Avaliação da ação germicida da luz ultravioleta de cabine de segurança biológica frente às espécies bacterianas / Evaluation of the germicidal action of ultraviolet light in biosafety cabinet concerning bacterial species

RESUMO: Introdução: A cabine de segurança biológica (CBS) é um equipamento de proteção coletiva, utilizado para efe-tuar a contenção de aerossóis produzidos nos procedimentos laboratoriais. A CBS protege tanto os trabalhadores, quanto o material manipulado e o meio ambiente. Dispõe de lâmpadas de luz ultravioleta (UV) que possui ação germicida, alterando os ácidos nucleicos dos micro-organismos. Objetivo: O objetivo do presente estudo foi avaliar a ação germicida da luz UV da CBS classe II, tipo A2, frente à cultura de duas espécies de bactérias com diferentes condições de exposição a luz UV. Material e Métodos: Para o desenvolvimento da pesquisa foram utilizadas as bactérias Staphylococcus aureus ATCC 25923 e Klebsiella pneumoniae ATCC 10031, na concentração de 1,5x108 Unidades Formadoras de Colônias/ml (UFC/ml), que após a semeadura em biplacas de Petri foram expostas à luz UV em diferentes condições e tempos. Resultados: Os resultados obtidos revelaram que as espécies de bactérias apresentaram igual perfil de crescimento ou inibição quando submetidas às diferentes condições de exposição. As biplacas de Petri com as tampas abertas e protegidas ou não com embalagem de esterilização apresentaram, nos tempos 15 e 20 minutos, inibição bacteriana. Nas biplacas protegidas pelo papel alumínio e nas biplacas com a tampa fechada, independentemente do tempo e da condição, os micro-organismos apresentaram crescimento bacteriano. Conclusão: Com os resultados obtidos, sugere-se que a ação germicida da luz UV foi eficaz, garantindo a descontaminação adequada e assegurando a qualidade na biossegurança laboratoria. (AU)

ABSTRACT: Introduction: The biological safety cabinet (BSC) is a collective protective device used to hold aerosols produced in laboratory procedures. The BSC protects workers, material handling, and the environment. It relies on ultraviolet light (UV) lamps that have germicidal action, altering the nucleic acids of microorganisms. Objective: The objective of the present study was to evaluate the germicidal action of BSC class II type A2 UV light against the culture of two bacterial species with different conditions of exposure to UV light. Methods: For the research, the bacteria Sta-phylococcus aureus ATCC 25923 and Klebsiella pneumoniae ATCC 10031 were used, at a concentration of 1.5x108Colony Forming Units/ml (CFU/ml), which were seeded in Petri biplates. Use UV light under different conditions and times. Results: The bacterial species showed the same growth or inhibition profile when subjected to different exposure conditions. Petri dishes with the cover open and protected or not with sterilization packaging showed bacterial inhibition at 15 and 20 minutes. The microorganisms in the biplates protected by the aluminum foil and in the biplates with the cover on, regardless of the time and condition, showed bacterial growth. Conclusion: With the results obtained, it is suggested that the germicidal action of UV light was effective, ensuring adequate decon-tamination and ensuring quality in laboratory biosafety. (AU)

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

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.

Carcinoma basocelular. Un reto actual para el dermatólogo / Basal cell carcinoma. An actual challenge for the dermatologist

RESUMEN El carcinoma basocelular es un tumor maligno de origen epitelial, su crecimiento es lento y rara vez metastiza. Este puede producir destrucción local y comprometer extensas áreas de tejido, cartílago y hueso. Existen variantes clínicas e histológicas y constituye el cáncer más frecuente en humanos y su incidencia está en aumento. Se realizó una revisión para exponer los aspectos esenciales sobre factores predisponentes, formas clínicas y diagnóstico, así como las opciones terapéuticas en esta entidad. Se desarrolló una búsqueda en la Biblioteca Virtual de Infomed y Google. Fueron revisados veinticinco trabajos científicos sin limitación de año y país, de los cuales quince pertenecen a los últimos 5 años. El carcinoma basocelular se considera de origen multifactorial, el carcinógeno más importante es la luz ultravioleta. La forma clínica más frecuente es la variedad nodular y la distribución es en cara y cuello. La elección del tratamiento dependerá del tamaño de la lesión, la localización, la edad y estado general del paciente. A pesar de tener baja malignidad y mortalidad, puede ocasionar destrucción y deformidad y repercutir en la vida de los pacientes. El dominio de los factores de riesgo, los elementos para el diagnóstico precoz y las opciones terapéuticas son indispensable para elegir la conducta adecuada frente a la enfermedad y promover cambios en el estilo de vida, que favorezcan la prevención y disminuyan la morbilidad por esta causa (AU).

ABSTRACT Basal cell Carcinoma (BCC) is an epidermal malignant tumor, it has a slow growth and seldom metastases. It can produce local destruction and compromise big tissue areas, cartilage and bone. There are clinical and histological presentations. It is one of the most common cancer in humans and its incidence is increasing. This project’s goal is to expose the essential aspects about the predisposal factors, clinic presentations and diagnoses as well as this disorder’s therapeutic options.This study was made from different bibliographical revisions. The research was developed on Infomed Database and Google. Twenty five Scientific studies were researched without country and/or timeline limit, from whom fifteen belongs to the last 5 years. BCC is considered to have a multifactorial origin, whose most important carcinogen is the ultraviolet light. The most frequent clinical presentation is the nodular and the most common distribution is face and neck. The treatment choice depends on the tumor size, its distribution and the patient’s age and current state. Although it is a low malignancy and low-death rate neoplasia, it can cause tissue destruction and affect patient’s social life. The management of the risk factors, the elements for the early diagnosis and the therapeutic options are indispensable to choose the adequate behavior for the disorder and promote life style changes that favor the prevention and lower the morbidity rate (AU).

The efficacy and safety of phototherapy in geriatric patients: a retrospective study

Abstract: Background: While phototherapy is a well-established treatment for many dermatoses, data from the literature regarding its use in elderly patients are quite limited. Objective: In this study, we aimed to determine the phototherapy indications in geriatric patients and to evaluate the effectiveness and reliability of phototherapy in this group. Methods: This study included 95 patients of 65 years of age and older who were treated in our phototherapy unit between 2006 and 2015. The data for this study were collected retrospectively from patient follow-up forms in the phototherapy unit. Results: Phototherapy was administered to 28 (29.5%) patients for mycosis fungoides, 25 (26.3%) patients foplaque type psoriasis, 12 (12.6%) patients for palmoplantar psoriasis, 12 (12.6%) patients for generalized pruritus, and 18 (19%) for other dermatoses. Of the patients, 64.2% had received a narrowband UVB (NB-UVB), 21.1% oral psoralen UVA (PUVA), and 14.7% local PUVA treatment. A complete response was achieved in 76.9-85.7% of the mycosis fungoides and in 73.71-100% of the psoriasis vulgaris patients treated with NB-UVB and PUVA, respectively. All the patients with generalized pruritus were treated with NB-UVB, and 80% of these patients achieved significant improvement. The erythema rate was found to be 0.43% per session for NB-UVB treatment and 0.46% per session for PUVA treatment as a side effect. Study limitations: The limitations of our study are that it was retrospective and the remission durations of the patients are not known. Conclusion: This study showed that phototherapy is effective and reliable in the elderly population with proper dose increases and close follow-up.

Hyperpigmentation as a peculiar presentation of mycosis fungoides

Abstract Hyperpigmented mycosis fungoides is an extremely rare subtype of mycosis fungoides. It presents as multiple pigmented macules and patches without poikilodermatous changes and characterized by a CD8+ phenotype on immunohistochemistry. This report describes a typical case of hyperpigmented mycosis fungoides in a 62-year-old woman, who presented with a 7-year history of multiple hyperpigmented macules and patches on the trunk and right leg with progression over this half a year. Histology and immunohistochemical staining of skin samples confirmed the diagnosis of mycosis fungoides. She received psoralen plus ultraviolet A (PUVA) therapy. After an 8-week treatment, the erythematous changes cleared without recurrence during a 6-month follow-up period. An intractable hyperpigmented patch should raise the clinical suspicion of mycosis fungoides with sequential skin biopsy.

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.

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.

Efficacy and safety of topical PUVA treatment for refractory lesions of mycosis fungoides / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of topical PUVA treatment of refractory lesions of mycosis fungoides.</p><p><b>METHODS</b>From January 2008 to 2014, a total of 10 patients (4 males and 6 females) with mycosis fungoides were treated with topical PUVA in Peking Union Medical College Hospital, including 7 cases in plaque stage and 3 cases in tumor stage. The average number of lesions were 1.9±0.9. The median age of these patients was (46.0±9.4) years. The average course of disease was (12.4±7.7) years. Psoralen was applied topically on treatment area 30 min before total body UVA irradiation treatment, 3 times a week. And the efficiency and safety of the therapy were evaluated.</p><p><b>RESULTS</b>All the patients were treated with topical PUVA with a median total dose of (161.60±135.96) J/cm2 in an average of (18.10±14.61) fractions. Total dose of UVA was (1 953.25±829.73) J/cm2, and total number of treatment was (261.90±116.79) fractions. The total treatment time was (45.80±26.64) months. Complete clinical response (CR) rate was 60.0%, partial response (PR) rate was 30.0%, and the overall response rate (CR+PR) was 90.0%. One patient showed no response. No severe acute or chronic side effects were observed.</p><p><b>CONCLUSION</b>Topical PUVA therapy is effective in the treatment of refractory lesions of mycosis fungoides with little severe side effects.</p>

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.

Combined therapy of psoralen plus ultraviolet A followed by narrow band ultraviolet B photochemotherapy for early stage mycosis fungoides / 中华肿瘤杂志

<p><b>OBJECTIVE</b>Only a few clinical reports in the treatment of early mycosis fungoides (MF)(IA, IB, IIA stage) are available in the literature. The purpose of this study was to compare the efficacy and safety of narrow-band UVB and psoralen plus ultraviolet A (PUVA) photochemoterapy in 24 patients with early-stage MF, and explore a new approach for the treatment of early mycosis fungoides.</p><p><b>METHODS</b>A total of 24 identified early mycosis fungoides patients received PUVA, NB-UVB and a combined therapy of PUVA followed by NB-UVB (n = 9/6/9) irradiation. A retrospective study was carried out to analyze the sex, age of onset, TNM stage, treatment, and duration of treatment, and times of treatment, duration of maintenance treatment, effective and recurrence in these patients. The data were analyzed using SPSS 17.0 and a two-sided test at the α = 0.05 level of significance was conducted.</p><p><b>RESULTS</b>Of the 24 patients studied, the average treatment was 104.5 (95% CI, 75.71-133.29) times. The average duration of treatment was 12.88 (95% CI, 9.90-15.85) months. The average maintenance treatment time was 11.08 (95% CI, 2.13-20.04) months. The effective rate (CR+PR) of PUVA treatment was 88.9%, recurrence rate was 11.1% (n = 9). In the NB-UVB treatment group, the effective rate was 100.0%, and the recurrence rate was 33.3% (n = 6). In the PUVA followed by NB-UVB (combination therapy) treatment group, the effective rate was 77.8% and the recurrence rate was 55.6% (n = 9). There were no significant differences among the three groups in terms of number of treatments, treatment duration, maintenance treatment duration, effective rate and recurrence rate (P > 0.05).</p><p><b>CONCLUSIONS</b>PUVA and NB-UVB are effective and safe in the targeted therapy of early stage mycosis fungoides. The combined therapy of PUVA followed by NB-UVB can reduce the total PUVA dose and risk of developing skin cancer.</p>

Palliative local radiotherapy in the treatment of tumor-stage cutaneous T-cell lymphoma/mycosis fungoides / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To determine the efficacy of palliative radiotherapy in treating tumor-stage cutaneous T-cell lymphoma/mycosis fungoides (MF).</p><p><b>METHODS</b>From January 2008 to January 2013, a total of 11 patients with tumor-stage MF were treated with local radiation therapy in Peking Union Medical College Hospital. The median age of these patients was 53.36 ± 14.45 years. Female-male ratio was 1:1.2. The average course of disease was 10.82 ± 3.37 years. All the patients were treated with local electronic beam irradiation with a total median dosage of 48.55 ± 9.51 (40-74) Gy in an average of 24.55 ± 5.57 (20-40) fractions, 5 fractions per week.</p><p><b>RESULTS</b>The median follow-up time was 55.27 ± 29.3 (13-103) months. No severe acute or chronic side effects of irradiation were observed. Complete clinical response (CR) rate of the radiated sites was 54.5% (6/11), partial response (PR) rate was 36.4% (4/11), and the overall response rate (CR+PR) was 90.9%. One patient showed no response.</p><p><b>CONCLUSION</b>Local radiotherapy with psolaren plus ultraviolet A and/or interferon maintaining treatment is an effective palliative therapy in the treatment of tumor-stage MF patients.</p>

Lymphocytoma cutis - case report / Linfocitoma cutis - relato de caso

We describe a clinical case involving a 62-year-old white male, diagnosed with lymphocytoma cutis (Spiegler-Fendt sarcoid) in the cephalic segment. The diagnosis was carried out by pathological study and confirmed by immunohistochemical panel: evidence of polyclonality. Phototherapy sessions were suggested as treatment (13 PUVA sessions, with an accumulated dose of 58.65 J/cm2 ). The improvement was partial. Thus, infiltration of triamcinolone was opted for (one intralesional infiltration every 3 weeks). After 5 sessions, satisfactory improvement was observed: regression of nearly all the lesions.

Relatamos um caso de um paciente de 62 anos, branco e com diagnóstico de linfocitoma cutis (Sarcoide de Spigler-Fendt) em segmento cefálico. O diagnóstico foi confirmado pelo histopatológico e reafirmado pelo painel imuno-histoquímico: evidência de policlonalidade. Sessões de fototerapia foram propostas como tratamento: 13 sessões de PUVA cuja dose acumulada foi de 58.65 J/cm2); a melhora foi parcial. Optado, então, por infiltrações de triancinolona (uma infiltração intralesional a cada 3 semanas). Na quinta sessão, satisfatória melhora já podia ser evidenciada: regressão de quase todas as lesões.

Psoralen-ultraviolet a treatment with psoralen-ultraviolet B therapy in the treatment of psoriasis

To compare the conventional psoralen-ultraviolet A treatment with psoralen-ultraviolet B therapy in the treatment of psoriasis. We studied 50 patients of plaque type psoriasis who were selected to receive either conventional psoralen-ultraviolet A or psoralen-ultraviolet B treatment. There was no significant difference between the two treatment groups in the number of patients whose skin cleared of psoriasis or the number of exposures required for clearance. Profile of side effects and disease status was also similar after three months of follow up. Psoralen-ultraviolet B treatment is as effective as conventional psoralen-ultraviolet A in the treatment of psoriasis. Further long term studies are needed to assess the safety of psoralen-ultraviolet B

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.