Phototherapy for mycosis fungoides.

Background: Both phototherapy and photochemotherapy have been used in all stages of mycosis fungoides since they improve the symptoms and have a favourable adverse effect profi le. Materials and Methods: We performed an extensive search of published literature using keywords like “phototherapy”, “photochemotherapy”, “NBUVB”, “PUVA”, “UVA1”, “mycosis fungoides”, and “Sezary syndrome”, and included systematic reviews, meta-analysis, national guidelines, randomized controlled trials (RCTs), prospective open label studies, and retrospective case series. These were then arranged according to their levels of evidence. Results: Five hundred and forty three studies were evaluated, of which 107 fulfi lled the criteria for inclusion in the guidelines. Conclusions and Recommendations: Photochemotherapy in the form of psoralens with ultraviolet A (PUVA) is a safe, effective, and well tolerated fi rst line therapy for the management of early stage mycosis fungoides (MF), that is, stage IA, IB, and IIA (Level of evidence 1+, Grade of recommendation B). The evidence for phototherapy in the form of narrow-band UVB (NB-UVB) is less robust (Level of evidence 2++, Grade of recommendation B) but may be considered at least as effective as PUVA in the treatment of early-stage MF as an initial therapy. In patients with patches and thin plaques, NB-UVB should be preferentially used. PUVA may be reserved for patients with thick plaques and those who relapse after initial NB-UVB therapy. For inducing remission, three treatment sessions per week of PUVA phototherapy or three sessions per week of NB-UVB phototherapy may be advised till the patient achieves complete remission. In cases of relapse, patients may be started again on PUVA monotherapy or PUVA may be combined with adjuvants like methotrexate and interferon (Level of evidence 2+, Grade of recommendation B). Patients with early-stage MF show good response to combination treatments like PUVA with methotrexate, bexarotene or interferon- α-2b. However, whether these combinations hold a signifi cant advantage over monotherapy is inconclusive. For late stage MF, the above-mentioned combination therapy may be used as fi rst-line treatment (Level of evidence 3, Grade of recommendation C). Currently, there is no consensus regarding maintenance therapy with phototherapy once remission is achieved. Maintenance therapy should not be employed for PUVA routinely and may be reserved for patients who experience an early relapse after an initial course of phototherapy (Level of evidence 2+, Grade of recommendation B). Bath-water PUVA may be tried as an alternative to oral PUVA in case the latter cannot be administered as the former may show similar effi cacy (Level of evidence 2-, Grade of recommendation C). In pediatric MF and in hypopigmented MF, both NB-UVB and PUVA may be tried (Level of evidence 3, Grade of recommendation D).

Effect of voltage stabilizer on the light intensity output of curing units

The success rate of light composite restorative treatments is in close relation to the light intensity of the light curing units. The purpose of this study was to evaluate the rate of light intensity of visible light curing units, before and after voltage stabilizer application. This study was performed on 82 light curing units in all clinics and dental offices of Yazd city. For evaluating light exit intensity, Hilux radiometer was used. At first, the light intensity was measured, and then by use of 220 V electrical voltage stabilizer the light exit intensity was recorded. Results were analyzed using Pearson and Spearman tests. Mean range of light intensity before and after voltage stabilizer was 241.3 and 272.6 mW/cm2 respectively. There were statistically significant differences between before and after use of voltage stabilizer [p < 0.05]. Considering the light intensity, 64.7% of the light curing units were suitable for optimum curing and 8.6% were in group that required increase light exposure time. 21.9% did not completely cure the composites, and 4.8% were in group with higher light intensity 2 [over 500 mW/Cm2]. Light intensity output of the curing units in dental clinics of Yazd city were less than expected, but by using voltage stabilizer, the light intensity was significantly increased

An audit of phototherapy units.

Audit of phototherapy aims to examine their efficacy and functioning. Twenty-four centres providing neonatal care were visited by a team of two persons. Data form were completed with information regarding age of phototherapy units, its buildup in relation to number of tubelights, type of light and irradiance provided. Total of 58 units examined had a wide variety in relation to their build. There were only 21 units (36.2%) in which all the lights were in working order. Only five of the units (8.6%) had the recommended special blue lights. Only 18 of the units (31%) provided an acceptable level of irradiance. Phototherapy demonstrates a dose response relationship. By not providing optimum irradiance, the efficacy is compromised. This prolongs hospital stay and treatment costs. Acceptable standards should be insisted upon in purchase and maintenance of medical equipments.