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Background@#Narrowband ultraviolet-B (NBUVB) is an effective treatment option for psoriasis. Vitamin D insufficiency is common in psoriasis patients. We assessed the effect of NBUVB on vitamin D levels amongst psoriasis patients with skin phototype III, IV and V.@*Methods@#Psoriasis patients planned for NBUVB phototherapy were enrolled in a prospective cohort study in Hospital Putrajaya and Hospital Kuala Lumpur from May 2020-December 2020. NBUVB phototherapy was given twice weekly for 12 weeks. Serum 25 (OH)D level was measured at baseline and at week 12.@*Results@#A total of 21(63.6%) male and 12(36.4%) female patients aged 18-66 years participated. Majority were Fitzpatrick skin phototype (FSP) IV (66.7%) followed by FSP V (21.2%) and FSP III (12.1%). Serum 25(OH)D increased significantly (p<0.001) from 52.09±21.43 nmol/L at baseline to 72.80±19.56 nmol/L at week 12 with the most increment seen in skin type V. There was also a significant improvement seen in Body Surface Area (BSA) involvement after 12 weeks of phototherapy (p<0.001). There was no correlation seen between BSA at week 12 with serum 25(OH)D and percentage of serum 25(OH) D increment.@*Conclusion@#NBUVB phototherapy increases the level of serum 25(OH)D in psoriasis patients with darker skin types while simultaneously clearing psoriasis.
Subject(s)
Psoriasis , Phototherapy , Vitamin DABSTRACT
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
Narrowband ultraviolet B has been applied to the treatment of vitiligo for more than 10 years in China.Currently,there are no consistent standards for clinical treatment parameters,and patients cannot benefit from non-standard treatment,which is liable to cause erythema,blisters,photoaging and other adverse reactions.Based on the Vitiligo Working Group recommendations for narrowband ultraviolet B phototherapy for vitiligo,relevant literature and clinical experiences,the authors discuss parameters of narrowband ultraviolet B phototherapy for vitiligo from the aspects of treatment frequency,initial dosing,dose adjustment during consecutive treatment or after missed treatment,response plateau,treatment course and maximum acceptable number of phototherapy,so as to improve the efficacy of narrowband ultraviolet B phototherapy for vitiligo.
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Background: 8‑oxoguanine, a major product of DNA oxidation, is considered a key parameter in measuring the carcinogenic effects of ultraviolet radiation. Objective: To assess and compare the carcinogenic potential of different photo (chemo) therapeutic modalities in photoresponsive skin diseases by measuring the levels of 8‑oxoguanine in dark‑skinned individuals before and after photo (chemo) therapy. Methods: A prospective, randomized controlled pilot study was conducted in 63 patients of skin types III–V with photo‑responsive dermatoses including vitiligo, psoriasis and mycosis fungoides. Patients were divided into three groups; Group 1 (received narrowband ultraviolet‑B), Group 2 (received psoralen plus ultraviolet‑A) and Group 3 (received broadband ultraviolet‑A). Biopsies were taken before and after phototherapy to measure 8‑oxoguanine levels using enzyme‑linked immunosorbent assay. Biopsies were also taken from the sun‑protected skin in 21 controls subjects who had no dermatological disease. Results: Regardless of the disease, a significantly higher level of 8‑oxoguanine was found after treatment when compared to the pre‑treatment baseline levels; however, these levels were comparable to those in control subjects. A weakly significant positive correlation was found between cumulative dose and 8‑oxoguanine levels following psoralen plus ultraviolet‑A therapy. In controls, comparing the 8‑oxoguanine levels between skin types III and IV showed significantly lower 8‑oxoguanine in skin type IV. Conclusion: Therapeutic doses of ultraviolet radiation are relatively safe in dark skinned patients; however, minimizing the cumulative dose of phototherapeutic modalities (particularly psoralen plus ultraviolet‑A) is recommended.
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Ever since artificial TL-01 lamps were developed, narrowband ultraviolet B (NBUVB) has gained giant strides in dermatology. Psoriasis is one of the common indications for the use of NBUVB in present day dermatology. We discuss here the evolution of NBUVB, its mechanism of action pertaining to psoriasis, indications and contraindications, dosimetry, complications of NBUVB while being used in patients with psoriasis, its merits and demerits in comparison with broadband UVB and psoralen+UVA (PUVA), and recent developments in the delivery system of NBUVB.
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BACKGROUND: Progressive macular hypomelanosis is characterized by ill-defined, non-scaly, hypopigmented macules primarily on the trunk of the body. Although numerous cases of progressive macular hypomelanosis have been reported, there have been no clinicopathologic studies of progressive macular hypomelanosis in Korean patients. OBJECTIVE: In this study we examined the clinical characteristics, histologic findings, and treatment methods for progressive macular hypomelanosis in a Korean population. METHODS: Between 1996 and 2005, 20 patients presented to the Department of Dermatology at Busan Paik Hospital with acquired, non-scaly, confluent, hypopigmented macules on the trunk, and with no history of inflammation or infection. The medical records, clinical photographs, and pathologic findings for each patient were examined. RESULTS: The patients included 5 men and 15 women. The mean age of onset was 21.05+/-3.47 years. The back was the most common site of involvement. All KOH examinations were negative. A Wood's lamp examination showed hypopigmented lesions compared with the adjacent normal skin. A microscopic examination showed a reduction in the number of melanin granules in the lesions compared with the adjacent normal skin, although S-100 immunohistochemical staining did not reveal significant differences in the number of melanocytes. Among the 20 patients, 7 received topical drug therapy, 6 were treated with narrow-band ultraviolet B phototherapy, 4 received oral minocycline, and 3 did not receive any treatment. CONCLUSION: Most of the patients with progressive macular hypomelanosis had asymptomatic ill-defined, non- scaly, and symmetric hypopigmented macules, especially on the back and abdomen. Histologically, the number of melanocytes did not differ significantly between the hypopigmented macules and the normal perilesional skin. No effective treatment is known for progressive macular hypomelanosis; however, narrow-band ultraviolet B phototherapy may be a useful treatment modality.