Targeted 307 nm UVB-phototherapy in psoriasis. A pilot study comparing a 307 nm excimer light with topical dithranol.

BACKGROUND: Phototherapy is a cornerstone in treatment of moderate-to-severe psoriasis. Narrow-band UVB has been shown to be a potent therapeutic tool. To reduce the potential carcinogenic risk, targeted phototherapy has been developed using excimer lasers or excimer light devices (ELD). OBJECTIVE: The role of excimer light therapy in practice and modes of action are not completely understood. We wanted to investigate a 307 nm ELD for plaque psoriasis in comparison with topical dithranol therapy twice daily. METHODS: We conducted a pilot trial in 21 adult patients with moderate plaque-type psoriasis. Two target lesions of comparable size and plaque-modified Psoriasis Activity and Severity Index (PSI) scores were selected. Lesion A was treated three times using a newly developed 307 nm ELD. Lesion B was treated twice daily with dithranol ointment. The mean period of treatment was 9 days. Clinical evaluation included PSI scores, safety, time needed to treat, and patient's satisfaction. In addition, fluorescence-remission imaging technique was used for objective evaluation. RESULTS: Both treatments improved the PSI score (mean 3.0 points). The treatments were safe but ELD was more convenient for patients. The time needed to treat the target lesion was significantly shorter with ELD. Targeted UVB therapy normalized NADH fluorescence in lesional skin. CONCLUSIONS: The 307 nm excimer light therapy for plaque type psoriasis was equipotent to twice daily topical dithranol. Efficacy, safety, and convenience suggest that targeted UVB therapy with quasi monochromatic light is a new useful treatment option for patients with limited psoriatic plaques.

Effects of low-frequency ultrasound on microcirculation in venous leg ulcers.

BACKGROUND: Therapeutic low-frequency ultrasound (US) has been used for many years to improve wound healing in chronic wounds like venous leg ulcers. No human data are available for the possible effects of single US applications on microcirculation and their frequency-dependency. AIMS: To investigated the role of therapeutic low-frequency US on microcirculation of venous leg ulcers in vivo. PATIENTS AND METHODS: This is a pilot study on an inpatient basis. We use a newly developed low-frequency continuous-wave US-equipment composed of a US transducer based on piezo-fiber composites that allow the change of frequency. In this study, we apply US of 34 kHz, 53.5 kHz, and 75 kHz respectively. Twelve patients with chronic venous leg ulcers are analyzed. As an adjunct to good ulcer care, therapeutic US is applied, non-contacting, once a day, in a subaqual position for 10 minutes. Microcirculation is assessed in the ulcers adjacent to skin before US-therapy, immediately after the treatment and 30 minutes later. We use a micro-light guide spectrophotometer (O2C, LEA Medizintechnik GmbH, Gieίen, Germany) for calculation of blood flow velocity, hemoglobin oxygen saturation (SCO(2)) and relative hemoglobin concentration (rHb) in 2 and 8 mm depth. Contact-free remission spectroscopy (SkinREM3, Color Control Chemnitz GmbH, Chemnitz, Germany) allows contact free measurements in the VIS-NIR range of the spectrum (400 ± 1600 nm). RESULTS: It is seen that therapeutic US is well tolerated. One patient dropped out from a treatment series since he developed erysipelas responding to standard antibiotic. Effects were seen at 34 kHz only. The SO(2) values increased after single US application. The values for rHb were higher in the superficial layer of the wound bed (depth 2 mm) compared to deeper parts (8 mm depth). US treatment did not result in significant changes of rHb and blood cell velocity. The data obtained by remission spectroscopy disclose an increase of oxygenized hemoglobin. CONCLUSIONS: The major findings are that continuous-wave low-frequency US of 34 kHz, but not, 53.5 kHz or 75 kHz, has a temporary stimulatory effect on microcirculation mainly due to an improved oxygenation. Further studies with treatment series are necessary.

Fluorescence--remission sensoring of skin tumours: preliminary results.

OBJECTIVE: Nonmelanoma skin cancer (NMSC) is one of the most common malignancies in men. Objective evaluation by digital dermoscopy, as for pigmented lesions, does not provide sufficient data to discriminate between benign and malignant lesions. Therefore, other techniques have to be developed. SETTING: Hospitalized patients of an academic teaching hospital were evaluated. PATIENTS AND METHODS: Because the simultaneous measurement of fluorescence and remission of skin is impossible, a principle of subsequent measurement of remission and fluorescence had been developed by our group. This was combined with dermoscopic imaging. VIS-NIR remission spectroscopy was performed using the laboratory device TIDAS. Fluorescence spectroscopy was realized using a SKINSKAN. Fluorescence emission was detected by a highly sensitive PMT-detector. Based on this evaluation, we developed an optimized measuring device (FRIS, fluorescence-remission-imaging sensor) combining sensors for fluorescence, remission and digital imaging with a white light ring illumination, a drilled mirror and fibre optics. FRIS consists of an industrial personal computer with a touch screen combining three UV-VIS spectrometer modules and a white light source for remission measurements and referencing. Furthermore, included are a CCD coloured camera module and an LED white light ring-illumination. Fluorescence emission is realized by a UV-LED with a peak wavelength of 370 nm. System control uses Window frames and a specifically developed software Skinrem3.exe . Using this technology, we performed a pilot study in 19 patients with 30 NMSC-suspicious lesions including: actinic keratosis (n=10), basal cell carcinoma (BCC; n=16) and squamous cell carcinoma (SCC; n=4 with two in situ carcinomas). RESULTS: Reproducibility measured or FRIS by relative standard deviation of repeated spectroscopic measurements was <0.1% for remission and 2% for fluorescence. The technology was able to generate typical pattern of remission-corrected fluorescence data. The fluorescence differences at 430 nm allow a differentiation between actinic keratoses and BCC. A decrease of the corrected lesional fluorescence >2 AU indicates BCC. To substantiate the diagnostic potency of this technology, further studies are needed. CONCLUSIONS: A combination of fluorescence and remission readings of skin provides objective data in NMSC. We developed the FRIS equipment that allows a reproducible measurement and easy handling.

Some effects of a topical collagen-based matrix on the microcirculation and wound healing in patients with chronic venous leg ulcers: preliminary observations.

The microcirculation of the wound bed is a key parameter for improving granulation tissue formation and, hence, wound healing. The aim of this study was to determine whether a wound dressing comprising collagen/oxidized regenerated cellulose has effects over a short term on wound healing. Wounds were evaluated using a clinical wound score; pain associated with wounds was measured using a visual analogue scale. Wound microcirculation was evaluated using a technique based on noncontact remission spectroscopy. A prospective trial was performed in 40 patients with chronic venous leg ulcers (mean age 74 years; range, 43-93 years; 25 females and 15 males). Patients in group A were treated with PROMOGRAN Matrix (Johnson& Johnson, New Brunswick, NJ) combined with "good" ulcer care for 2 weeks. Control group B consisted of 10 patients who received only good ulcer care. The authors measured a favorable clinical response in 76.9% (group A) versus 66.7% (group B). The mean reduction of ulcer area was statistically significant in group A (P < .05). The wound score improved in group A from 2.28 +/- 1.24 (before treatment) increasing to 3.72 +/- 1.57 (after 1 week; P < .00023) and 4.92 +/- 1.68 (after 2 weeks; P < .000027). In group B, the score improved from 1.44 +/- 1.33 (before treatment) to 3.22 +/- 1.30 (after 1 week; P < .0077). The mean visual analogue pain score before treatment was 8.72 (group A) and 7.88 (group B) (ns, P > .05). After 1 week of treatment, the score dropped to 5.76 (group A) and 6.66 (group B). In the second week, group A patients had a mean pain score of 3.84 compared with the pain score before treatment (P < .05). After 1 week of treatment, in group A there was a decrease in remission spectroscopy, which is considered to reflect an improvement in microcirculation.