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Ibbotson SH, Ferguson J, Moseley H, Samuel IDW, Lesar A, Dawe RS. A Randomised Assessor Blinded Comparison of Low Irradiance and Conventional Irradiance Photodynamic Therapy for Superficial Basal Cell Carcinoma and Bowen's Disease. Br J Dermatol 2021; 186:577-579. [PMID: 34545565 DOI: 10.1111/bjd.20762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 11/26/2022]
Abstract
The inconvenience and pain of hospital-based photodynamic therapy (PDT) is sometimes limiting.1 We developed very low irradiance LEDs for ambulatory PDT. Preliminary studies showed this to be convenient and relatively painless.1-4 Here we evaluate the Ambulight® device (Ambicare Health Ltd) in a randomised controlled assessor-blinded study comparing low irradiance ambulatory PDT (APDT) with conventional PDT (CPDT) for superficial basal cell carcinoma (SBCC) and Bowen's disease (BD) (lesions ≤2cm).
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Affiliation(s)
- S H Ibbotson
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - J Ferguson
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - H Moseley
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - I D W Samuel
- School of Physics and Astronomy, SUPA, University of St Andrews, St Andrews, Fife, UK
| | - A Lesar
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - R S Dawe
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
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2
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Ibbotson SH, Allan D, Dawe RS, Eadie E, Farr PM, Fassihi H, Fedele F, Ferguson J, Fityan A, Freeman P, Fullerton L, Goulden V, Haque S, Ling TC, Mackay A, McKenna K, Ralph N, Rhodes LE, Sarkany R, Turner D, Ungureanu S, Weatherhead S. Photodiagnostic services in the UK and Republic of Ireland: a British Photodermatology Group Workshop Report. J Eur Acad Dermatol Venereol 2021; 35:2448-2455. [PMID: 34459043 DOI: 10.1111/jdv.17632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Photodiagnostic investigations are essential for the accurate diagnosis of abnormal cutaneous photosensitivity and provide important information for the management of patients with photodermatoses (cutaneous photosensitivity disorders). Although photodiagnosis has been undertaken since the early 1970s, specialist services in the United Kingdom (UK) and Republic of Ireland are limited and there is no formal guidance on diagnostic approach. Indeed, there is a limited literature in this area of methodology and diagnostic practice. OBJECTIVES The primary objective was to undertake a British Photodermatology Group Workshop to review the role and activities of specialist centres in the UK and Republic of Ireland in order to ascertain whether there were consensus practices. Secondary objectives were to identify key priorities for service, training and research. METHODS An initial detailed survey review of current activities was undertaken prior to the Workshop and data from this survey were used to inform discussion at the Workshop, which was attended by key photodermatology experts from the UK and Republic of Ireland. RESULTS/CONCLUSIONS We have undertaken a detailed review of current Photodiagnostic Services in the UK and Republic of Ireland and report on our findings from the 12 centres and we have identified key areas of consensus practice. This is an important step in the process of standardising and optimising procedures and protocols and defining minimum clinical standards for photodiagnostic investigations, which are of such diagnostic importance in Dermatology.
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Affiliation(s)
- S H Ibbotson
- Photobiology Unit, NHS Tayside, Ninewells Hospital & Medical School, Dundee, UK.,Photobiology Unit, University of Dundee School of Medicine, Ninewells Hospital & Medical School, Dundee, UK
| | - D Allan
- Medical Physics Department, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Salford, UK
| | - R S Dawe
- Photobiology Unit, NHS Tayside, Ninewells Hospital & Medical School, Dundee, UK
| | - E Eadie
- Photobiology Unit, NHS Tayside, Ninewells Hospital & Medical School, Dundee, UK
| | - P M Farr
- Department of Dermatology, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| | - H Fassihi
- Photodermatology Unit, St John's Institute of Dermatology, Guy's Hospital, London, UK
| | - F Fedele
- Photodermatology Unit, St John's Institute of Dermatology, Guy's Hospital, London, UK
| | - J Ferguson
- Photodermatology Unit, St John's Institute of Dermatology, Guy's Hospital, London, UK
| | - A Fityan
- Department of Dermatology, University Hospital Southampton NHS Foundation Trust, Hampshire, UK
| | - P Freeman
- Department of Medical Physics, St Thomas' Hospital, London, UK
| | - L Fullerton
- Photobiology Unit, NHS Tayside, Ninewells Hospital & Medical School, Dundee, UK
| | - V Goulden
- Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - S Haque
- Department of Dermatology, Cambridge University Hospital, Cambridge, UK
| | - T C Ling
- Photobiology Unit, Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - A Mackay
- Photobiology Unit, Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - K McKenna
- Department of Dermatology, Belfast City Hospital, Belfast, UK
| | - N Ralph
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - L E Rhodes
- Photobiology Unit, Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - R Sarkany
- Photodermatology Unit, St John's Institute of Dermatology, Guy's Hospital, London, UK
| | - D Turner
- Photodermatology Unit, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - S Ungureanu
- Department of Dermatology, Solihull Hospital, Solihull, Birmingham, UK
| | - S Weatherhead
- Department of Dermatology, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
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3
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Hickerson RP, Conneely MJ, Hirata Tsutsumi SK, Wood K, Jackson DN, Ibbotson SH, Eadie E. Minimal, superficial DNA damage in human skin from filtered far-ultraviolet C. Br J Dermatol 2021; 184:1197-1199. [PMID: 33452809 DOI: 10.1111/bjd.19816] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 01/30/2023]
Affiliation(s)
- R P Hickerson
- Division of Biological Chemistry and Drug Discovery, School of Life Sciences, University of Dundee, Dundee, DD1 5EH, UK
| | - M J Conneely
- Division of Biological Chemistry and Drug Discovery, School of Life Sciences, University of Dundee, Dundee, DD1 5EH, UK
| | - S K Hirata Tsutsumi
- Division of Biological Chemistry and Drug Discovery, School of Life Sciences, University of Dundee, Dundee, DD1 5EH, UK
| | - K Wood
- SUPA, School of Physics & Astronomy, University of St Andrews, St Andrews, KY16 9SS, UK
| | - D N Jackson
- Department of Dermatology, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - S H Ibbotson
- Scottish Photobiology Service, Photobiology Unit, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - E Eadie
- Scottish Photobiology Service, Photobiology Unit, NHS Tayside, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
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4
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Todd BK, Lesar A, O'Mahoney P, Eadie E, Ibbotson SH. Is there an optimal irradiation dose for photodynamic therapy: 37 J cm -2 or 75 J cm -2 ? Br J Dermatol 2019; 182:1287-1288. [PMID: 31677268 DOI: 10.1111/bjd.18644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- B K Todd
- Photobiology Unit, NHS Tayside, Ninewells Hospital, Dundee, DD1 9SY, U.K
| | - A Lesar
- Photobiology Unit, NHS Tayside, Ninewells Hospital, Dundee, DD1 9SY, U.K
| | - P O'Mahoney
- The Scottish Photodynamic Therapy Centre, Dundee, U.K.,School of Medicine, University of Dundee, Dundee, U.K
| | - E Eadie
- Photobiology Unit, NHS Tayside, Ninewells Hospital, Dundee, DD1 9SY, U.K
| | - S H Ibbotson
- Photobiology Unit, NHS Tayside, Ninewells Hospital, Dundee, DD1 9SY, U.K.,The Scottish Photodynamic Therapy Centre, Dundee, U.K.,School of Medicine, University of Dundee, Dundee, U.K
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5
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Nassan H, Dawe RS, Moseley H, Ibbotson SH. A review of photodiagnostic investigations over 26 years: experience of the National Scottish Photobiology Service (1989-2015). J R Coll Physicians Edinb 2019. [PMID: 29537405 DOI: 10.4997/jrcpe.2017.408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The Scottish Photobiology Service is the national referral pathway for patients with cutaneous photosensitivity diseases in Scotland. We reviewed the pattern of diagnosis of photosensitivity diseases and investigations performed between 1989 and 2015. Methods and Results Data were collected from the Photodiagnostic Database, annual reports and paper records. The total number of patients assessed each year was stable over the period studied (median 242 [range 231-266]), with most being new patients (median 69 [range 62-73]%). Monochromator phototesting was the most utilised investigation, although the use of provocation testing and photopatch testing has increased. The most common diagnosis was polymorphic light eruption, and there was a trend to increasing diagnosis of photoaggravated atopic eczema. Conclusions The pattern of diagnosis of photosensitivity diseases remains fairly stable in Scotland and we wish to emphasise the importance of this Scottish specialist service for patients with photosensitivity diseases and referrers.
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Affiliation(s)
- H Nassan
- H Naasan, Dermatology Department, Ninewells Hospital and Medical School, Dundee, UK.
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6
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Naasan H, Dawe RS, Ibbotson SH. Efficacy of localized hand and foot phototherapy: a review of patients treated in a teaching hospital setting. Clin Exp Dermatol 2019; 44:356-358. [DOI: 10.1111/ced.13776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2018] [Indexed: 12/01/2022]
Affiliation(s)
- H. Naasan
- Photobiology Unit; Department of Dermatology; University of Dundee; Ninewells Hospital and Medical School; Dundee UK
| | - R. S. Dawe
- Photobiology Unit; Department of Dermatology; University of Dundee; Ninewells Hospital and Medical School; Dundee UK
| | - S. H. Ibbotson
- Photobiology Unit; Department of Dermatology; University of Dundee; Ninewells Hospital and Medical School; Dundee UK
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7
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Collier NJ, Haylett AK, Wong TH, Morton CA, Ibbotson SH, McKenna KE, Mallipeddi R, Moseley H, Seukeran D, Ward KA, Mohd Mustapa MF, Exton LS, Green AC, Rhodes LE. Conventional and combination topical photodynamic therapy for basal cell carcinoma: systematic review and meta-analysis. Br J Dermatol 2018; 179:1277-1296. [PMID: 29889302 DOI: 10.1111/bjd.16838] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Topical photodynamic therapy (PDT) is an established treatment option for low-risk basal cell carcinoma (BCC). OBJECTIVES To compare efficacy, cosmesis and tolerability of PDT for BCC with alternative treatments. METHODS MEDLINE, PubMed, Embase and CENTRAL databases were searched from inception until 1 September 2017. Included studies were randomized controlled trials (RCTs) of PDT for nodular (n) and superficial (s) BCC reporting at least one of the following outcomes: clearance at 3 months and sustained at 1 or 5 years; recurrence at ≥ 1 year; cosmesis; adverse events; tolerability. RESULTS From 2331 search results, 15 RCTs (2327 patients; 3509 BCCs) were included. PDT efficacy (5-year sustained clearance) was high but inferior to excisional surgery [nBCC pooled risk ratio (RR) 0·76; 95% confidence interval (CI) 0·63-0·91], and without re-treatment of partially responding lesions, was modestly inferior to imiquimod (sBCC: RR 0·81; 95% CI 0·70-0·95) and similar to fluorouracil (sBCC: RR 0·88; 95% CI 0·75-1·04). Five-year sustained clearance was inferior with conventional vs. fractionated PDT (sBCC: RR 0·76; 95% CI 0·68-0·84). PDT cosmesis was superior to surgery (sBCC: RR 1·68, 95% CI 1·32-2·14; nBCC: RR 1·82, 95% CI 1·19-2·80) and cryosurgery (BCC: RR 3·73, 95% CI 1·96-7·07), and without re-treatment of partially responding lesions was similar to imiquimod (sBCC: RR 1·01, 95% CI 0·85-1·19) and fluorouracil (sBCC: RR 1·04, 95% CI 0·88-1·24). Peak pain was higher but of shorter duration with PDT than topical treatments. Serious adverse reactions were rarer with PDT than imiquimod (sBCC: RR 0·05, 95% CI 0·00-0·84) and fluorouracil (sBCC: RR 0·11, 95% CI 0·01-2·04). Combination PDT regimens demonstrated reduced recurrence and improved cosmesis; however, results from these small studies were often nonsignificant. CONCLUSIONS PDT is an effective treatment for low-risk BCC, with excellent cosmesis and safety. Imiquimod has higher efficacy than single-cycle PDT but more adverse effects. Highest efficacy is with excisional surgery. Fractionated and combination PDT options warrant further study.
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Affiliation(s)
- N J Collier
- Photobiology Unit, Dermatology Centre, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - A K Haylett
- Photobiology Unit, Dermatology Centre, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - T H Wong
- Stirling Community Hospital, Stirling, U.K
| | - C A Morton
- Stirling Community Hospital, Stirling, U.K
| | - S H Ibbotson
- The Photobiology Unit, Department of Dermatology, University of Dundee, Ninewells Hospital & Medical School, Dundee, U.K
| | - K E McKenna
- Department of Dermatology, Belfast City Hospital, Belfast, U.K
| | - R Mallipeddi
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, U.K
| | - H Moseley
- The Photobiology Unit, Department of Dermatology, University of Dundee, Ninewells Hospital & Medical School, Dundee, U.K
| | - D Seukeran
- The James Cook University Hospital, Middlesborough, U.K
| | - K A Ward
- Cannock Chase Hospital, Cannock, U.K
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, U.K
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, U.K
| | - A C Green
- Photobiology Unit, Dermatology Centre, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K.,CR-UK Manchester Institute, The University of Manchester, Manchester, U.K.,QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - L E Rhodes
- Photobiology Unit, Dermatology Centre, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
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8
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Abstract
SummaryThrombotic diseases increase in incidence with advancing years and this might be partly due to an increased propensity for fibrin formation in older individuals. Accordingly we decided to investigate whether the time taken to generate 50% thrombin activity in vitro varied with the age of the plasma donor. Coagulation was initiated in defibrinated, diluted plasma by contact activation and thrombin activity measured using the chromogenic substrate, S2238. The rate of thrombin generation was assessed by measuring the time taken to reach 50% maximal activity (T50/s). There was a highly significant negative correlation between T50 and age, T50 declining from 93 s at 19 years to 71 s at 65 years (r = −0.637, p <0.0001). A strong negative correlation was demonstrated between T50 and FVII level (r = -0.415, p = 0.0007) and FVIII: C level (r = -0.465, p = 0.0001). Although FVII concentration correlated with age (r = 0.307, p = 0.014) no relationship was seen between age and FVIII :C. These data suggest that coagulation rates in plasma accelerate with age.
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Affiliation(s)
| | - G M Tate
- The Department of University Medicine and Haematology, Leeds, UK
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9
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Ibbotson SH, Davies JA, Grant PJ. The Influence of Infusions of 1-Desamino-8-D-Arginine Vasopressin (DDAVP) In Vivo on Thrombin Generation In Vitro. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1656314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryTo investigate the effect of increasing FVIII:C in-vivo on coagulation ex-vivo, DDAVP was infused over 15 min in 10 volunteers and in-vitro thrombin generation measured. FVIII:C rose from 0.42 and 0.43 IU/ml before DDAVP to 1.38, 1.73 and 1.78 IU/ml at 15, 30 and 60 min respectively (p <0.001).A computer-assisted thrombin generation test was performed in defibrinated plasma using chromogenic substrate, S2238. Time to reach 50% maximal thrombin activity (T50/s) and lag phase of thrombin generation (lag/s) were measured. Lag shortened from 75 and 60 s before to 45 s during and after infusion (p <0.001). T50 shortened from 78.5 and 76.0 to 62.5, 60.0 and 58.5 s at times 15 (p <0.01), 30 (p <0.001) and 60 (p <0.001) min. FVIII:C correlated inversely with lag and T50 (r = –0.847, p <0.001, r = –0.826, p <0.001, n = 10) respectively.These findings show that acute elevations of FVIII:C in-vivo accelerate in-vitro thrombin production. This work suggests that elevated FVIII:C levels in-vivo may be important in thrombo-occlusive disease.
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Affiliation(s)
- S H Ibbotson
- The Academic Unit of Medicine, The General Infirmary, Leeds, United Kingdom
| | - J A Davies
- The Academic Unit of Medicine, The General Infirmary, Leeds, United Kingdom
| | - P J Grant
- The Academic Unit of Medicine, The General Infirmary, Leeds, United Kingdom
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10
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Ibbotson SH, Grant PJ, Kerry R, Findlay VS, Prentice CRM. The Influence of Infusions of 1-Desamino-8-D-Arginine vasopressin (DDAVP) In Vivo on the Anticoaguhht Effect of Recombinant Hirudin (CGP39393) In Vitro. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1647455] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryHirudin is a specific, potent inhibitor of thrombin that may be a valuable antithrombotic agent. The aim of this study was to investigate the hypothesis that the haemostatic effects of DDAVP counteract the coagulation defect induced by hirudin. The effect of DDAVP was studied in vivo on the anticoagulant action of recombinant hirudin (CGP39393) in vitro. Blood samples were taken at intervals from 10 normal volunteers infused with DDAVP. Factor VIII: C rose from (mean) 0.68 IU/ml before DDAVP to 2.L9 and 2.16 IU/ml after 30 and 60 min infusion, respectively. Samples taken during DDAVP infusion showed a dose related decrease in the hirudin (0.5 and 1.0 αM) induced prolongation of the APTT that occurred at FVIII: C concentrations of up to twice normal. At higher concentrations of hirudin no effect on the APTT occurred. These results demonstrate that DDAVP infusion elevates factor VIII: C levels with an associated significant reduction in the anticoagulant effect of hirudin in vitro.
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Affiliation(s)
- S H Ibbotson
- The University Department of Medicine, The General Infirmary Leeds, UK
| | - P J Grant
- The University Department of Medicine, The General Infirmary Leeds, UK
| | - R Kerry
- The Thrombosis Research centre, ciba Geigy Pharmaceuticals, Horsham, West Sussex, UK
| | - V S Findlay
- The Thrombosis Research centre, ciba Geigy Pharmaceuticals, Horsham, West Sussex, UK
| | - C R M Prentice
- The University Department of Medicine, The General Infirmary Leeds, UK
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11
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Fargnoli MC, Ibbotson SH, Hunger RE, Rostain G, Gaastra MTW, Eibenschutz L, Cantisani C, Venema AW, Medina S, Kerrouche N, Pérez-Garcia B. Patient and physician satisfaction in an observational study with methyl aminolevulinate daylight photodynamic therapy in the treatment of multiple actinic keratoses of the face and scalp in six European countries. J Eur Acad Dermatol Venereol 2017; 32:757-762. [PMID: 29136306 PMCID: PMC6084323 DOI: 10.1111/jdv.14691] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/03/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Guidelines recommend treating actinic keratoses (AKs) as they are recognized as precursors of invasive squamous cell carcinoma. OBJECTIVE The objective of this study was to collect real-world clinical data on the use of methyl aminolevulinate daylight photodynamic therapy (MAL DL-PDT) for the treatment of face and scalp AK in Europe. METHODS A prospective, multicenter, non-interventional study was conducted in six European countries in patients receiving a single treatment of MAL DL-PDT for face and/or scalp AK. Patient-reported outcomes were assessed by patient questionnaires at baseline and at 3 months after treatment, efficacy was assessed at 3 months using a 6-point global improvement scale, and adverse events (AE) were recorded at each visit. RESULTS Overall, 325 patients were enrolled from 52 investigational centres, 314 of whom attended the 3-month visit. Most patients had multiple lesions (58.4% had >10 lesions) with lesions mainly located on the scalp (60.0%) and/or forehead (54.2%). AKs were predominantly grade I (39.4%) or grade II (33.2%), and 10.5% of patients had grade III lesions. The proportions of patients and physicians that were overall satisfied to very satisfied with the MAL DL-PDT treatment were 80.4% and 90.3%, respectively. The vast majority of patients (90.0%) would consider using MAL DL-PDT again if needed. Physician-assessed efficacy at 3 months was at least much improved in 83.5% of patients, with 45.9% of patients requiring no retreatment. Related AEs were reported in 15% of patients. CONCLUSION Use of MAL DL-PDT for multiple face and/or scalp AKs resulted in high levels of patient and physician satisfaction in clinical practice in Europe, reflecting the good efficacy and high tolerability of this convenient procedure.
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Affiliation(s)
- M C Fargnoli
- Department of Dermatology, University of L'Aquila, L'Aquila, Italy
| | - S H Ibbotson
- Photobiology Unit, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK
| | - R E Hunger
- Department of Dermatology, Bern University Hospital, Inselspital, Bern, Switzerland
| | | | | | - L Eibenschutz
- Dermato Oncology Unit, San Gallicano Dermatological Institute, Rome, Italy
| | - C Cantisani
- Department of Dermatology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - S Medina
- Dermatology Department, Príncipe de Asturias University Hospital, Madrid, Spain
| | | | - B Pérez-Garcia
- Department of Dermatology, Ramón y Cajal University Hospital, Madrid, Spain
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12
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Eadie E, Ibbotson SH, Dawe RS. Irradiance, as well as body site and timing of readings, is important in determining ultraviolet A minimal erythema dose. Br J Dermatol 2017; 178:297-298. [PMID: 28940196 DOI: 10.1111/bjd.16005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- E Eadie
- Department of Medical Physics, Photobiology Unit, Ninewells Hospital and Medical School, Dundee, DD1 9SY, U.K
| | - S H Ibbotson
- Photobiology Unit, University of Dundee, Department of Dermatology, Ninewells Hospital and Medical School, Dundee, DD1 9SY, U.K
| | - R S Dawe
- Department of Dermatology, Photobiology Unit, Ninewells Hospital and Medical School, Dundee, DD1 9SY, U.K
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13
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Ray S, Belch JJ, Craigie AM, Khan F, Kennedy G, Hill A, Barton KL, Dawe RS, Ibbotson SH. Can antioxidant-rich blackcurrant juice drink consumption improve photoprotection against ultraviolet radiation? Br J Dermatol 2015; 174:1101-3. [PMID: 26581666 DOI: 10.1111/bjd.14299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Ray
- The Institute of Cardiovascular Research (TICR) and Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, U.K.,Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, U.K
| | - J J Belch
- The Institute of Cardiovascular Research (TICR) and Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, U.K
| | - A M Craigie
- The Institute of Cardiovascular Research (TICR) and Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, U.K
| | - F Khan
- The Institute of Cardiovascular Research (TICR) and Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, U.K
| | - G Kennedy
- The Institute of Cardiovascular Research (TICR) and Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, U.K
| | - A Hill
- The Institute of Cardiovascular Research (TICR) and Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, U.K
| | - K L Barton
- The Institute of Cardiovascular Research (TICR) and Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, U.K
| | - R S Dawe
- Photobiology Unit, Dermatology Department, Ninewells Hospital and Medical School, Dundee, U.K
| | - S H Ibbotson
- Photobiology Unit, Dermatology Department, Ninewells Hospital and Medical School, Dundee, U.K
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Ibbotson SH, Moseley H, Brancaleon L, Padgett M, O'Dwyer M, Woods JA, Lesar A, Goodman C, Ferguson J. Photodynamic therapy in dermatology: Dundee clinical and research experience. Photodiagnosis Photodyn Ther 2014; 1:211-23. [PMID: 25048335 DOI: 10.1016/s1572-1000(04)00045-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Topical photodynamic therapy (PDT) is increasingly accepted and used as a highly effective treatment for superficial non-melanoma skin cancer and dysplasia. We describe the developments in topical PDT for the treatment of skin diseases in our own PDT Centre in Dundee, both clinically and from a research base. Improvements in PDT could be achieved by optimisation of photosensitiser and light delivery, and these goals underpin the aims of our centre. We hope to facilitate the dissemination of use of PDT in dermatology throughout Scotland and outline some of the progress in these areas.
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Affiliation(s)
- S H Ibbotson
- Photobiology Unit, Barbara Stewart Cancer Trust, Scottish PDT Centre, Ninewells Hospital and Medical School, University of Dundee, Dundee DD19SY, UK
| | - H Moseley
- Photobiology Unit, Barbara Stewart Cancer Trust, Scottish PDT Centre, Ninewells Hospital and Medical School, University of Dundee, Dundee DD19SY, UK
| | - L Brancaleon
- Photobiology Unit, Barbara Stewart Cancer Trust, Scottish PDT Centre, Ninewells Hospital and Medical School, University of Dundee, Dundee DD19SY, UK
| | - M Padgett
- Optics Group, Department of Physics and Astronomy, University of Glasgow, Glasgow, UK
| | - M O'Dwyer
- Optics Group, Department of Physics and Astronomy, University of Glasgow, Glasgow, UK
| | - J A Woods
- Photobiology Unit, Barbara Stewart Cancer Trust, Scottish PDT Centre, Ninewells Hospital and Medical School, University of Dundee, Dundee DD19SY, UK
| | - A Lesar
- Photobiology Unit, Barbara Stewart Cancer Trust, Scottish PDT Centre, Ninewells Hospital and Medical School, University of Dundee, Dundee DD19SY, UK
| | - C Goodman
- Photobiology Unit, Barbara Stewart Cancer Trust, Scottish PDT Centre, Ninewells Hospital and Medical School, University of Dundee, Dundee DD19SY, UK
| | - J Ferguson
- Photobiology Unit, Barbara Stewart Cancer Trust, Scottish PDT Centre, Ninewells Hospital and Medical School, University of Dundee, Dundee DD19SY, UK
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Affiliation(s)
- S H Ibbotson
- Photobiology Unit, University Department of Dermatology, Ninewells Hospital and Medical School, Dundee, DD1 9SY, U.K.
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Cameron H, Yule S, Dawe RS, Ibbotson SH, Moseley H, Ferguson J. Review of an established UK home phototherapy service 1998-2011: improving access to a cost-effective treatment for chronic skin disease. Public Health 2014; 128:317-24. [PMID: 24726005 DOI: 10.1016/j.puhe.2014.01.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 01/14/2014] [Accepted: 01/16/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To review the Tayside home phototherapy service, including numbers of patients treated, diagnoses and outcomes, side-effects and safety, cost-effectiveness and absolute costs. To consider why home or outpatient phototherapy is not available to all patients who might benefit and how this could be addressed. STUDY DESIGN Observational and cost analysis. METHODS Analysis of the Tayside home phototherapy database 1998 and 2011, home phototherapy patient questionnaires, outcome data, costs and a comparison with outpatient phototherapy. Review of literature and current national guidelines for phototherapy, traditional systemic and biologic therapies for psoriasis. RESULTS 298 courses of home narrowband UVB (NB-UVB) phototherapy were undertaken by 212 patients between 1998 and 2011, five courses in 1998 increasing to 36 in 2011. The main diagnoses treated were psoriasis (72%), atopic dermatitis (8%), and desensitization of photodermatosis (7%). For psoriasis, 74.5% achieved clearance or minimal residual activity in a median of 30 exposures (range 10-60). The estimated costs to the hospital ranged from £229 to £314 per course (£307 to £422 per effective course for psoriasis), compared with £114 for out-patient therapy (£149 per effective course for psoriasis). The total cost to society (hospital and patient costs) is around £410 per course, compared to an estimated £550 for outpatient therapy for this group of patients. Treatment was well tolerated, erythema rates were similar to outpatient therapy, there were no complaints and the vast majority would choose home over outpatient phototherapy if required in the future. CONCLUSIONS Hospital supervised home phototherapy appears as safe and effective as outpatient therapy and provides equality of access for patients who cannot attend for outpatient therapy. These patients may otherwise be inadequately treated or given more costly and higher risk systemic therapies, particularly for psoriasis. Commissioners and clinicians involved in dermatology services should provide accessible phototherapy for all patients who might benefit, utilizing home phototherapy where outpatient access is not possible.
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Affiliation(s)
- H Cameron
- Photobiology Unit, The Department of Dermatology, Level 8, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
| | - S Yule
- Photobiology Unit, The Department of Dermatology, Level 8, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - R S Dawe
- Photobiology Unit, The Department of Dermatology, Level 8, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - S H Ibbotson
- Photobiology Unit, The Department of Dermatology, Level 8, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - H Moseley
- Photobiology Unit, The Department of Dermatology, Level 8, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - J Ferguson
- Photobiology Unit, The Department of Dermatology, Level 8, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
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Ibbotson SH, Dawe RS, Morton CA. A survey of photodynamic therapy services in dermatology departments across Scotland. Clin Exp Dermatol 2013; 38:511-6. [DOI: 10.1111/ced.12051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2012] [Indexed: 12/01/2022]
Affiliation(s)
- S. H. Ibbotson
- Photobiology Unit; Ninewells Hospital & Medical School; Dundee; UK
| | - R. S. Dawe
- Photobiology Unit; Ninewells Hospital & Medical School; Dundee; UK
| | - C. A. Morton
- Department of Dermatology; Stirling Community Hospital; Stirling; UK
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Valentine RM, Wood K, Brown CTA, Ibbotson SH, Moseley H. Monte Carlo simulations for optimal light delivery in photodynamic therapy of non-melanoma skin cancer. Phys Med Biol 2012; 57:6327-45. [DOI: 10.1088/0031-9155/57/20/6327] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Kerr AC, Ferguson J, Attili SK, Beattie PE, Coleman AJ, Dawe RS, Eberlein B, Goulden V, Ibbotson SH, Menage HDP, Moseley H, Novakovic L, Walker SL, Woods JA, Young AR, Sarkany RPE. Ultraviolet A1 phototherapy: a British Photodermatology Group workshop report. Clin Exp Dermatol 2012; 37:219-26. [DOI: 10.1111/j.1365-2230.2011.04256.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ferguson J, Ibbotson SH. A case of false-negative monochromator phototesting in a patient with chronic actinic dermatitis taking prednisolone. Br J Dermatol 2012; 167:214-5. [PMID: 22250731 DOI: 10.1111/j.1365-2133.2012.10834.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Berroeta L, Man I, Dawe RS, Ferguson J, Ibbotson SH. Randomized double-blind comparative study of 8-methoxypsoralen bath plus UV-A treatment regimens. Actas Dermosifiliogr 2011; 101:729-30. [PMID: 20965019 DOI: 10.1016/j.ad.2010.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Berroeta L, Attili S, Wong A, Man I, Dawe RS, Ferguson J, Ibbotson SH. Time course for development of psoralen plus ultraviolet A erythema following oral administration of 5-methoxypsoralen. Br J Dermatol 2009; 160:717-9. [PMID: 19183168 DOI: 10.1111/j.1365-2133.2008.09007.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cameron H, Ibbotson SH, Dawe RS, Ferguson J, Moseley H. Within-patient right-left blinded comparison of diode (810 nm) laser therapy and intense pulsed light therapy for hair removal. Lasers Med Sci 2007; 23:393-7. [PMID: 18038179 DOI: 10.1007/s10103-007-0510-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Accepted: 10/01/2007] [Indexed: 11/25/2022]
Affiliation(s)
- H Cameron
- The Photobiology Unit, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
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Berroeta L, Man I, Goudie DR, Whatley SD, Elder GH, Ibbotson SH. Late presentation of erythropoietic protoporphyria: case report and genetic analysis of family members. Br J Dermatol 2007; 157:1030-1. [PMID: 17711525 DOI: 10.1111/j.1365-2133.2007.08117.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Erythropoietic protoporphyria (EPP) is an inherited disorder of haem biosynthesis caused by decreased activity of the enzyme ferrochelatase (FECH), which catalyses the insertion of iron into protoporphyrin, the last step in haem biosynthesis. Development of clinically overt EPP usually requires inheritance of a severe FECH mutation trans to a low-expression FECH variant (FECH IVS3-48C), which is present in 13% of the U.K. population. Reduced FECH activity leads to accumulation of protoporphyrin in various tissues. An excess amount of free protoporphyrin in the skin causes photosensitivity. EPP usually presents in early childhood or infancy, with painful burning and pruritus within minutes of light exposure. Onset of symptoms in adults is rare and often associated with acquired somatic mutation of the FECH gene secondary to haematological malignancy. Here we describe a patient with EPP, in whom the presenting clinical symptom, night-time itch, did not appear until middle age and who had an asymptomatic sister with the same FECH genotype.
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Affiliation(s)
- L Berroeta
- Photobiology Unit, Ninewells Hospital and Medical School, Dundee, UK.
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Smith G, Wilkie MJV, Deeni YY, Farr PM, Ferguson J, Wolf CR, Ibbotson SH. Melanocortin 1 receptor (MC1R) genotype influences erythemal sensitivity to psoralen-ultraviolet A photochemotherapy. Br J Dermatol 2007; 157:1230-4. [PMID: 17916200 DOI: 10.1111/j.1365-2133.2007.08209.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The melanocortin 1 receptor (MC1R) is a highly polymorphic G protein-coupled receptor. Inheritance of various MC1R alleles has been associated with a red hair/fair skin phenotype, increased incidence of skin cancer and altered sensitivity to ultraviolet (UV) radiation. OBJECTIVES To investigate whether MC1R genotype influences erythemal sensitivity to psoralen-UVA photochemotherapy (PUVA) in patients with psoriasis and other common skin diseases. METHODS Patients (n = 111) about to start PUVA were recruited to the study. Erythemal responses were assessed visually at 72 h and 96 h following PUVA by assessment of the minimal phototoxic dose (MPD). MC1R genotype was determined by direct sequencing. RESULTS Inheritance of the MC1R Arg(151)Cys allele was associated with a red hair phenotype (odds ratio 25.19, P = 0.0004). In contrast, inheritance of the Val(60)Leu and Arg(163)Gln SNPs was associated with increased PUVA erythemal sensitivity (reduced MPD) 72 h following treatment in all patients (n = 111; Val(60)Leu chi(2) = 5.764, P = 0.016; Arg(163)Gln chi(2) = 5.469, P = 0.019) and in a subset of patients with psoriasis (n = 55; Val(60)Leu chi(2) = 4.534, P = 0.033; Arg(163)Gln chi(2) = 7.298, P = 0.007). Inheritance of two or more MC1R SNPs was also associated with increased PUVA erythemal sensitivity (reduced MPD) in both patient groups (n = 111; chi(2) = 8.166, P = 0.017; n = 55; chi(2) = 10.303, P = 0.016). CONCLUSIONS Our data demonstrate that MC1R genotype influences PUVA erythemal sensitivity in patients with psoriasis and other common skin diseases.
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Affiliation(s)
- G Smith
- Biomedical Research Centre, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
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Berroeta L, Clark C, Dawe RS, Ibbotson SH, Fleming CJ. A randomized study of minimal curettage followed by topical photodynamic therapy compared with surgical excision for low-risk nodular basal cell carcinoma. Br J Dermatol 2007; 157:401-3. [PMID: 17573890 DOI: 10.1111/j.1365-2133.2007.07996.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kerr AC, Ferguson J, Ibbotson SH. Acute phototoxicity with urticarial features during topical 5-aminolaevulinic acid photodynamic therapy. Clin Exp Dermatol 2007; 32:201-2. [PMID: 17244343 DOI: 10.1111/j.1365-2230.2006.02327.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yule S, Dawe RS, Cameron H, Ferguson J, Ibbotson SH. Does narrow-band ultraviolet B phototherapy work in atopic dermatitis through a local or a systemic effect? Photodermatol Photoimmunol Photomed 2007; 21:333-5. [PMID: 16313246 DOI: 10.1111/j.1600-0781.2005.00184.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The likely mechanisms of action of narrow-band ultraviolet B (NB-UVB) in atopic dermatitis are several. We attempted, in a 12 patient prospective intraindividually controlled study, to determine whether the effect of NB-UVB in atopic dermatitis is primarily through systemic or local effects. Change in observer-assessed severity of patches of dermatitis covered during each whole-body NB-UVB treatment was compared with change in uncovered neighbouring patches. We found great variation between patients in responses. Only in two (of 12) patients was there a large difference between directly exposed and covered patch dermatitis severity. We suspect that the balance of local and systemic effects important in determining response to NB-UVB in atopic dermatitis varies from patient to patient. This study did not conclusively answer our original question, but did show that in some patients localized effects of NB-UVB are important.
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Affiliation(s)
- S Yule
- Department of Dermatology, Ninewells Hospital & Medical School, Dundee, Scotland, UK
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29
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Smith G, Ibbotson SH, Comrie MM, Dawe RS, Bryden A, Ferguson J, Wolf CR. Regulation of cutaneous drug-metabolizing enzymes and cytoprotective gene expression by topical drugs in human skin in vivo. Br J Dermatol 2006; 155:275-81. [PMID: 16882163 DOI: 10.1111/j.1365-2133.2006.07317.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Individuality in the expression and regulation of hepatic drug-metabolizing enzymes (DMEs) and cytoprotective (CP) genes is an important determinant of treatment response. There is increasing evidence that many DMEs and CP genes are also expressed in human skin. Responses to topical drugs used to treat common skin diseases, such as psoriasis, are unpredictable and may potentially be rationalized, at least in part, by interindividual differences in cutaneous DME and CP gene expression. OBJECTIVES We investigated whether three topical drugs [coal tar, all-trans retinoic acid (atRA) and clobetasol 17-propionate] used in routine clinical practice modulated the expression of a variety of DME and CP genes [cytochrome P450s, glutathione S-transferases (GSTs) and drug transporters] in healthy human skin in vivo. METHODS Healthy adult volunteers (n = 30) were invited to participate in the study. Each subject was randomly allocated to receive two of the three study chemicals and one control site application. Crude coal tar (n = 13), atRA (n = 14) or clobetasol 17-propionate (n = 10) was applied under occlusion to photoprotected buttock skin for 96 h. A vehicle control (white soft paraffin) was also applied under the same conditions at an adjacent site in all subjects. Full-thickness punch biopsies (4-mm diameter) were then taken from treated and control sites. Total RNA was extracted and reverse transcribed into cDNA, which was used as a template in subsequent real-time polymerase chain reaction analysis, where fluorescent output was directly proportional to input cDNA concentration. Triplicate measurements of skin mRNA expression were made from each sample, and the arithmetic mean values taken. After logarithmic transformation, the paired t-test was used to compare values between treated and control skin. RESULTS Cytochrome P450s CYP1A1, CYP1A2, CYP1B1, CYP2C18, quinone reductase (NQO-1), GSTP1, gamma-glutamyl cysteine synthetase (gamma-GCS), glutathione peroxidase-1 (GPx-1), cyclooxygenase-2 (COX-2) and haem oxygenase-1 (HO-1) were induced by coal tar; CYP26, NADPH P450 reductase (CPR), GSTP1 and HO-1 by atRA; and CYP3A5 by clobetasol 17-propionate. In contrast, CYP1A1 and CYP1A2 expression was suppressed by atRA, and gamma-GCS and MRP1 by clobetasol 17-propionate. Marked interindividual variation in gene regulation by topical drugs was seen for the majority of genes examined. CONCLUSIONS These data demonstrate that topical drugs can modulate DME gene expression in human skin in vivo and indicate that variation in the expression and regulation of these genes may be a determinant of individuality in response to topical therapies for common skin diseases.
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Affiliation(s)
- G Smith
- Biomedical Research Centre and Photobiology Unit, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
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Abstract
The primary cause of collagen degeneration in necrobiosis lipoidica (NL) is proposed to be immunologically mediated vascular disease. Ultraviolet (UV)A1 has been used successfully to treat scleroderma in which both vascular damage and collagen dysregulation also occur. We treated six patients with NL [(five women; mean age of 32 years (range 22-70) and mean disease duration of 2.9 years (range 6 months to 5 years)] with a high-output ultraviolet (UV)A1 2-kW filtered metal halide source (Dr Hönle; Dermalight ultrA 1) having an emission spectrum of 340-440 nm. All patients had NL on the shins, which had been unresponsive to potent topical corticosteroid therapy (n = 6) and had responded minimally or not at all to TL-01 UVB (n = 2), topical psoralen plus UVA (PUVA) soaking (n = 2) or oral PUVA (n = 1) therapy. Patients received a variable number of total exposures (15-51), given 3-5 times weekly. NL resolved completely in one patient; this patient had minimal improvement after the first course of 16 exposures, but after a further 13 exposures, resolution occurred 6 months later. Two subjects obtained moderate improvement in their overall disease severity after 15 and 24 exposures, while two had only minimal improvement after 15 and 51 exposures. The remaining patient had no improvement after 16 treatments. Patients with the shortest disease duration had the greatest response. UVA1 therapy may be of benefit for the treatment of NL as an adjuvant therapy to topical corticosteroids or as a second-line alternative to other phototherapies, and may have a superior outcome in a proportion of patients.
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Affiliation(s)
- P E Beattie
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
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So JSY, Edwards SL, Ibbotson SH. Carbamazepine-Induced Hypersensitivity Syndrome Occurring in a Photodistributed Pattern. Dermatology 2006; 213:166-8. [PMID: 16902299 DOI: 10.1159/000093861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Accepted: 03/23/2006] [Indexed: 11/19/2022] Open
Abstract
A 76- year- old man was commenced on carbamazepine for partial seizures. This was followed by the development of a rash in an apparently photodistributed pattern, fever, lymphadenopathy, eosinophilia, abnormal liver function tests and atypical lymphocytosis fulfilling the criteria for drug-induced hypersensitivity syndrome. Discontinuation of carbamazepine and application of topical steroid resulted in clearance of the rash, normalization of liver function tests and improvement in eosinophilia. The photodistributed pattern in this case of carbamazepine-induced hypersensitivity syndrome is of interest.
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Affiliation(s)
- J S Y So
- Department of Dermatology, Ninewells Hospital and Medical School, Dundee, UK.
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Bryden AM, Moseley H, Ibbotson SH, Chowdhury MMU, Beck MH, Bourke J, English J, Farr P, Foulds IS, Gawkrodger DJ, George S, Orton DI, Shaw S, McFadden J, Norris P, Podmore P, Powell S, Rhodes LE, Sansom J, Wilkinson M, van Weelden H, Ferguson J. Photopatch testing of 1155 patients: results of the U.K. multicentre photopatch study group. Br J Dermatol 2006; 155:737-47. [PMID: 16965423 DOI: 10.1111/j.1365-2133.2006.07458.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Photoallergic contact dermatitis can be difficult to diagnose if not appropriately investigated. Currently, the most common U.K. photoallergens appear to be sunscreen chemicals. The investigation of choice is photopatch testing (PPT), which is probably underused. In part, this is due to differences in methodology and results interpretation. OBJECTIVES To conduct PPT using a group of sunscreen chemicals, defined indications and a standardized methodology including interpretation and relevance of reactions in patients attending for investigation at 17 centres across the U.K., Ireland and the Netherlands. METHODS Patients (n = 1155) who fulfilled the inclusion criteria were investigated with PPT using sunscreen chemicals in addition to suspected topical products. Readings were taken at 24, 48 and 72 h following standardized ultraviolet A irradiation (5 J cm(-2)). The clinical relevance of any reaction was recorded. RESULTS Of the 1155, 130 had allergic reactions (11.3%). Of these, 51 had photoallergy (PA) (4.4%), 64 had contact allergy (CA) (5.5%), and 15 patients had combined PA and CA (1.3%). Multiple PA was seen in some. The most common photoallergen was benzophenone-3 (27 reactions; 21%). Most reactions (60%) were clinically relevant. The most common indication for testing in patients found to have PA was a history of reacting to a sunscreen (41%). The other 59% had an exposed-site dermatitis/skin problem or a photodermatosis. Some centres (n = 8) performed readings after the standard 48-h reading, and an extra 32 PA and 22 CA reactions were detected, which were not evident at 48 h. A new photoallergen (octyl triazone) was detected in two patients. CONCLUSIONS Sunscreen PA and CA are probably equally uncommon. Most reactions, of both reaction types, were relevant clinically. A large proportion of patients (59%) found to have PA was unaware of reacting to a sunscreen chemical, suggesting that PA should be considered as an explanation in any exposed-site dermatitis. Although this study focused on reactions at 48 h postirradiation, readings performed up to 96 h, while inconvenient, add value by detecting additional relevant responses. A previously unknown photoallergen was found, highlighting the need for awareness of novel photoallergens in the marketplace. A standardized PPT method not only encourages more use of this investigation, but also facilitates comparison of results between centres and so will improve our understanding of PA.
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Affiliation(s)
- A M Bryden
- The Welsh Institute of Dermatology, University Hospital of Wales, Cardiff, UK.
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Abstract
BACKGROUND Lichen sclerosus (LS) is characterized histologically by an inflammatory T-cell infiltrate, sclerosis and thickening of the dermis, and epidermal atrophy. Ultraviolet (UV) A1 therapy has been shown to be effective in the management of morphea and scleroderma, diseases that have some histological and clinical similarities with LS, and more recently in extragenital LS. AIM To determine the effectiveness of UVA1 therapy for genital LS. METHODS Seven women with severe genital LS uncontrolled by ultrapotent topical corticosteroids, with a median age of 62 years (range 48-78) and disease duration of 6-47 years, were treated with UVA1 therapy from a high output source. After completion of UVA1 therapy, a clinician and the patient graded the overall response of symptoms and physical signs. RESULTS Five patients improved with therapy. Three obtained moderate improvement in overall disease severity and two had minimal improvement. Of these five, one relapsed within 3 months and another after a year. Both had a further course of UVA1 therapy, resulting in minimal improvement in one and moderate improvement in the other. In the remaining three, disease severity had improved to a point where intermittent use of topical corticosteroids resulted in acceptable control. DISCUSSION UVA1 therapy may be of benefit in the management of vulval LS, a disease that is often poorly responsive to standard therapies. The therapy is well tolerated and could provide an acceptable therapeutic option for patients with severe disease.
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Affiliation(s)
- P E Beattie
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
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Ibbotson SH, Jong C, Lesar A, Ferguson JS, Padgett M, O'Dwyer M, Barnetson R, Ferguson J. Characteristics of 5-aminolaevulinic acid-induced protoporphyrin IX fluorescence in human skin in vivo. Photoderm Photoimm Photomed 2006; 22:105-10. [PMID: 16606416 DOI: 10.1111/j.1600-0781.2006.00202.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE Topical photodynamic therapy (PDT) is increasingly being used to treat skin cancers. Knowledge of the detailed characteristics of 5-aminolaevulinic acid (ALA)-induced protoporphyrin IX (PpIX) fluorescence in diseased and normal skin is incomplete. Understanding the characteristics of PpIX fluorescence in normal skin may facilitate optimization of PDT regimes while minimizing side effects in the surrounding normal skin. We investigated the characteristics of ALA-induced PpIX fluorescence in normal skin. METHODS ALA was applied to the arm, back and leg skin of 21 healthy volunteers for 1-6 h, and PpIX fluorescence was measured for up to 24 h after ALA application using a fluorescent spectrometer. The effect of tape stripping on fluorescence was also examined. RESULTS Considerable inter-subject variation was observed in the time to reach peak PpIX fluorescence. Intra-subject variation in the time to peak fluorescence was dependent on ALA application time. Six hours after ALA application, no significant difference was observed in the degree of fluorescence achieved irrespective of ALA application times ranging between 1 and 6 h. PpIX fluorescence was reduced on the leg and increased by tape stripping. CONCLUSIONS Marked inter- and intra-subject variation in ALA-induced PpIX fluorescence occurs in normal human skin. ALA application time, body site and the state of the stratum corneum are all determinants of PpIX fluorescence within subjects and these factors need to be taken into account in optimization of PDT regimes.
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Affiliation(s)
- S H Ibbotson
- Photobiology Unit, Ninewells Hospital, University of Dundee, Dundee, UK.
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Ibbotson SH, Jong C, Lesar A, Ferguson JS, Padgett M, O'Dwyer M, Barnetson R, Ferguson J. Characteristics of 5-aminolaevulinic acid-induced protoporphyrin IX fluorescence in human skin in vivo. Photodermatol Photoimmunol Photomed 2006; 22:105-110. [PMID: 16606416 DOI: 10.1111/ppp.2006.22.issue-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND/PURPOSE Topical photodynamic therapy (PDT) is increasingly being used to treat skin cancers. Knowledge of the detailed characteristics of 5-aminolaevulinic acid (ALA)-induced protoporphyrin IX (PpIX) fluorescence in diseased and normal skin is incomplete. Understanding the characteristics of PpIX fluorescence in normal skin may facilitate optimization of PDT regimes while minimizing side effects in the surrounding normal skin. We investigated the characteristics of ALA-induced PpIX fluorescence in normal skin. METHODS ALA was applied to the arm, back and leg skin of 21 healthy volunteers for 1-6 h, and PpIX fluorescence was measured for up to 24 h after ALA application using a fluorescent spectrometer. The effect of tape stripping on fluorescence was also examined. RESULTS Considerable inter-subject variation was observed in the time to reach peak PpIX fluorescence. Intra-subject variation in the time to peak fluorescence was dependent on ALA application time. Six hours after ALA application, no significant difference was observed in the degree of fluorescence achieved irrespective of ALA application times ranging between 1 and 6 h. PpIX fluorescence was reduced on the leg and increased by tape stripping. CONCLUSIONS Marked inter- and intra-subject variation in ALA-induced PpIX fluorescence occurs in normal human skin. ALA application time, body site and the state of the stratum corneum are all determinants of PpIX fluorescence within subjects and these factors need to be taken into account in optimization of PDT regimes.
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Affiliation(s)
- S H Ibbotson
- Photobiology Unit, Ninewells Hospital, University of Dundee, Dundee, UK.
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Beattie PE, Dawe RS, Traynor NJ, Woods JA, Ferguson J, Ibbotson SH. Can St John's wort (hypericin) ingestion enhance the erythemal response during high-dose ultraviolet A1 therapy? Br J Dermatol 2006; 153:1187-91. [PMID: 16307656 DOI: 10.1111/j.1365-2133.2005.06946.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND St John's wort (SJW) is widely used as a treatment for depression. A phototoxic reaction, due to its content of hypericin, can occur in animals and in cell culture, and has been reported in humans. Hypericin displays absorption within the ultraviolet (UV) A1 spectrum and there may therefore be a potential for phototoxicity if taken during high-dose UVA1 therapy. OBJECTIVES To assess the phototoxicity risk of SJW ingestion. METHODS Eleven adult volunteers of skin types I and II were exposed to a geometric dose series of UVA1 irradiation from a high-output source (Dermalight Ultra 1; Dr Hönle, Martinsreid, Germany; irradiance 70-77 mW cm(-2)) on the photoprotected lower back skin at eight 1.5-cm(2) test areas. Irradiation was carried out at baseline and after 10 days of SJW extract 1020 mg (equivalent to 3000 microg of hypericin) daily. Four, 8, 24 and 48 h after each exposure, the minimal erythema dose (MED) and the presence or absence of pigmentation were recorded visually and erythema was assessed objectively with an erythema meter. RESULTS The median MED and D(0.025), an objective measure of MED, were lower at all time-points after SJW ingestion. The visual erythemal peak (lowest median MED), which was seen at 8 h postirradiation, was lower after SJW (median 14 J cm(-2), range 10-56) than at baseline (median 20 J cm(-2), range 14-56) (P = 0.047). Similarly, the median D(0.025) at 8 h postirradiation was lower after SJW (median 22.0 J cm(-2), range 15.2-53.9) than at baseline (median 33.7 J cm(-2), range 22.9-136.0) (P = 0.014). The MED and D(0.025) were also significantly different at the 48-h and 4-h time-points, respectively. Significance was not reached at the 24-h time-point. Median intensity of postirradiation erythema increased at all time-points after ingestion of SJW. Despite these differences, the maximum slope of the dose-response curve was not increased after SJW ingestion. CONCLUSIONS These data suggest that SJW extract has the potential to lower the erythemal threshold to UVA1 irradiation in a significant proportion of individuals and highlight the importance of ascertaining a full drug history, including herbal remedies, before initiating UVA1 phototherapy.
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Affiliation(s)
- P E Beattie
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, U.K.
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Finlan LE, Kernohan NM, Thomson G, Beattie PE, Hupp TR, Ibbotson SH. Differential effects of 5-aminolaevulinic acid photodynamic therapy and psoralen + ultraviolet A therapy on p53 phosphorylation in normal human skin in vivo. Br J Dermatol 2005; 153:1001-10. [PMID: 16225614 DOI: 10.1111/j.1365-2133.2005.06922.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Phosphorylation of the tumour suppressor p53 by the CK2/FACT pathway plays a central role in suppressing ultraviolet (UV)-induced skin cancer in animal models. Although p53 protein stabilization is induced after solar-simulated irradiation of human skin in vivo, p53 phosphorylation has not been defined. OBJECTIVES To investigate the effects of clinically effective treatments for skin diseases including psoralen + UVA (PUVA) and photodynamic therapy (PDT) on p53 phosphorylation to determine whether the tumour-suppressing p53 kinase pathways are activated upon use of these therapies. METHODS We used antibodies to the ATM/ATR and CK2/FACT phosphorylation sites on p53. RESULTS We found that p53 activation was induced selectively by PUVA treatment, while 8-oxo-7,8-dihydroguanine DNA damage was induced selectively by 5-aminolaevulinic acid (ALA)-PDT treatment. Importantly, PUVA treatment resulted in p53 kinase activation, as defined by p53 modification at AT (serine-15) and CK2/FACT (serine-392) sites within the proliferative compartment. CONCLUSIONS These data demonstrate that PUVA provokes accumulation and phosphorylation of p53 by AT and CK2/FACT within critical proliferative focal points (as determined by p63 colocalization studies) where DNA damage may lead to tumorigenesis. PDT is mechanistically distinct in that there is a lower level of induction of p53 expression with no evidence of AT- or CK2/FACT-mediated phosphorylation. This suggests that the type of DNA damage created by the reactive oxygen species generated by ALA-PDT does not induce the p53 pathway classically required for the repair of DNA photoadducts induced by UV.
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Affiliation(s)
- L E Finlan
- University of Edinburgh, Divisin of Oncology, Cancer Research UK Cell Signalling Unit, South Crewe Road, Edinburgh EH4 2XU, UK.
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Traynor NJ, Beattie PE, Ibbotson SH, Moseley H, Ferguson J, Woods JA. Photogenotoxicity of hypericin in HaCaT keratinocytes: Implications for St. John's Wort supplements and high dose UVA-1 therapy. Toxicol Lett 2005; 158:220-4. [PMID: 15890476 DOI: 10.1016/j.toxlet.2005.03.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Revised: 03/31/2005] [Accepted: 03/31/2005] [Indexed: 11/20/2022]
Abstract
Extract of St. John's Wort (Hypericum perforatum) is commonly used as natural remedy for treatment of mild to moderate depression. However, it contains a powerful photoactive component, hypericin, which can cause a severe photodermatitis when eaten by grazing animals (hypericism). In humans, there is evidence that supplementation with St. John's Wort can reduce the minimal erythemal dose (MED) in patients undergoing high dose UVA-1 phototherapy. This is a recent development in phototherapy where the most erythemogenic parts of the UVA spectrum are filtered out, allowing delivery of higher doses of the longer wavelengths of UVA. Although current published evidence suggests that the plasma levels of hypericin are unlikely to cause clinical phototoxicity, it has been established that photoactive compounds can cause DNA damage at sub-toxic and sub-erythemal doses, the effects of which might not be apparent for many years after the event. The present study used HaCaT keratinocytes to investigate the photoclastogenic ability of hypericin on irradiation with UVA. The results show that although the combination of hypericin and UVA light increased the genotoxic burden, when all factors are taken into account, the risk of significant photogenotoxic damage incurred by the combination of Hypericum extracts and UVA phototherapy may be low in the majority of individuals.
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Affiliation(s)
- N J Traynor
- Photobiology Unit, Department of Dermatology, Ninewells Hospital and Medical School, University of Dundee, Scotland, Dundee DD1 9SY, UK
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Beattie PE, Finlan LE, Kernohan NM, Thomson G, Hupp TR, Ibbotson SH. The effect of ultraviolet (UV) A1, UVB and solar-simulated radiation on p53 activation and p21. Br J Dermatol 2005; 152:1001-8. [PMID: 15888160 DOI: 10.1111/j.1365-2133.2005.06557.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND High-dose ultraviolet (UV) A1 therapy (doses in the order of 130 J cm(-2)) is effective for atopic dermatitis and scleroderma. UVA1 has been shown to induce a dose-dependent increase in p53 expression in keratinocytes. OBJECTIVES To examine the effect of UVA1 on the activation of p53 by phosphorylation, which has not yet been studied. METHODS Five adult volunteers were exposed to dose series of UVA1 (10-100 J cm(-2)) and, for comparison, narrowband UVB (TL-01) (25-550 mJ cm(-2)) and solar-simulated radiation (SSR) (5.6-30 J cm(-2)) on photoprotected buttock skin and the minimal erythema dose (MED) for each was determined at 24 h. Separate sites on the buttock were subsequently irradiated with a 3-MED dose of UVA1, TL-01 and SSR. At 24 h, punch biopsies (4 mm) were taken from each irradiated site and from an adjacent unirradiated control site, and immunohistochemical staining for p53 (Do-1), activation of p53 (assessed by phosphorylation at serine 15 and serine 392) and p21 was performed. Cell staining was expressed as the mean number of cells stained per three high-power fields (HPFs) and as a percentage of 1000 cells. Sunburn cells (SBCs) were also counted per HPF. RESULTS UVA1 produced negligible numbers of SBCs, relatively little p53 (Do-1) staining (mean +/- SD cell count per HPF 16 +/- 10), no p53 activation and very little evidence of p21 expression (mean +/- SD cell count per HPF 5.3 +/- 7), in contrast to TL-01 (mean +/- SD cell count per HPF of 11.83 +/- 2.1 SBCs, 146.3 +/- 38 for Do-1, 26.6 +/- 15 for serine 15, 14.9 +/- 12 for serine 392 and 77.9 +/- 30 for p21) or SSR irradiation (mean +/- SD cell count per HPF of 3.5 +/- 1.2 SBCs, 147.5 +/- 62 for Do-1, 54 +/- 50 for serine 15, 38.9 +/- 18 for serine 392 and 56.7 +/- 30 for p21). CONCLUSIONS These data indicate that there are fundamental differences in the effects of UVA1 on p53 and its activation pathways compared with TL-01 and SSR, and may in part explain the differential effects of these phototherapies.
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Affiliation(s)
- P E Beattie
- Photobiology Unit, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
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Abstract
BACKGROUND Limited information is available on the carcinogenic risk associated with narrowband TL-01 UVB phototherapy in humans. OBJECTIVES To determine the skin cancer incidence in a population treated with TL-01 phototherapy. PATIENTS AND METHODS All TL-01-treated patients were identified from the departmental computerized database. Patients with malignant melanoma (MM), squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) were identified by record linkage with the Scottish Cancer Registry. The incidence of each was compared with the normal Scottish population matched for age and sex. RESULTS Data were obtained from 1908 patients. The median follow-up duration was 4 years (range 0.04-13). The median cumulative number of TL-01 treatments and dose were 23 (1-199) and 13 337 (30-284 415) mJ cm(-2), respectively. No increased incidence of SCC or MM was observed. Ten patients developed BCC compared with an expected 4.7 in the Scottish population [standardized rate ratio 213 (95% confidence interval 102-391); P < 0.05]. CONCLUSIONS A small but significant increase of BCC was detected in the TL-01 group. This could be explained by a number of factors, including ascertainment bias. To determine the true carcinogenic risk of TL-01 phototherapy, longer follow-up is essential.
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Affiliation(s)
- I Man
- Photobiology Unit, Department of Dermatology and Department of Public Health and Epidemiology, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
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Dawe RS, Yule S, Cameron H, Moseley H, Ibbotson SH, Ferguson J. A randomized controlled comparison of the efficacy of Dead Sea salt balneophototherapy vs. narrowband ultraviolet B monotherapy for chronic plaque psoriasis. Br J Dermatol 2005; 153:613-9. [PMID: 16120152 DOI: 10.1111/j.1365-2133.2005.06663.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Dead Sea (DS) salt solution soaks are used in combination with narrowband ultraviolet B (NB-UVB) to treat psoriasis in many centres, particularly in continental Europe. No previously published controlled study has assessed DS salt + NB-UVB balneophototherapy. OBJECTIVES To compare DS salt balneophototherapy with NB-UVB monotherapy for chronic plaque psoriasis. METHODS Sixty patients with chronic plaque psoriasis participated in this paired, controlled study, with pretreatment DS salt soaks randomly allocated to each participant's right or left study limb. Psoriasis severity was assessed with a Scaling, Erythema and Induration score by a blinded observer. Assessments were weekly during the therapy course, and thereafter 8-weekly until relapse or for up to 1 year after clearance. RESULTS The mean area under the psoriasis severity-time curves during treatment was not detectably lower with DS salt balneophototherapy than with NB-UVB monotherapy (P = 0.099). The psoriasis severity score fell slightly more from beginning to end of courses with DS salt balneophototherapy than with NB-UVB monotherapy (P = 0.019). There was no detectable difference in times to relapse. CONCLUSIONS In this population the addition of pretreatment DS salt soaks to NB-UVB did not result in a clinically important improvement in clearance of psoriasis.
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Affiliation(s)
- R S Dawe
- Photobiology Unit, Department of Dermatology, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
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Berroeta L, Lewis-Jones MS, Evans AT, Ibbotson SH. Woringer-Kolopp (localized pagetoid reticulosis) treated with topical photodynamic therapy (PDT). Clin Exp Dermatol 2005; 30:446-7. [PMID: 15953099 DOI: 10.1111/j.1365-2230.2005.01783.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Lentigo maligna (LM) is an in situ form of malignant melanoma, and surgical excision is often unsatisfactory. Imiquimod cream is an immune response modifier and induces a predominantly T-helper 1 type response. OBJECTIVES Assessment of histological and clinical response of surgically resectable LM after treatment with 5% imiquimod cream. METHODS Six patients with LM were treated with 5% imiquimod cream daily for 6 weeks. The whole site of the original lesion was then excised. Clinical and histological and appearances were measured using clinical response and histological grading scores. RESULTS Complete or almost complete clearance of pigmentation with minimal residual histological evidence of LM was observed in four patients, one patient showed no clinical or histological improvement, and the remaining patient had almost no residual pigmentation clinically after treatment yet histopathological changes remained as severe as before treatment. CONCLUSIONS Topical imiquimod cream merits further investigation as a new therapy for LM.
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Affiliation(s)
- C J Fleming
- Departments of Dermatology and Pathology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
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Ibbotson SH, Bilsland D, Cox NH, Dawe RS, Diffey B, Edwards C, Farr PM, Ferguson J, Hart G, Hawk J, Lloyd J, Martin C, Moseley H, McKenna K, Rhodes LE, Taylor DK. An update and guidance on narrowband ultraviolet B phototherapy: a British Photodermatology Group Workshop Report. Br J Dermatol 2004; 151:283-97. [PMID: 15327535 DOI: 10.1111/j.1365-2133.2004.06128.x] [Citation(s) in RCA: 199] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Summary These guidelines for use of narrowband (TL-01) ultraviolet B have been prepared for dermatologists by the British Photodermatology Group on behalf of the British Association of Dermatologists. They present evidence-based guidance for treatment of patients with a variety of dermatoses and photodermatoses, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of background photobiology.
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Affiliation(s)
- S H Ibbotson
- Pathobiology Unit, Ninewells Hospital and Medical School, Dundee, UK.
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Bruynzeel DP, Ferguson J, Andersen K, Gonçalo M, English J, Goossens A, Holzle E, Ibbotson SH, Lecha M, Lehmann P, Leonard F, Moseley H, Pigatto P, Tanew A. Photopatch testing: a consensus methodology for Europe. J Eur Acad Dermatol Venereol 2004; 18:679-82. [PMID: 15482294 DOI: 10.1111/j.1468-3083.2004.01053.x] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A group of interested European Contact Dermatologists/Photobiologists met to produce a consensus statement on methodology, test materials and interpretation of photopatch testing. While it is recognized that a range of local variables operate throughout Europe, the underlying purpose of the work is to act as an essential preamble to a Pan European Photopatch Test Study focusing particularly on sunscreen chemicals.
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Affiliation(s)
- D P Bruynzeel
- Photobiology Unit, Ninewells Hospital, Medical School, Dundee DD19SY, UK
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Beattie PE, Traynor NJ, Woods JA, Dawe RS, Ferguson J, Ibbotson SH. Can a positive photopatch test be elicited by subclinical irritancy or allergy plus suberythemal UV exposure? Contact Dermatitis 2004; 51:235-40. [PMID: 15606647 DOI: 10.1111/j.0105-1873.2004.00432.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Photopatch test (PhPT) interpretation is difficult and clinical relevance is not always apparent. A positive PhPT may reflect photocontact allergy or phototoxicity. We hypothesized that it may also reflect the additive or synergistic effects of a suberythemal reaction to a contact irritant [e.g. sodium lauryl sulfate (SLS)] or allergen (e.g. nickel) and suberythemal UV exposure. 10 nickel allergic volunteers had duplicate SLS and nickel series applied on either side of the back for 24 h and 48 h, respectively. After removal, one side was irradiated with 5 J/cm(2) UVA or the dose below the minimal erythema dose for solar-simulated radiation (SSR). The minimal irritancy dose (MID) for SLS and the minimal allergenic dose (MAD) for nickel were determined visually and objectively by erythema meter. While photoaugmentation of subclinical contact allergy or irritancy occurred in some subjects, photosuppression occurred in roughly an equal number. UVA changed the nickel MAD at 48 h in 2 of 5 volunteers but not the SLS MID. SSR changed the nickel MAD in 4 of 5 and the SLS MID in 3 of 5. 2 subjects (none after UVA) showed erythema only in the irradiated set of patches, which could have been interpreted as a positive PhPT. We have demonstrated photoaugmentation and photosuppression of contact allergy and irritancy, which could result in false-positive or false-negative interpretation of PhPTs.
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Affiliation(s)
- P E Beattie
- Photobiology Unit, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
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Beattie PE, Dawe RS, Ferguson J, Ibbotson SH. Lack of efficacy and tolerability of topical PDT for psoriasis in comparison with narrowband UVB phototherapy. Clin Exp Dermatol 2004; 29:560-2. [PMID: 15347356 DOI: 10.1111/j.1365-2230.2004.01604.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
BACKGROUND We recently investigated the characteristics of psoralen plus ultraviolet (UV) A erythema in skin photosensitized by topical 8-methoxypsoralen (8-MOP) in three independent studies. OBJECTIVES In order to determine the optimal time to read the minimal phototoxic dose (MPD) after treatment with topical 8-MOP and irradiation with UVA, we assessed the overall data. METHODS One forearm of each subject was immersed in 8-MOP solution for 15 min and test sites on the flexor surface of the forearm were immediately exposed to a UVA dose series. Erythema was assessed visually and objectively using a reflectance instrument at 24-h intervals for 7 days. RESULTS Results were obtained from 44 subjects (predominantly Fitzpatrick skin phototype II). A broad erythemal plateau was evident beyond 72 h and the visual MPD was significantly lower at 96, 120 and 144 h than at 72 h (P < 0.01). Only 30% of subjects were at peak erythema at the conventional MPD assessment time of 72 h. The median time to reach maximal erythema was 96 h (range 48-144). Objectively, 85% of subjects were at peak erythema at or beyond 96 h. CONCLUSIONS We recommend that (i) the optimal time to read the topical 8-MOP MPD is 4 days after UVA exposure as readings beyond this time may be difficult to interpret because of the development of pigmentation, and (ii) 40% of the topical 8-MOP MPD should be considered for the first treatment.
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Affiliation(s)
- I Man
- Photobiology Unit, Department of Dermatology, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
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Clark C, Cameron H, Moseley H, Ferguson J, Ibbotson SH. Treatment of superficial cutaneous vascular lesions: experience with the KTP 532�nm laser. Lasers Med Sci 2004; 19:1-5. [PMID: 15316851 DOI: 10.1007/s10103-004-0294-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2002] [Accepted: 12/23/2002] [Indexed: 11/28/2022]
Abstract
Whilst most facial telangiectasias respond well to short-pulse-duration pulsed dye laser therapy, studies have shown that for the treatment of larger vessels these short-duration pulses are sub-optimal. Long-pulse frequency-doubled neodymium:YAG lasers have been introduced with pulse durations ranging from 1-50 ms and treatment beam diameters of up to 4 mm. We report the results of KTP/532 nm laser treatment for superficial vascular skin lesions. The aim was to determine the efficacy of the KTP/532 nm laser in the treatment of superficial cutaneous vascular lesions at a regional dermatology centre in a 2 year retrospective analysis. Patients were referred from general dermatology clinics to a purpose-built laser facility. A test dose was performed at the initial consultation and thereafter patients were reviewed and treated at 6 week intervals. Outcome was graded into five classifications by the patient and operator independently based on photographic records: clear, marked improvement, partial response, poor response, and no change or worsening. Over the 2 year period, 204 patients with 246 diagnoses were treated [156 female; median age 41 (range 1-74) years; Fitzpatrick skin types I-III]. Equal numbers of spider angioma (102) and facial telangiectasia (102) were treated. Of those patients who completed treatment and follow up, 57/58 (98%) of spider angiomas and 44/49 (90%) of facial telangiectasia markedly improved or cleared. Satisfactory treatment outcomes, with one clearance and two partial responses, occurred in three of five patients with port-wine stain. Few patients experienced adverse effects: two declined further treatment due to pain, and a small area of minimal superficial scarring developed in one case. Two patients developed mild persistent post-inflammatory hyperpigmentation, and one subject experienced an episode of acute facial erythema, swelling and blistering after one treatment. The KTP/532 nm frequency-doubled neodymium:YAG laser is a safe and effective treatment for common superficial cutaneous vascular lesions in patients with Fitzpatrick skin types I-III.
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Affiliation(s)
- C Clark
- Photobiology Unit, Department of Dermatology, Ninewells Hospital Medical School, University of Dundee, DD1 9SY, UK
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