Treatment of morphea with narrowband ultraviolet B: A case series

Introduction@#Morphea, is a rare autoimmune disease presenting with fibrotic changes in the dermis and subcutis. It is a benign condition associated with significant atrophy and sclerosis leading to disfigurement, flexure contractures, and impaired function. Ultraviolet A1 and photochemotherapy are highly effective treatment options but are not readily available in the country. Narrowband ultraviolet B (NBUVB), on the other hand, is readily available, affordable, and safe to use. @*Case summary@#Three patients diagnosed with different variants of morphea (bilateral generalize morphea, unilateral generalized morphea, and circumscribed morphea). underwent 30 sessions of NBUVB. Treatment response was assessed using tightness and itch Visual Analogue Scale (VAS), Modified Skin Score (MSS), photographic comparison, ultrasonographic measurement, and histopathologic analysis. NBUVB treatment resulted to 14-60% decrease in the tightness and itch VAS. MSS was also reduced by 35-50%. The size, pigmentation, and erythema of the lesions also decreased. Ultrasonography showed an improvement in the thickness of lesions after treatment. Histopathologic study showed less packed collagen with increase in inter-bundle spaces.@*Conclusion@#Response to treatment was influenced by the age of the lesion and anatomical location. More chronic lesions tend to have less response. Lesions on the face exhibited the greatest improvement while lesions on the lower extremities had the least improvement. This is the first case series study in the country that uses NBUVB as treatment for morphea. The improvement of the sclerotic and atrophic lesions treated with narrowband UVB treatment may be an acceptable substitute for UVA1 and PUVA.

A case of disseminated granuloma annulare successfully treated with acitretin and narrowband UV-B phototherapy

Introduction@#Granuloma annulare(GA) is a benign, inflammatory skin condition characterized by asymptomatic, flesh colored or erythematous papules. The disseminated variant of granuloma annulare is uncommon, usually affecting women older than 40 years.@*Case Summary@#We report a case of a 52-year-old female, who presented with a 4-year history of skin colored to erythematous papules and annular plaques covering the entire skin surface. Correlation of the clinical presentation, histopathology and dermoscopy findings established the diagnosis of disseminated granuloma annulare. The patient was treated with 25 sessions of narrowband ultraviolet-B (NB-UVB) phototherapy and acitretin 20mg/day for 5 months.@*Conclusion@#Both histopathology and dermoscopy were noted to be valuable tools in the diagnosis of disseminated GA, as well as in monitoring response to the combined therapy.

Hyper Immunoglobulin E Syndrome with Concomitant Folliculotropic Mycosis Fungoides in a Filipino child treated with Narrowband UVB Phototherapy: A case report

@#Hyper Immunoglobulin E Syndrome (HIES) is a primary immunodeficiency disorder characterized by the classic triad of recurrent staphylococcal abscesses, frequent airway infections, and increased serum immunoglobulin E. It is now widely accepted as a multisystem disorder with involvement of the skeletal, connective tissue, dental, and vascular systems. Lymphoma has been reported to occur at an increased frequency. Follicu-lotropic mycosis fungoides (FMF) is a rare variant of cutaneous T-cell lymphoma in which the neoplastic T lymphocytes display tropism for the follicular epithelium. We report a case of a 14-year old Filipino male with the classic type of HIES presenting with severe eczema associated with intractable pruritus, recurrent respiratory tract infections, cold abscesses, and a serum IgE of 9,350 IU/ml. Skin biopsy also revealed findings consistent with FMF. Narrowband UVB (NB-UVB) phototherapy was initiated three times a week with continuation of supportive medication. Patient reported significant relief of pruritus and gradual improvement of eczematous lesions after one month.

Hypopigmented mycosis of fungoides in an eight-year-old girl managed with narrowband ultraviolet B therapy

Mycosis fungoides presenting with hypopigmented lesions is an uncommon variant, which is usually described among dark-skinned patients. We report a case of hypopigmented mycosis fungoides in an eight-year-old girl who has responded favorably to narrowband-ultraviolet B therapy. The disease mimics several benign inflammatory skin conditions, hence, a high clinical suspicion is warranted in patients presenting with widespread hypopigmentation.

A Case of Generalized Pigmented Purpuric Dermatosis Treated with Narrowband Ultraviolet B Phototherapy in a Child / 대한피부과학회지

Pigmented purpuric dermatosis (PPD) represents a group of cutaneous lesions exhibiting petechiae, pigmentation, and occasionally telangiectasia in the absence of an associated venous insufficiency or hematological disorder. PPD may resolve spontaneously but tends to persist for months to years. Various treatment modalities such as oral griseofulvin, pentoxifylline, cyclosporine, ascorbic acid, topical corticosteroids, and PUVA therapy have been used with unsatisfactory results. Recently, some studies reported that PPD showed a dramatic response to narrowband ultraviolet B (UVB) phototherapy. In these studies, narrowband UVB phototherapy was an effective treatment method with few side effects. Here, we present the case of a 7-year-old boy with generalized PPD that improved rapidly following narrowband UVB phototherapy.

Eczematid-like Purpura of Doucas and Kapetanakis Showing Clinical Improvement with Narrowband UVB / 대한피부과학회지

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.

Ultrathin split-thickness skin grafting followed by narrowband UVB therapy for stable vitiligo: An effective and cosmetically satisfying treatment option.

Background: Different surgical techniques in the form of tissue or cellular grafting procedures are used alone or in combination with narrowband UVB (NBUVB) to treat stable vitiligo resistant to medical treatment. Aim: To evaluate the cosmetic results obtained with ultrathin split-thickness skin grafts followed by NBUVB therapy in resistant, stable vitiligo. Methods: Forty patients of stable vitiligo were treated with ultrathin split-thickness grafting and the patients were then put on NBUVB therapy. The results obtained were analyzed by the extent of repigmentation achieved as well as the final cosmetic outcome at the recipient as well as donor sites. Results: The first evidence of repigmentation was seen in the second week after starting NBUVB. On objective assessment, more than 90% repigmentation was seen in 83% of patients and the overall cosmetic results at the recipient site were graded as good to excellent in 90% patients at the end of NBUVB treatment. Perigraft halo of depigmentation was seen in six patients (15%) on the recipient site. Hypertrophic scarring was observed in two patients at the donor site. Conclusions: Ultrathin split-thickness skin grafting, when combined with NBUVB therapy, leads to better cosmetic outcome with faster onset of repigmentation in resistant stable vitiligo.

Survey of dermatologists' phototherapy practices for vitiligo.

Background: The details of phototherapy practices for vitiligo have been rarely studied. Objective: To explore the details of phototherapy practices for vitiligo among dermatologists. Methods: A self-administered questionnaire about the details of phototherapy practices for vitiligo was distributed to all dermatologists attending a national general dermatology conference in Riyadh, Saudi Arabia, in 2008. Results: Questionnaires were returned by 121 of 140 participants (response rate = 86.4%). The mean age of the respondents was 39.34 ΁ 9.7 years, and 65% were males. One hundred eight of 110 (98.2%) respondents provided phototherapy to their vitiligo patients. The mean number of vitiligo patients who underwent phototherapy each week per dermatologist's office was 18 ΁ 2.26. Narrowband ultraviolet B (NB-UVB) was the most common modality chosen to treat generalized vitiligo (84%). Excimer laser was the most common modality used to treat focal and segmental vitiligo (53% and 39%, respectively). Sixty-eight percent of dermatologists administered a fixed starting dose of NB-UVB to all patients, whereas 31% used the minimal erythema dose as a guide. Fifty percent reported that NB-UVB resulted in better color matching with the surrounding skin. Thirty-seven percent favored NB-UVB over psoralen + ultraviolet A for a faster response, and 31% preferred NB-UVB for a pigmentation that is more durable. Forty-seven percent (50/106) of the respondents limited the number of phototherapy sessions to reduce the risks of skin cancer. However, no respondent reported any skin cancer incidence in phototherapy-treated vitiligo patients. Conclusion: There is a need for phototherapy guidelines for the treatment of vitiligo in patients with skin of color.

Narrowband Ultraviolet B Phototherapy of Early Stage Mycosis Fungoides in Korean Patients

BACKGROUND: Narrowband UVB (NBUVB) is currently used to treat early mycosis fungoides (MF). There are a number of reports on the efficacy and safety of NBUVB in Caucasians, but little data is available for Asians. OBJECTIVE: This study was designed to evaluate the effectiveness and safety of NBUVB for early stage MF in Korean patients. METHODS: We enrolled 14 patients (12 men, 2 women; age range, 10~64 years) with clinically and histologically proven MF. Three patients were stage IA, and the others were stage IB. The patients received NBUVB phototherapy three times a week. The starting dose was 70% of the minimal erythema dose and was increased in 20 percent increments if the previous treatment did not cause erythema. Clinical response, total number of treatments, total cumulative dose, duration of remission and side effects were investigated. RESULTS: Eleven of 14 patients (78.6%) achieved complete remission within a mean of 15.36+/-5.71 weeks (range, 5~27 weeks), 31.0+/-7.4 treatments (range, 16~39 treatments) and a mean cumulative UVB dose of 31.31+/-12.16 J/cm2 (range, 11.4~46.8 J/cm2). Three of the 14 patients (21.4%) achieved a partial remission. After discontinuation of treatment, 6 of 11 patients (54.5%) with complete remission relapsed after a mean of 8.5+/-4.09 months. No serious adverse effects were observed except for hyperpigmentation (7/14, 50%). CONCLUSION: Our data suggest that NBUVB therapy is safe and effective for the treatment of early stage MF in Korean patients.

Topical placental extract: Does it increase the efficacy of narrowband UVB therapy in vitiligo.

Background: Narrowband UVB therapy is presently one of the most effective therapies for generalized vitiligo. Many topical agents have been used in combination with narrowband UVB therapy to increase its efficacy in causing repigmentation in vitiligo. Placental extract is used topically usually in combination with sun exposure to cause repigmentation of vitiligo lesions. Aims: The present study aims to study whether the efficacy of narrowband UVB therapy would be enhanced by addition of topical placental extract to the treatment regimen. Methods: Ninety patients with vitiligo having more or less bilaterally symmetrical lesions on the face, trunk or limbs and receiving narrowband UVB therapy were enrolled for the study and instructed to apply topical placental extract (placentrex) lotion on their vitiligo lesions on the right side of the body. The other side of the body received narrowband UVB therapy alone and served as the control side. The extent of repigmentation achieved was assessed by VASI scoring and compared between the symmetrical lesions present on the two sides at monthly intervals and at the end of study period. Results: Seventy-eight patients with 218 symmetrically distributed lesions, excluding those present on the hands or feet, were evaluated for study results at the end of treatment period. The time to onset of repigmentation as well as the mean NB-UVB dosage required was the same on the two sides. The mean repigmentation achieved was 63% (VASI score of 3.69) on the right (placental extract) sided lesions in comparison with 62% (VASI score of 3.60) on the left (control) sided lesions. Greater than 90% repigmentation was achieved in 70 symmetrical lesions in 24 patients. Of these 70 lesions, 39 were located on the right side of the body while 31 belonged to the left side of the body. Conclusions: Addition of the topical placental extract was seen to have a modest but a statistically insignificant effect on the efficacy of NB-UVB therapy in causing repigmentation in vitiligo.

Fototerapia con radiación ultravioleta (UVB) de banda estrecha: una opción segura de manejo para vitiligo y otras dermatosis / Phototherapy with ultraviolet (UVB) narrow band a safe option for vitiligo management and other dermatoses

La radiación UVB de banda estrecha es una modalidad de fototerapia, empleada en diversas enfermedades dermatológicas. Ha obtenido gran auge en los últimos años por su eficacia y pocos efectos adversos. Es considerada de elección en vitiligo generalizado y además es útil en psoriasis en placas, dermatitis atópica y estadíos iniciales de micosis fungoides, entre otras dermatosis. Debe valorarse en forma clara la indicación de su uso y otras alternativas disponibles, así como patologías o condiciones que contraindiquen su empleo. Se presenta una revisión de las principales indicaciones, posibles contraindicaciones y efectos adversos. Hacemos especial hincapié en vitíligo. [Rojas RF, Vergara JI. Fototerapia con radiación ultravioleta (UVB) de banda estrecha: una opción segura de manejo para vitíligo y otras dermatosis. MedUNAB 2010; 13:38-43].

La radiación UVB de banda estrecha es una modalidad de Narrowband UVB is a phototherapy modality; It is used in fototerapia,empleadaendiversasenfermedadesmany dermatological diseases. In the last years, NB UVB dermatológicas. Haobtenido gran auge en los últimos años has obtain a huge importance because of its efficacy and low por su eficacia y pocos efectos adversos. Es considerada de rates of adverse effects. It ́s the first line phototherapeutic elección en vitiligo generalizado y además es útil en psoriasis option for patients with generalized vitiligo and appears also en placas, dermatitis atópica y estadíos iniciales de micosis effective in plaque psoriasis, atopic dermatitis, plaque stage fungoides, entre otras dermatosis. Debe valorarse en forma of Mycosis fungoide and other dermatoses without an strong clara la indicación de su uso y otras alternativas disponibles, evidence.Dermatologistshouldassesswhatistheasí como patologías o condiciones que contraindiquen su phototherapy indication and alternatives, conditions or empleo. Se presenta una revisión de las principales diseases that could be a contraindication of use. Our aim is indicaciones,posiblescontraindicacionesyefectosto review phototherapy UVB NB main indications, especially adversos. Hacemos especial hincapié en vitíligo. [Rojas RF, in vitiligo, possible contraindications and adverse effects. Vergara JI. Fototerapia con radiación ultravioleta (UVB) de [Rojas RF, Vergara JI. Narrowband UVB phototherapy: a banda estrecha: una opción segura de manejo para vitíligo y safety option to treat vitiligo and other dermatosis. otras dermatosis. MedUNAB 2010; 13:38-43].MedUNAB 2010; 13:].

Short-term, High Dose Methylprednisolone and Narrowband UVB Combination Therapy for 2 Patients with Vitiligo / 대한피부과학회지

Systemic corticosteroid arrests the progression of vitiligo and leads to repigmentation, but it may produce side effects. It has been reported that the maximum effect for corticosteroid can be achieved without major side effects when it is used at high doses over a short period of time. Recently, narrowband UVB has been used to treat vitiligo. However, there have been no reports on the effectiveness for a combined treatment with narrowband UVB and systemic corticosteroid. We encountered 2 cases of vitiligo patients who had rapid and effective repigmentation after combination therapy with high dose methylprednisolone and narrowband UVB. Intravenous high dose (25 mg/kg) of methylprednisolone for 3 days was followed by narrowband UVB once or twice weekly. After 2 months, rapid improvements were seen in both patients with >75% repigmentation. Combination treatment with high dose methylprednisolone therapy and narrowband UVB may be an effective therapeutic option for vitiligo.

Three Cases of Acquired Reactive Perforating Collagenosis Improved by Narrowband Ultraviolet B Phototherapy / 대한피부과학회지

Acquired reactive perforating collagenosis (ARPC) is difficult to treat. We herein report 3 cases of ARPC, which have been improved by narrowband UVB phototherapy. They had been treated with topical corticosteroid and oral antihistamine, which had no therapeutic effects on their conditions. They were treated with narrowband UVB phototherapy twice a week and four-week treatments resulted in relief of pruritus in three patients and eight-week treatments lead to significant reduction of skin lesions in two patients. Based on our experience, it is suggested that narrowband UVB phototherapy is a good therapeutic modality for recalcitrant skin lesions and severe pruritus of ARPC.

13 Cases of Leukoderma Punctata after Narrowband UVB Therapy in Vitiligo Patients / 대한피부과학회지

BACKGROUND: Leukoderma punctata is a peculiar disorder with punctiform, hypopigmented and achromic spots. Histopathologically, a focal reduction of melanocytes and melanin granules are found in the depigmented macule. The phototoxic effect of phototherapy on melanocytes has been suggested as the most likely cause. This occurs mostly after application of systemic or topical psolaren on photochemotherapy. However, a case following narrowband UVB therapy is very rare. OBJECTIVE: The purpose of our study was to investigate the characteristics of leukoderma punctata patients and find the cause of leukoderma punctata. METHODS: We reviewed the medical records of leukoderma punctata patients, and a skin biopsy was taken from punctiform hypopigmented macules. The tissues were stained with hematoxyline and eosin, Fontana-Masson, and dopa-oxidase. RESULTS: The average age of patients was 51 years old. There was no difference between results of male and female patients. Involvement sites of patients were mostly the arms and legs. 76% of patients did not have preceding subjective symptoms. In eight of nine patients, a marked reduction of melanin and melanocytes was noted with both Fontana-Masson staining and dopa-oxidase staining. The average total period of PUVA therapy was 26 months and average total dose of PUVA irradiation was 351.2 J/cm2 in leukoderma punctata patients. Before leukoderma punctata developed, the average total period of narrowband UVB therapy was 6.9 months and average total dose of narrowband UVB was 22.45 J/cm2. The results suggest that leukoderma punctata developed in very small dose of narrowband UVB, although it did not develop with large doses of PUVA. CONCLUSION: Narrowband UVB (311 nm) is the most likely spectrum for development of leukoderma punctata.