carl-Neuberg-Str. 1 D-30625 Hannover Germany
| |
Collapse
|
38
|
Comparison of the Efficacy of Methotrexate and Narrow-Band Ultraviolet B for the Treatment of Plaque-Type Psoriasis. Am J Ther 2014; 23:e405-10. [PMID: 25470611 DOI: 10.1097/mjt.0000000000000128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although many treatment methods for psoriasis are available, it is still a challenging task for the dermatologist to choose the optimal one. To the best of our knowledge, there was only 1 small study of head-to-head comparison of the efficacy of these medications to date. In this retrospective study, we compared the clinical efficacy and recurrence rates of narrow-band ultraviolet B (NB-UVB) and methotrexate (MTX) treatments for plaque-type psoriasis. Sixty-seven patients with psoriasis who received NB-UVB (n = 35) or MTX (n = 32) treatments were included in the study. Response was assessed by Psoriasis Area and Severity Index (PASI) at baseline, 4th and 12th week. Our results revealed that both treatment modalities significantly reduced the PASI score compared with baseline (P < 0.001 and P < 0.001, respectively). Moreover, there was no significant difference between both regimens regardless of baseline PASI scores (P = 0.796 at 4th week and P = 0.606 at 12th week). Recurrence rates in both treatments were also similar at 3 months (42.9% for NB-UVB and 65.2% for MTX, P = 0.162). In conclusion, the use of NB-UVB can be considered as a preliminary treatment method rather than MTX when taking into account of the lower side effect profile even in patients with severe psoriasis.
Collapse
|
39
|
|
40
|
Ruiz V, Manubens E, Puig L. Psoriasis y embarazo: revisión (i). ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:734-43. [DOI: 10.1016/j.ad.2013.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 06/18/2013] [Accepted: 06/24/2013] [Indexed: 12/18/2022] Open
|
41
|
Xu F, Vostal JG. Inactivation of bacteria via photosensitization of vitamin K3 by UV-A light. FEMS Microbiol Lett 2014; 358:98-105. [DOI: 10.1111/1574-6968.12544] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/17/2014] [Accepted: 07/17/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- Fei Xu
- Laboratory of Cellular Hematology; CBER; FDA; Bethesda MD USA
| | | |
Collapse
|
42
|
Almutawa F, Thalib L, Hekman D, Sun Q, Hamzavi I, Lim HW. Efficacy of localized phototherapy and photodynamic therapy for psoriasis: a systematic review and meta-analysis. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2013; 31:5-14. [DOI: 10.1111/phpp.12092] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Fahad Almutawa
- Department of Medicine, Faculty of Medicine; Kuwait University; Al-jabriya Kuwait
| | - Lukman Thalib
- Department of Community Medicine (Biostatistics); Faculty of Medicine; Kuwait University; Al-jabriya Kuwait
| | - Daniel Hekman
- Grand Rapids Medical Education Partners; Grand Rapids MI USA
| | - Qing Sun
- Department of Dermatology; Qilu Hospital of Shandong University; Jinan China
| | - Iltefat Hamzavi
- Department of Dermatology; Henry Ford Hospital; Detroit MI USA
| | - Henry W. Lim
- Department of Dermatology; Henry Ford Hospital; Detroit MI USA
| |
Collapse
|
43
|
Chen X, Yang M, Cheng Y, Liu GJ, Zhang M. Narrow-band ultraviolet B phototherapy versus broad-band ultraviolet B or psoralen-ultraviolet A photochemotherapy for psoriasis. Cochrane Database Syst Rev 2013; 2013:CD009481. [PMID: 24151011 PMCID: PMC11076274 DOI: 10.1002/14651858.cd009481.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The most commonly used types of phototherapy for treating psoriasis are narrow-band ultraviolet B (NB-UVB); broad-band ultraviolet B (BB-UVB), which includes selective (delivering radiation with a wavelength range of 305 to 325 nm) and conventional BB-UVB (280 to 320 nm); and psoralen ultraviolet A photochemotherapy (oral or bath PUVA). There is substantial controversy regarding their efficacy when compared with each other. OBJECTIVES To assess the effects of narrow-band ultraviolet B phototherapy versus broad-band ultraviolet B or psoralen ultraviolet A photochemotherapy for psoriasis. SEARCH METHODS We searched the following databases up to August 2013: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2013, Issue 7), MEDLINE (from 1946), and EMBASE (from 1974). We searched the following databases up to November 2012: CNKI (from 1974) and CBM (from 1978). We also searched trials registers and the OpenGrey database. SELECTION CRITERIA We included all randomised controlled trials (RCTs) that compared NB-UVB phototherapy with BB-UVB or PUVA for treating psoriasis, which included chronic plaque psoriasis (CPP), guttate psoriasis (GP), and palmoplantar psoriasis (PPP). DATA COLLECTION AND ANALYSIS Two review authors independently conducted the study selection, 'Risk of bias' assessment, and data extraction. MAIN RESULTS We included 13 RCTs, with a total of 662 participants. We report the results of intention-to-treat analyses (ITT) here. Our primary outcomes of interest were as follows: Participant-rated global improvement, Percentage of participants reaching Psoriasis Area and Severity Index (PASI) 75 (which meant equal to or more than 75% reduction in PASI score), Withdrawal due to side-effects, and Clearance rate.In one RCT of NB-UVB compared with oral PUVA in participants with CPP, the difference in PASI 75 was not statistically significant (risk ratio (RR) 0.91, 95% confidence interval (CI) 0.63 to 1.32; N = 51; low quality). In three other RCTs of CPP, the clearance rates were inconsistent because in one, there was no difference between the groups (RR 1.01, 95% CI 0.91 to 1.12; N = 54), and in the other two, the clearance rates were statistically significantly in favour of oral PUVA: RR 0.66, 95% CI 0.47 to 0.93; N = 93 and RR 0.75, 95% CI 0.59 to 0.96; N = 100, respectively. Pooled data from these three studies indicated that withdrawals due to adverse events were not significantly different between either group (RR 0.71, 95% CI 0.20 to 2.54; N = 247; low quality).The evidence from the comparison of NB-UVB with bath PUVA in terms of clearance rate for CPP was also inconsistent: Pooled data from two left-right body comparison RCTs found no significant difference between the NB-UVB and bath PUVA groups (RR 1.79, 95% CI 0.46 to 6.91; N = 92; low quality), while a parallel RCT favoured bath PUVA (RR 0.18, 95% CI 0.05 to 0.71; N = 36; low quality).In participants with PPP, one RCT found there were no significant differences between NB-UVB treated sides and topical PUVA treated sides in terms of clearance rate (RR 0.09, 95% CI 0.01 to 1.56; N = 50; low quality).Two RCTs found NB-UVB plus retinoid (re-NB-UVB) and PUVA plus retinoid (re-PUVA) had similar effects for treating people with CPP or GP in terms of clearance rate (RR 0.93, 95% CI 0.79 to 1.10; N = 90; low quality).One RCT in people with CPP found no significant differences between NB-UVB and selective BB-UVB in terms of clearance rate (RR 1.40, 95% CI 0.92 to 2.13; N = 100; low quality) and withdrawals due to adverse events (RR 3.00, 95% CI 0.32 to 27.87; N = 100; low quality).No studies reported our primary outcomes for NB-UVB compared with conventional BB-UVB. AUTHORS' CONCLUSIONS Current evidence is very heterogeneous and needs to be interpreted with caution. The clearance rate between oral PUVA and NB-UVB is inconsistent among the included studies. Evidence regarding NB-UVB versus bath PUVA is also inconsistent. Re-NB-UVB and re-PUVA are similarly effective for treating people with CPP or GP. In practice, NB-UVB may be more convenient to use since exogenous photosensitiser is not required before phototherapy.NB-UVB is considered ineffective for PPP in clinical practice, and a small RCT did not detect a statistically significant difference between NB-UVB and topical PUVA for clearing PPP. NB-UVB seemed to be similar to selective BB-UVB for clearing CPP.Larger prospective studies are needed to confirm the long-term safety of NB-UVB.
Collapse
Affiliation(s)
- Xiaomei Chen
- West China Hospital, Sichuan UniversityDepartment of Dermatology & VenereologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Ming Yang
- West China Hospital, Sichuan UniversityCenter of Geriatrics and GerontologyNo. 37, Guo Xue LaneChengduSichuanChina610041
| | - Yan Cheng
- West China Hospital, Sichuan UniversityDepartment of Dermatology & VenereologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Guan J Liu
- West China Hospital, Sichuan UniversityChinese Cochrane Centre, Chinese Evidence‐Based Medicine CentreNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Min Zhang
- West China Hospital, Sichuan UniversityDepartment of Dermatology & VenereologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | | |
Collapse
|
44
|
Lifting the silver flakes: the pathogenesis and management of chronic plaque psoriasis. BIOMED RESEARCH INTERNATIONAL 2013; 2013:168321. [PMID: 24062996 PMCID: PMC3766987 DOI: 10.1155/2013/168321] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 07/10/2013] [Indexed: 12/03/2022]
Abstract
Psoriasis is a common chronic inflammatory skin condition in which patients suffer from mild to chronic plaque skin plaques. The disease manifests through an excessive inflammatory response in the skin due to complex interactions between different genetic and environmental factors. Psoriasis can affect the physical, emotional, and psychosocial well-being of patients, and currently there is no cure with treatments focusing primarily on the use of anti-inflammatory agents to control disease symptoms. Traditional anti-inflammatory agents can cause immunosuppression and adverse systemic effects. Further understanding of the disease has led to current areas of research aiming at the development of selective molecular targets to suppress the pathogenic immune responses.
Collapse
|
45
|
McCoy J, Goren A, Lotti T. In vitro evaluation of a novel topical cream for vitiligo and psoriasis that selectively delivers NB-UVB therapy when exposed to sunlight. Dermatol Ther 2013; 27:117-20. [DOI: 10.1111/dth.12079] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Andy Goren
- Applied Biology; Irvine California
- Department of Dermatology and Venereology; University of Rome “G. Marconi”; Rome Italy
| | - Torello Lotti
- Department of Dermatology and Venereology; University of Rome “G. Marconi”; Rome Italy
| |
Collapse
|
46
|
Abstract
The treatment of psoriasis has been revolutionized since the introduction of biologic therapies. Prior to their introduction, it was unclear if psoriasis was primarily a keratinocyte signaling dysfunction or an autoimmune T-cell mediated pathway. Nonspecific T-cell targeting treatments had been used with some success, but they were limited by a narrow therapeutic index. The nonspecific nature of these agents was fraught with side effects, and the efficacy of these treatments pales in comparison to current treatments. The initial biologic molecules, alefacept and efalizumab, were not specific for any T-cell driven pathway, and neither are currently available in the USA. The successors to these early therapies have shown high efficacy and low side effects in psoriasis and other autoimmune diseases through the specific targeting of tumor necrosis factor-alpha (TNF-α). Since the initial use of antitumor necrosis factor agents, a renaissance in our understanding of psoriasis has been underway, leading to the elucidation of the T-helper 17 (Th17) from the Th1 pathway. With each new treatment, the pathogenesis for psoriasis continues to be more defined, allowing for improved targeted therapies and the ability to achieve new milestones in efficacy.
Collapse
Affiliation(s)
| | | | - Henry K Wong
- College of Medicine, Ohio State University, Columbus, OH, USA
| |
Collapse
|
47
|
Spectroscopic and vibrational analysis of the methoxypsoralen system: A comparative experimental and theoretical study. J Mol Struct 2013. [DOI: 10.1016/j.molstruc.2012.08.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
48
|
Akasaka E, Mabuchi T, Manabe Y, Yahagi E, Yamada-Hiruma A, Yamaoka H, Kojima T, Kato M, Ikoma N, Ozawa A, Haruki Y. Long-term efficacy of psoriasis vulgaris treatments: Analysis of treatment with topical corticosteroid and/or vitamin D3analog, oral cyclosporin, etretinate and phototherapy over a 35-year period, 1975-2010. J Dermatol 2013; 40:238-43. [DOI: 10.1111/1346-8138.12069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 11/19/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Emiko Akasaka
- Department of Dermatology; Tokai University School of Medicine; Kanagawa; Japan
| | - Tomotaka Mabuchi
- Department of Dermatology; Tokai University School of Medicine; Kanagawa; Japan
| | - Yasuaki Manabe
- Department of Dermatology; Tokai University School of Medicine; Kanagawa; Japan
| | - Eiichiro Yahagi
- Department of Dermatology; Tokai University School of Medicine; Kanagawa; Japan
| | - Azusa Yamada-Hiruma
- Department of Dermatology; Tokai University School of Medicine; Kanagawa; Japan
| | - Hanako Yamaoka
- Department of Dermatology; Tokai University School of Medicine; Kanagawa; Japan
| | - Tomoko Kojima
- Department of Dermatology; Tokai University School of Medicine; Kanagawa; Japan
| | - Masayuki Kato
- Department of Dermatology; Tokai University School of Medicine; Kanagawa; Japan
| | - Norihiro Ikoma
- Department of Dermatology; Tokai University School of Medicine; Kanagawa; Japan
| | - Akira Ozawa
- Department of Dermatology; Tokai University School of Medicine; Kanagawa; Japan
| | - Yasuo Haruki
- Department of Basic Medical Science; Tokai University School of Medicine; Kanagawa; Japan
| |
Collapse
|
49
|
Paul C, Gallini A, Archier E, Castela E, Devaux S, Aractingi S, Aubin F, Bachelez H, Cribier B, Joly P, Jullien D, Le Maître M, Misery L, Richard MA, Ortonne JP. Evidence-based recommendations on topical treatment and phototherapy of psoriasis: systematic review and expert opinion of a panel of dermatologists. J Eur Acad Dermatol Venereol 2012; 26 Suppl 3:1-10. [DOI: 10.1111/j.1468-3083.2012.04518.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|