Phototherapy

Abstract Of all the therapeutic options available in Dermatology, few of them have the history, effectiveness, and safety of phototherapy. Heliotherapy, NB-UVB, PUVA, and UVA1 are currently the most common types of phototherapy used. Although psoriasis is the most frequent indication, it is used for atopic dermatitis, vitiligo, cutaneous T-cell lymphoma, and cutaneous sclerosis, among others. Before indicating phototherapy, a complete patient assessment should be performed. Possible contraindications should be actively searched for and it is essential to assess whether the patient can come to the treatment center at least twice a week. One of the main method limitations is the difficulty that patients have to attend the sessions. This therapy usually occurs in association with other treatments: topical or systemic medications. Maintaining the regular monitoring of the patient is essential to identify and treat possible adverse effects. Phototherapy is recognized for its benefits and should be considered whenever possible.

Fototerapia con Lámpara de Diodos Emisores de Luz (LED) versus Lámpara Fluorescente Estudio Clínico Cuasi-aleatorizado / Light-Emitting Diode (LED) Lamp Phototherapy versus Fluorescent Lamp Quasi-randomized Clinical Study

Introducción: Se ha establecido que la fototerapia con tecnología LED es más efectiva que la fototerapia convencional para el tratamiento de hiperbilirrubinemia neonatal al reducir el número de horas de tratamiento requerido en los recién nacidos a término y pretérmino. El objetivo del presente estudio fue realizar un estudio clínico aleatorizado con tres tipos de lámparas incluida una de prototipo. Métodos: En el presente estudio clínico con un diseño paralelo de tres grupos, participaron recién nacidos con necesidad de tratamiento por hiperbilirrubinemia, ingresados en la Unidad de Neonatología del Hospital Homero Castanier Crespo en Azogues-Ecuador. Fueron distribuidos en 3 grupos: Grupo 1 (G1) Fototerapia con lámpara fluorescente, Grupo 2 (G2) fototerapia LED comercializada (Medix®, Mediled®), Grupo 3 (G3) con Fototerapia LED de prototipo. Se mide la concentración de bilirrubinas y la diferencia de medias de su reducción en cada grupo para demostrar no inferioridad. Resultados: El peso en G1 (n=30) fue 3050 ±134 gr, en G2 (n=30): 3200 ±186; G3 (n=30): 3034 ±234 (P=0.70). La edad gestacional en G1: 39 ±1 semanas, en G2 39.1±1.1, en G3 39 ±1.1 (P=0.80). Bilirrubina en G1: 15.8 ±6.2, en G2: 14. 93 ±5.9 y en G3: 15.62 ±5.9 mg/dl. (P=0.60). Las diferencias de bilirrubina (Delta 1) pre-tratamiento y a las 24 horas de tratamiento fueron -2.4 en G1, -2.4 en G2 y -2.25 mg/dl en G3 (P=0.60). Delta 2 a las 48 horas: -4.5 en G1, -4.26 en G2 y -4.42 mg/dl en G3 (P=0.62). Conclusión: los tres tratamientos demostraron No inferioridad en el tratamiento de hiperbilirrubinemia neonatal

Introduction: It has been established that phototherapy with LED technology is more effective than conventional phototherapy for the treatment of neonatal hyperbilirubinemia by reducing the number of hours of treatment required in term and preterm newborns. The objective of the present study was to carry out a randomized clinical study with three types of lamps, including a prototype. Methods: In the present clinical study with a parallel design of three groups, newborns with need of treatment for hyperbilirubinemia, admitted to the Neonatology Unit of the Homero Castanier Crespo Hospital in Azogues-Ecuador, participated. They were divided into 3 groups: Group 1 (G1) Phototherapy with fluorescent lamp, Group 2 (G2) commercialized LED phototherapy (Medix®, Mediled®), Group 3 (G3) with prototype LED phototherapy. The bilirubin concentration and the mean difference of its reduction in each group are measured to demonstrate non-inferiority. Results: The weight in G1 (n = 30) was 3050 ± 134 gr, in G2 (n = 30): 3200 ± 186; G3 (n = 30): 3034 ± 234 (P = 0.70). Gestational age in G1: 39 ± 1 weeks, in G2 39.1 ± 1.1, in G3 39 ± 1.1 (P = 0.80). Bilirubin in G1: 15.8 ± 6.2, in G2: 14. 93 ± 5.9 and in G3: 15.62 ± 5.9 mg / dl. (P = 0.60). The differences in bilirubin (Delta 1) pre-treatment and at 24 hours of treatment were -2.4 in G1, -2.4 in G2 and -2.25 mg / dl in G3 (P = 0.60). Delta 2 at 48 hours: -4.5 in G1, -4.26 in G2 and -4.42 mg / dl in G3 (P = 0.62). Conclusion: the three treatments demonstrated non-inferiority in the treatment of neonatal hyperbilirubinemia

Comparative Study of Safety and Efficacy of Narrow Band Ultraviolet B (NBUVB) and Psoralen Ultraviolet A (PUVA) Therapy in Psoriasis Vulgaris

Introduction: Psoriasis is a group of chronic, inflammatoryand proliferative condition of skin, associated withsystemic manifestations in many organ systems. The mostcharacteristic lesions consist of erythematous, scaly, sharplydemarcated indurated plaques, present particularly over theextensor surfaces and scalp). Phototherapy is one of the mostefficacious treatment options for psoriasis. New, emergingstudies are beginning to define the biological mechanismsby which phototherapy improves psoriasis- with NBUVBand psoralen ultraviolet A (PUVA) as the most widely usedapplications.Material and methods: This prospective study was carriedout on 76 patients attending OPD of Rohilkhand medicalcollege and hospital in one year from November 2017 toOctober 2018. The patients were randomly divided intotwo groups;Systemic PUVA (Trimethylpsoralen+UVA) andNBUVB groups and therapy will be administered thrice perweek on non-consecutive days.Results: The initial mean PASI score was 17.43 and 17.01in group A and group B patients respectively, while posttreatment PASI score was 3.08 and 2.01 in respective groups.The average cumulative dose for 80% clearance with PUVAwas found to be 60.51 J/cm2 while with NBUVB it wasfound to be 6.76 J/cm2. Side effects were observed in 28.94%patients in group A while 5.2% patientsin group B. Amongstgroup A 18.42%, 7.8% and 2.6% patients presented witherythema, burning and vesiculations respectively while undergroup B 2.6% patients in each group presented with erythemaand burning.Conclusion: Both PUVA and NBUVB are effective for thetreatment of psoriasis vulgaris. However, NBUVB has adistinct edge over PUVA in terms of efficacy and lesser sideeffects. The advantages of NBUVB therapy over PUVAtherapy includes lack of psoralen-related side effects and lessmean cumulative dose for clearance and so, good adherence.

Blocking or enhancing effects of some basic emollients in UVA penetration

Abstract: Background: Topical agents used in combination with phototherapy or photochemotherapy may have both blocking or enhancing effects in ultraviolet rays. Objective: In this in vivo study, the effects of topical petrolatum, basis cream, glycerine, and olive oil on the transmission of ultraviolet A radiation were investigated. Methods: A test was performed to determine the minimal phototoxic dose on 29 volunteers with only psoralen plus ultraviolet A (PUVA) and then the same test was repeated with white petrolatum, basis cream, glycerine, olive oil, and sunscreen (0.3cc/25cm2). The effects of each agent on the minimal phototoxic dose were determined after 72 h. Results: When compared to pure PUVA, there was a statistically significant increase in the mean minimal phototoxic dose values by the application of white petrolatum (P = 0.011), but there was no significant increase or decrease in the mean minimal phototoxic dose values after the application of basis cream (P = 0.326), glycerine (P = 0.611) or olive oil (P = 0.799). Study limitations: Low number of patients Conclusion: The application of white petrolatum, which has a blocking effect, and also of basis cream immediately before PUVA therapy should not be recommended. Although we specify that glycerine and maybe olive oil can be used before photochemotherapy, there is a need for further research in larger series.

Secondary Cutaneous Amyloidosis in a Patient with Mycosis Fungoides

Secondary cutaneous amyloidosis refers to clinically unapparent amyloid deposits within the skin in association with a pre-existing skin condition or skin tumors, such as basal cell carcinoma, porokeratosis, solar elastosis, Bowen's disease, and mycosis fungoides. A 70-year-old woman presented with a 6-month history of asymptomatic multiple yellowish plaques on both legs. She had been diagnosed with mycosis fungoides 7 years ago and was treated with psoralen and ultraviolet A radiation (PUVA) therapy, narrow-band ultraviolet B (UVB) therapy, and acitretin for 5 years. Finally, she reached complete remission of mycosis fungoides. However, new yellowish lesions started to appear 1 year after discontinuing the phototherapy. A physical examination revealed multiple yellowish plaques on both extremities. The plaques were well circumscribed and slightly elevated. All laboratory tests were normal. A biopsy specimen showed multiple nodular deposits of eosinophilic amorphous material in papillary dermis and upper reticular dermis. The deposits represented apple green birefringence on Congo red stain viewed under polarized light. Acellular small nodules in the upper dermis consisted of randomly oriented, non-branching, 6.67~12.7 nm thick amyloid fibrils on electron microscopy. We report an interesting and rare case of secondary cutaneous amyloidosis after narrow-band UVB therapy and PUVA therapy in a patient with mycosis fungoides.

Secondary Cutaneous Amyloidosis in a Patient with Mycosis Fungoides

Secondary cutaneous amyloidosis refers to clinically unapparent amyloid deposits within the skin in association with a pre-existing skin condition or skin tumors, such as basal cell carcinoma, porokeratosis, solar elastosis, Bowen's disease, and mycosis fungoides. A 70-year-old woman presented with a 6-month history of asymptomatic multiple yellowish plaques on both legs. She had been diagnosed with mycosis fungoides 7 years ago and was treated with psoralen and ultraviolet A radiation (PUVA) therapy, narrow-band ultraviolet B (UVB) therapy, and acitretin for 5 years. Finally, she reached complete remission of mycosis fungoides. However, new yellowish lesions started to appear 1 year after discontinuing the phototherapy. A physical examination revealed multiple yellowish plaques on both extremities. The plaques were well circumscribed and slightly elevated. All laboratory tests were normal. A biopsy specimen showed multiple nodular deposits of eosinophilic amorphous material in papillary dermis and upper reticular dermis. The deposits represented apple green birefringence on Congo red stain viewed under polarized light. Acellular small nodules in the upper dermis consisted of randomly oriented, non-branching, 6.67~12.7 nm thick amyloid fibrils on electron microscopy. We report an interesting and rare case of secondary cutaneous amyloidosis after narrow-band UVB therapy and PUVA therapy in a patient with mycosis fungoides.

Cuándo emplear PUVA o NB-UVB en micosis fungoide / When to use PUVA or NB-UVB in mycosis fungoides

La micosis fungoide es un linfoma cutáneo de células T de etiología desconocida que afecta principalmente a la población adulta. En sus fases iniciales la fototerapia sigue siendo una de las principales opciones terapéuticas. La terapia con NB-UVB en estadios tempranos IA-IB en parches y placas delgadas ofrece ventajas sobre el PUVA, debido a su mejor tolerancia y menores efectos secundarios; la terapia PUVA sigue siendo la elección en micosis fungoide en placas de mayor grosor. En cuanto a la terapia de mantenimiento se plantea que podría estar asociada a mayor radiación acumulada, sin lograr prevenir futuras lesiones, siendo el antecedente de recaída el principal factor predisponente para presentar nuevas lesiones en el futuro.

Mycosis fungoides (MF) is a cutaneous T-cell lymphoma of unknown etiology that primarily affects the adult population. In early stages of the disease phototherapy is a major therapeutic option. At the time NB-UVB therapy in early stages IA-IB patchy and thin plaques offers advantages over PUVA, due to its better tolerance and fewer side effects, the PUVA therapy remains the choice to MF in thinner plaques. The maintenance therapy is posed that could be associated with higher accumulation of radiation without achieving prevents future lesions, being the history of relapse the main predisposing factor to present new lesions in the future.

Evaluation of 25 years of phototherapy for treating psoriasis at a teaching hospital in southern Spain

AbstractBACKGROUND:For years, phototherapy has been used in a wide range of skin diseases, which is unsurprising as skin is the anatomical feature most directly exposed to light, especially in psoriasis. Although the role of light therapy has been replaced by different therapeutic modalities in recent years, this treatment is now an established option for many skin diseases.OBJECTIVES:The aim was to characterize the patient population thathad received the aforementioned treatment in the Virgen Macarena Health Area in Seville (Spain) between June 1985 and October 2011.METHODS:We have designed a descriptive study with a univariate analysis covering 443 treatments with light therapy, all administered to the same number of patients suffering from psoriasis.RESULTS:79.15% of patients were discharged due to improvement or healing, while the 20.85% were discharged due to other reasons. The average total accumulative dose was 131.53 J/cm2. We do not detected an increase in proportion in patients for develop NMSK after light therapy treatment.CONCLUSIONS:We consider that phototherapy is still an effective and efficient treatment that will have to be reconsidered in the current macroeconomic context.

Tratamento de micose fungoide com fototerapia UVB de banda estreita (UVB-NB) / Treatment of mycosis fungoides with narrow-band UVB phototherapy (NB-UVB)

O linfoma cutâneo de células T (LCCT) compreende um grupo heterogêneo de neoplasias de linfócitos T que se apresentam de diversas formas clínicas, histológicas, imunofenotípicas e evolutivas. Micose fungoide (MF) é a forma mais comum de LCCT e corresponde a 50% de todos os linfomas cutâneos primários. A variante hipocrômica da micose fungoide apresenta características epidemiológicas próprias, sendo rara em pacientes caucasianos, atingindo faixas etárias precoces, apresentando evolução na maioria das vezes benigna. O tratamento de eleição para MF é terapia direcionada à pele nos estágios iniciais, enquanto a terapia sistêmica fica reservada para os casos mais avançados. Dentre as terapias descritas, a fototerapia é um dos métodos mais utilizados atualmente para fases iniciais de MF pelos bons resultados apresentados e menor efeito colateral em relação aos demais. Recentemente muitos relatos têm mostrado que UVB-NB é efetiva para o tratamento de estádios precoces de MF. Descrevemos um caso de MF em uma adolescente no estágio IA da doença, apresentando resposta satisfatória com o tratamento com UVB-NB, duas vezes por semana.

Phototherapy as an effective treatment for Majocchi's disease - Case report

Pigmented purpuric dermatoses are chronic and relapsing disorders characterized by a symmetrical rash of petechial and pigmentary macules, mainly confined to the lower limbs. Purpura annularis telangiectodes of Majocchi is a less common variant of Pigmented purpuric dermatoses characterized by punctate telangiectatic macules progressing to annular, hyperpigmented patches with central clearing and infrequent atrophy. A 12 year-old girl presented with asymptomatic round to oval reddish brown macules, present symmetrically over her lower and upper limbs for 3 years. Few lesions were annular in shape. Biopsy from the lesion was compatible with Pigmented purpuric dermatoses. On the basis of clinical and histopathological findings, a diagnosis of Purpura annularis telangiectodes of Majocchi was made. The patient began phototherapy thrice a week and showed excellent response.

Various Treatments for Vitiligo: Problems Associated and Solutions.

The present review includes the study of vitiligo, its different types and treatments available into the market. Vitiligo is a skin disorder in which white patches occurs on the skin may be in the form of lesions or on the whole body. These white patches occur due to destruction of colour producing cells melanocytes. Different drugs like methoxsalen, trioxsalen and psoralen are available for the treatment of vitiligo in oral capsule form or topical cream or lotion form. Psoralen with light therapy is also given which is also known as PUVA therapy. Treatment of vitiligo always poses a problem as the patient compliance is less. Most of the times the treatment gets discontinued by the patients as the effect are very slow. This inefficiency leads to frustration in patients. This may be one of the reasons for discontinuation or ‘give up’ by the patients. Some patients also face the problem of additional symptoms or side effect like itching, burning, gastric disturbances etc. This review discusses on all above mentioned issues with problems associated with treatment and the related possible solutions.

Photochemotherapy (PUVA) in psoriasis and vitiligo.

Phototherapy with photochemotherapy (PUVA) is a well‑known and well‑studied modality for the treatment of psoriasis, which involves systemic or topical administration of chemicals known as psoralens and administration of ultraviolet light in increasing dosages after requisite time gap. PUVA is also used in the treatment of widespread vitiligo with moderately good results, though it is being surpassed by ultraviolet B (UVB), which is equally or slightly more efficacious with fewer side effects. PUVA induces repigmentation by varying mechanisms such as stimulation of melanogenesis, immunomodulation and activation of growth factors, though the exact mechanism is still speculative. There are various studies evaluating the efficacy of PUVA in psoriasis as well as in vitiligo, either alone or in combination with other immunosuppressants like azathioprine and calcipotriene.

Accidental PUVA Burns Leading to Prurigo Nodularis: A Rare Complication of Phototherapy.

Medical treatment function vitiligo aims to restore color to use depigmented patches. Psoralen photochemotherapy (PUVA) may be used if there is extensive vitiligo. Possible long-term adverse effects of PUVA therapy include accelerated skin aging with wrinkle formation, telangiectasias, lentigines, elastosis, xerosis and pigmentary changes. Accidental burns during photochemotherapy have been reported though nodular prurigo has never been reported. Vitiliginous skin is more rone to burns.

Combination Therapy with Cyclosporine and Psoralen Plus Ultraviolet A in the Patients with Severe Alopecia Areata: A Retrospective Study with a Self-Controlled Design

BACKGROUND: Alopecia areata (AA) is believed to be an organ-specific autoimmune disease in which a mononuclear cell infiltrate develops in and around anagen hair follicles. There is no definitive therapy for AA. OBJECTIVE: We sought to determine whether the combination therapy of cyclosporine and psoralen plus ultraviolet A (PUVA) could be an effective treatment for severe AA. METHODS: A total of 41 patients with severe AA were treated with oral cyclosporine and topical PUVA. Cyclosporine was given at an initial daily dose of 200 mg for adult and 100 mg for children for periods of up to 16 weeks. Eight-methoxypsoralen (Methoxsalen) was applied topically 20 minutes prior to ultraviolet A (UVA) exposure, and the patients were irradiated with UVA twice a week for 16 weeks. RESULTS: Of the total 41 patients, 2 (7.3%) patients were lost to follow-up, and 1 (2.4%) patient discontinued the treatment due to abdominal discomfort. Six (14.6%) patients were treated for less than 12 weeks. Of remaining 32 patients, 3 (9.4%) showed excellent response, 3 (9.4%) showed good response, 12 (37.5%) showed fair response, and 14 (43.7%) showed poor response. CONCLUSION: Although limited by its uncontrolled character, this study shows that the combination therapy with cyclosporine and PUVA may be an additional choice for severe and recalcitrant AA.

Preventive effect of genistein against psoralens plus ultraviolet A-induced photoaging in human dermal fibroblasts / 中华皮肤科杂志

Objective To evaluate the protective effect of genistein on psoralens plus ultraviolet A (PUVA)-induced photoaging in human dermal fibroblasts (HDFs) in vitro.Methods Dermal fibroblasts were isolated from the foreskin of a healthy 5-year-old boy,and subjected to primary culture.After 5-8 passages of subculture,the fibroblasts were collected and used in the following experiment.To determine the optimal concentration of genistein,methyl thiazolyl tetrazolium (MTT) assay was conducted to detect the proliferation of fibroblasts pretreated with 8-methoxypsoralen (8-MOP) and various concentrations (0-20 μg/ml) of genistein for 24 hours followed by UVA irradiation.Then,the fibroblasts were divided into 3 groups:normal control group receiving no treatment,photoaging group incubated with 8-MOP for 24 hours followed by UVA irradiation,and genistein group incubated with both 8-MOP and genistein at the optimal concentration for 24 hours followed by UVA irradiation.After additional culture,invert microscopy was carried out to observe the morphology of fibroblasts,enzyme histochemistry to assess senescent cells by using SA-β-Gal kit,flow cytometry to determine the level of reactive oxygen species (ROS),real-time fluorescence-based quantitative PCR to detect the matrix metalloproteinase-1 (MMP-1) expression.One-way analysis of variance was conducted to assess the differences in these parameters among these groups.Results At 24 hours after UVA irradiation,the percentage of fibroblasts positive for SA-β-galactosidase was (0.67 ± 0.58)％,(96.67 ± 1.53)％ and (51.67 ± 2.08)％ in the normal control group,photoaging group and genistein group respectively,with significant differences among these groups (P ＜ 0.01).The level of ROS in the photoaging group and genistein group was (0.88 ± 0.24) and (0.62 ± 0.02) fold higher than that in the control group(both P ＜ 0.01).Moreover,the MMP-1 expression level in the photoaging group and genistein group was 10 times and 6 times that in the control group,respectively,with significant differences among the 3 groups (P ＜ 0.05).Conclusion In vitro,genistein can protect against PUVA-induced photoaging in human dermal fibroblasts to some extent.

Accidental PUVA burns, vitiligo and atopic diathesis resulting in prurigo nodularis: a logical but undocumented rarity / Prurigo nodular induzido por queimaduras acidentais por PUVA, vitiligo e diátese atópica: uma raridade lógica, mas não documentada

Vitiligo is a dreaded disease in India due to its social and cultural consequences. PUVA and PUVAsol are the main treatment modalities for vitiligo vulgaris. To the best of our knowledge, this is the first case of accidental PUVA burns eventuating in prurigo nodularis lesions to be reported in a female patient who was undergoing home PUVA therapy. The itch is so prominent and disabling that the focus of the patient has shifted from treating her vitiligo to ameliorating the pruritus.

O vitiligo é uma doença temida na Índia por suas consequências sociais e culturais. As principais modalidades de tratamento do vitiligo vulgar são as terapias PUVA e PUVAsol. Pelo que sabemos, este é o primeiro relato de caso de prurigo nodular induzido por queimaduras acidentais por PUVA em paciente do sexo feminino em tratamento domiciliar com PUVA. O prurido é tão intenso e incapacitante que o foco da paciente passou do vitiligo à busca constante pela melhora do prurido.

Localized scleroderma: assessment of the therapeutic response to phototherapy / Esclerodermia cutânea: avaliação da resposta terapêutica à fototerapia

BACKGROUND: Scleroderma is a chronic autoimmune disease characterized by progressive connective tissue sclerosis and microcirculatory changes. Localized scleroderma is considered a limited disease. However, in some cases atrophic and deforming lesions may be observed that hinder the normal development. Literature reports indicate phototherapy as a therapeutic modality with favorable response in cutaneous forms of scleroderma. OBJECTIVES: This study had the purpose of assessing the phototherapy treatment for localized scleroderma. METHODS: Patients with localized scleroderma were selected for phototherapy treatment. They were classified according to the type of localized scleroderma and evolutive stage of the lesions. Clinical examination and skin ultrasound were used to demonstrate the results thus obtained. RESULTS: Some clinical improvement was observed after an average of 10 phototherapeutic sessions. All skin lesions were softer at clinical palpation with scores reduction upon pre and post treatment comparison. The ultrasound showed that most of the assessed lesions presented a decrease in dermal thickness, and only five maintained their previous measure. Treatment response was similar regardless of the type of phototherapeutic treatment employed. CONCLUSIONS: The proposed treatment was effective for all lesions, regardless of the phototherapeutic modality employed. The improvement was observed in all treated skin lesions and confirmed by clinical evaluation and skin ultrasound.

FUNDAMENTOS: A esclerodermia é uma doença autoimune caracterizada pela esclerose progressiva do tecido conjuntivo e alterações da microcirculação. A forma cutânea é considerada uma doença autolimitada. No entanto, em alguns casos, ocorrem lesões atróficas, deformantes, que dificultam o desenvolvimento normal. Relatos da literatura apontam a fototerapia como uma modalidade terapêutica com resposta favorável nas formas cutâneas da esclerodermia. OBJETIVOS: Este trabalho teve como objetivo avaliar o tratamento da esclerodermia cutânea com fototerapia. MÉTODOS: Foram selecionados pacientes com diagnóstico de esclerodermia cutânea para o tratamento com fototerapia, os quais foram classificados de acordo com o tipo clínico e o estágio evolutivo das lesões. Utilizou-se o exame clínico e a ultrassonografia da pele como metodologia para demonstrar os resultados obtidos com o tratamento proposto. RESULTADOS: Foi observado o início da melhora clínica das lesões com média de 10 sessões de fototerapia. A palpação clínica mostrou amolecimento em todas as lesões estudadas, com redução nos escores de avaliação estabelecidos. No exame de ultrassom, a maioria das lesões avaliadas mostrou diminuição da espessura da derme, e apenas cinco mantiveram sua medida. Não se observou diferença na resposta ao tratamento de acordo com o tipo de fototerapia instituída. CONCLUSÕES: O tratamento proposto foi efetivo em todas as lesões, independentemente do tipo de fototerapia realizada. A melhora foi observada em todas as lesões tratadas e comprovada pela avaliação clínica e pelo exame de ultrassom da pele.

Comparative evaluation of NBUVB phototherapy and PUVA photochemotherapy in chronic plaque psoriasis.

Background: Psoralen UV-A (PUVA) is an established therapy for psoriasis, but there is a well-documenated risk of melanoma and nonmelanoma skin cancer. Narrow-band Ultraviolet-B (NBUVB) therapy has a lower carcinogenic risk, has equal therapeutic potential and is considerably safe in the long term than PUVA. Aim: The aim of present study was to compare the efficacy and side-effects of PUVA and NBUVB in chronic plaque psoriasis. Methods: Sixty patients of chronic plaque psoriasis were taken up for the study and were randomly divided into two groups of 30 each. They were well matched in terms of age, sex, psoriasis extent and pretreatment psoriasis area severity index (PASI) scoring. One group was treated with twice-weekly narrow-band UV-B (TL-01) phototherapy and the other group received twice-weekly oral 8-Methoxsalen PUVA for a period of 3 months. Results: Both the groups achieved >75% reduction in the PASI score or complete clearance at the end of 3 months, but PUVA group patients required significantly fewer number of treatment sessions and fewer number of days to clear the psoriasis as compared to the NBUVB group, while the mean cumulative clearance dose and adverse effects were significantly lower in the NBUVB group. Conclusion: We concluded that PUVA group patients achieved a faster clearance, but the adverse effects were significantly lower in the NBUVB group.

Comparación entre la efectividad del psoraleno más luz ultravioleta A (PUVA) y la luz ultravioleta B de banda estrecha (UVB-NB) en el tratamiento de la psoriasis / Comparison of the effectiveness of psoralen plus ultraviolet A light (PUVA) and ultraviolet B narrow band (UVB-NB) in the treatment of psoriasis

La psoriasis es una enfermedad inflamatoria crónica caracterizada por la hiperproliferación de queratinocitos como respuesta a la activación del sistema inmune. El manejo de esta patología es variado, pero las opciones terapéuticas disminuyen cuando la severidad aumenta, y hay que recurrir a medicaciones o terapias que traen mayores efectos secundarios no deseados. La fototerapia hace parte de los tratamientos utilizados en formas severas; la primera que se introdujo fue el uso de psoralenos más luz ultravioleta A (PUVA), pero es una terapia no del todo inocua que puede producir cataratas o inclusive cáncer de piel, lo que imposibilita su uso en algunos pacientes. Con el advenimiento de la terapia con luz ultravioleta B de banda estrecha (UVB-NB) en 1997, se abrió un nuevo espectro de alternativas de tratamiento para este tipo de pacientes, con similares características en cuanto a efectividad. Al comparar estos dos tipos de terapias, la literatura no es concluyente y deja un sinnúmero de dudas acerca de cuál de las dos terapias es más efectiva. Con la aparición de nuevas terapias, es importante conocer la más efectiva, pues son tratamientos menos costosos en comparación con los que están llegando al mercado.

Psoriasis is a chronic inflammatory disease characterized by keratinocyte hyperproliferation in response to activation of the immune system. The management of this condition is varied, but the therapeutic options decrease as the severity increases, and we must resort to medications or therapies that bring more unwanted side effects. Phototherapy is part of the treatments used in severe forms, the first to be introduced was the use of psoralen plus ultraviolet A light (PUVA), but it is not entirely safe therapy that can cause cataracts or even skin cancer, which precludes their use in some patients. With the advent of light therapy narrow band ultraviolet B (UVB-NB) in 1997, it opened a new spectrum of treatment alternatives for these patients, with similar characteristics in terms of effectiveness. By comparing these two types of therapies, the literature is not conclusive and leaves a host of questions about which of the two therapies is more effective. With the advent of new therapies, it is important to know the most effective, they are less expensive treatments compared with those who are coming to market.

Qual é o tipo de fototerapia mais comumente indicada no tratamento da psoríase?: UVB banda estreita e PUVA: comportamento da prescrição / What is the most common phototherapy prescription for psoriasis: NB-UVB or PUVA? Prescription behavior

FUNDAMENTOS: Formas moderada e grave de psoríase requerem fototerapia e/ou medicações sistêmicas. Tanto UVB banda estreita quanto fototerapia UVA com psoralênicos (PUVA) podem ser utilizadas no tratamento dessas formas de psoríase, sendo comprovada a efetividade de ambas as terapias. OBJETIVOS: Avaliar as indicações de dois tipos de fototerapia no tratamento da psoríase refratária à terapia tópica: UVB banda estreita e PUVA. MÉTODOS: Entre janeiro de 2006 e dezembro de 2007, os pacientes encaminhados a dois serviços de fototerapia foram incluídos neste estudo. Dados sobre os casos e tipos de prescrição foram coletados de maneira retrospectiva. RESULTADOS: Dentre os 67 pacientes estudados, 51 (76 por cento) foram tratados com UVB banda estreita. As razões para sua indicação foram presença de psoríase em gotas (22 por cento), presença de finas placas (15 por cento), uso de drogas fotossensibilizantes (15 por cento), idade abaixo de 20 anos (9 por cento), fototipo I (9 por cento) e doença hepática (6 por cento). Os 16 (24 por cento) restantes foram tratados com PUVA. A principal indicação dessa terapia foi gravidade da doença (15 por cento), seguida de fototipo IV (9 por cento). CONCLUSÕES: As prescrições de UVB banda estreita excederam as de PUVA devido ao menor número de contraindicações, menor possibilidade de efeitos colaterais, e ainda por ser uma opção mais prática.

BACKGROUND: Moderate and severe forms of psoriasis require phototherapy and / or systemic medications. Both UVA and UVB can be used to treat cases of moderate and severe psoriasis, and the effectiveness of both has been proven. OBJECTIVE: to access the prescription behavior relating to two types of phototherapy for treating psoriasis refractory to topical treatment: narrowband UVB (NB-UVB) or psoralen plus UVA phototherapy (PUVA). METHODS: Between January 2006 and December 2007, patients referred to two phototherapy services were included in this study. Data on the cases and on the type of prescription were collected retrospectively. RESULTS: Among the 67 studied patients, 51 (76 percent) were treated with narrowband UVB. The reasons for the indication were the presence of the guttate type of psoriasis (22 percent), the presence of thin plaques (15 percent), the use of drugs that affected photosensitivity (15 percent), age less than 20 years (9 percent), skin type I (9 percent), and liver disease (6 percent). The remaining 16 (24 percent) were treated with PUVA. The main indication for this therapy was the severity of the disease (15 percent), followed by the presence of skin type IV (9 percent). CONCLUSIONS: Prescriptions of narrowband UVB exceeded those of PUVA because of fewer contraindications and fewer possible side effects, and because it was a more practical option.