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Background@#Phototherapy had been a less favourable treatment in recent years. Our study aims to audit the usage of NB-UVB phototherapy service in a tertiary hospital in East Malaysia.@*Methods@#This is a retrospective study. Phototherapy file of patients who underwent NB-UVB phototherapy between year 2016 and 8 March 2021 were reviewed. Demographic data, treatment history, and acute side effects were analysed.@*Results@#Forty eight subjects were recruited in this study. The majority (33.3%) of the subjects were in 20-29 age group. There was an equal number of male and female subjects. About 66.7% of the subjects had psoriasis and 18.8% of them had vitiligo. Nearly 36.6% of the subjects had 26-50% body surface area involved at initial phototherapy. Almost 54.2% of the subjects had <50 sessions of NB-UVB phototherapy. About 52.1% of the subjects had a cumulative dose of NB-UVB <25 J/cm2 while 26.7% of subjects had a cumulative dose >200 J/cm2. Acute side effects including burning (17.8%), pruritus (4.4%) and flare of psoriasis (2.2%).@*Discussion@#Low utilization rate of NB-UVB phototherapy was likely due to logistical and transportation factors. Psoriasis was the commonest indication for NB-UVB in our study followed by vitiligo. Annual skin malignancy surveillance should be done especially on patients received NB-UVB >350 sessions even after the discontinuation of treatment. Most patients tolerate NB-UVB phototherapy well with no major side effects.@*Conclusion@#In conclusion, NB-UVB phototherapy is a relatively safe yet underutilised treatment in our centre.
Subject(s)
Phototherapy , Tertiary Care Centers , MalaysiaABSTRACT
OBJECTIVE:To observe therapeutic efficacy and safety of NB-UVB combined with Total glucosides of white paeony(TGP)capsules and Urea cream in the treatment of psoriasis vulgaris. METHODS:A total of 75 patients with psoriasis vulgaris in dermatology department of our hospital during Jan. 2015-Dec. 2016 were divided into control group(37 cases)and observation group(38 cases)according to random number table. Control group was given TGP capsules 0.6 g orally,3 times a day,reducing to 0.3 g,3 times a day if diarrhea or stool increased significantly after taking the medicine+Urea cream,smearing on the skin,day and evening,for consecutive 12 weeks. Observation group was additionally given NB-UVB irradiation with initial dose of 0.36 J/cm2,2 min/time,every other day,adjusted according to skin reaction for consecutive 8 weeks,on the basis of control group. Clinical efficacies of 2 groups were observed,and PASI scores before and after treatment and the occurrence of ADR were observed. RESULTS:One patient of observation group withdrew from therapy after suffering from obvious edematous erythema with pain due to irradiation. All patients of control group completed treatment. Total response rate of observation group (86.49%)was significantly higher than that of control group(56.76%),with statistical significance(P<0.05). Before treatment, there was no statistical significance in PASI scores between 2 groups(P>0.05). After treatment,PASI scores of 2 groups were significantly lower than before treatment,and observation group was significantly lower than control group,with statistical significance(P<0.05). There was no statistical significance in total incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:NB-UVB combined with TGP capsules and Urea cream show good therapeutic efficacy and safety for psoriasis vulgaris,and can significantly decrease PASI score of patients.
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To evaluate the efficacy of different courses of Narrowband Ultraviolet B phototherapy ( NB-UVB) in the treatment of vitiligo .50 vitiligo patients who had finished 3 courses of phototherapy and met the inclusion criteria were included in our study .Each course contained at least 30 times of phototherapy , and between two courses , there was a rest of 3~6 months .The repigmentation of each vitiligo lesion after every course of phototherapy was recorded .To the same lesion , the efficacy difference between the first course and the second course was not statisti -cally significant.But the efficacy of the first course was better than the third course (P<0.05),while the efficacy of the second course was also better than the third course ( P<0.05 ) .There was no significant difference among the three courses concerning the average single irradiation dose .In conclusion , when using NB-UVB in treating vitili-go, the efficacy of first course was equivalent to the second course , but it reduced in the third course .Whenever a plateform stage occurs , a rest of more than 3 months is long enough for the vitiligo lesion to recover initial light sen-sitivity.
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Objective To observe the clinical curative effect of NB -UVB combined with prednisone on neuralgia following herpes zoster .Methods 84 patients with neuralgia following herpes zoster were randomly divided into treatment group and control group , with 42 in each.The treatment group were given NB -UVB 3 times weekly, and oral prednisone tablet 10mg three times daily for 14 days.The control group was treated with prednisone tablet 10mg three times and indomethacin 25 mg two times daily for 14 days.The visual analogue scale (VAS) was used to evaluate the therapeutic effects in the two groups .Results The effective rate of the treatment group was 88.1%, and that of the control group was 69.05%.The therapeutic effect in the treatment group was statistically significant higher than that of the control group (χ2 =5.974, p=0.015).No marked side effects were observed in both groups .Con-clusion NB-UVB combined with prednisone is effect in the treatment of neuralgia following herpes zostert .
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Eczematid-like purpura of Doucas and Kapetanakis is a type of pigmented purpuric dermatoses. It is clinically characterized by pruritic seasonal eruptions occurring in the spring and summer, and histopathologically characterized by spongiosis and parakeratosis in the epidermis and by the lymphocyte-mediated leakage of erythrocytes from capillaries in the papillary dermis. We report a case of eczematid-like purpura of Doucas and Kapetanakis that showed clinical improvement with narrowband UVB (NB-UVB). The patient was a 66-year-old man with pruritic, well-demarcated scaly purpuric patches on his feet that appeared 2 months prior. A histopathological study showed mild superficial perivascular lymphocytic infiltration, focal spongiosis with exocytosis, and erythrocyte leakage. We initiated treatment with an oral antihistamine, ascorbic acid, and a topical steroid, but the lesion was aggravated. We therefore treated the patient with NB-UVB for 6 months, and the lesions regressed progressively with residual postinflammatory hyperpigmentation.
Subject(s)
Aged , Humans , Ascorbic Acid , Capillaries , Dermis , Epidermis , Erythrocytes , Exocytosis , Foot , Hyperpigmentation , Parakeratosis , Purpura , Seasons , Skin DiseasesABSTRACT
BACKGROUND: These days, narrowband-UVB (NB-UVB) phototherapy is used worldwide for treating psoriasis. Some evidence allegedly suggests that, in contrast to broadband UVB therapy, near- erythemogenic doses are not required as starting doses for NB-UVB phototherapy to decrease the risk of burning. However, a recent study has proved that the near-erythemogenic dose to start NB-UVB phothotherapy was preferable to the far-erythemogenic dose method. OBJECTIVE: We compared the therapeutic effects between 70% MED (MED70%) and 50% MED (MED50%) methods in NB-UVB phototherapy of psoriasis. In addition, to elucidate the action mechanism of NB-UVB in psoriasis treatment, we also investigated the immunosuppresive effects of Langerhans cells, macrophages and chemokine/chemokine receptors. METHOD: We compared the near-erythemogenic NB-UVB protocol (initial 70% MED+delta10% increase at each visit, twice per week) with the far-erythemogenic protocol (initial 50% MED+delta10% increase at each visit, twice per week). We performed skin biopsies after 4 times of 1 MED, once of 4 MED and once of 1 MED, along with corresponding controls from the lesional and non-lesional sites. Immunohistochemistry was also performed with anti-CD1a, anti-CD11b, anti-MCP-1 and anti-CCR2 antibodies. RESULTS: The results of immunohistochemcial experiments were as follows; 1. NB-UVB irradiation decreased the number of CD1a+ Langerhans cells in the epidermis, but increased CD11b+ macrophages in the dermis. CD11b+ macrophages were increased more in the dermis in single high-dose irradiation than repeated small dose irradiations of equivalent total doses. 2. MCP-1 was expressed only in the entire epidermis of the psoriatic lesion, and was especially high in proliferating keratinocytes of basal and suprabasal layers. It was also expressed in the papillary dermis to a lesser extent. CCR2, a receptor for MCP-1, was also found to be expressed in a similar pattern to MCP-1. Single high-dose irradiation reduced MCP-1 and CCR2 to a moderate degree, especially in the basal layer, more than the repeated low-dose irradiation of an equivalent total dose. CONCLUSION: The near erythemogenic NB-UVB protocol (MED70%) showed an earlier resolution of the psoriatic lesions and a lower recurrent rate than the far-erythemogenic NB-UVB protocol. Higher NB-UVB reduced the number of CD1a+ Langerhans cells in the epidermis, and increased CD11b+ monocytes/macrophages in the dermis. A higher dose of NB-UVB downregulated CCR-2 and MCP-1 expression. The expression patterns of epidermal and dermal APCs and chemokines in this study indicate that NB-UVB in psoriasis treatment has immunosuppressive properties. For better NB-UVB protocols in psoriasis treatment, higher starting doses and incremental doses may be desirable.