Is there still a role for UV therapy in itch treatment?

Itching is a frequent and greatly distressing symptom related to many skin and systemic diseases. New insights into the pathophysiology of itchy skin and potentially involved mediators have increased the interest in and development of new treatments that specifically act on targets involved in the transmission and perception of itching. Phototherapy has long been known and used as an effective treatment for various kinds of chronic itching. However, despite its well-known beneficial effects, the mechanisms behind the antipruritic effect of phototherapy are less well-known. In addition, phototherapy requires the use of expensive equipment in dermatology offices, patients must undergo repeated treatments and no large, randomized, controlled trials have yet supported the antipruritic effect of UV. Therefore, phototherapy is rarely recommended as a treatment method for chronic pruritic diseases or only used as a last recourse. However, the wide range of pruritic conditions that can be successfully treated with phototherapy, together with its low acute side effects, extremely low frequency of interactions with other medications, possibilities to combine phototherapy with other treatment modalities and the fact that patients of almost all ages-from childhood to old age, including women during pregnancy or lactation-can be treated make UV therapy advantageous over other treatments of chronic pruritus. Thus, despite the development of new targeted therapies against pruritus, UV therapy is neither outdated nor the 'last recourse', but should be considered early on in the treatment of chronic pruritus.

Phototherapy for the treatment of prurigo nodularis: a review.

BACKGROUND/PURPOSE: Review the available literature on phototherapy for treatment of prurigo nodularis (PN). METHODS: Literature search was conducted on MEDLINE. RESULTS:  6 prospective trials, 2 retrospective studies, and 3 case series were found investigating efficacy and safety of phototherapy for treatment of PN. CONCLUSION: Although large randomized clinical trials are necessary, phototherapy appears to be a safe and efficacious treatment for PN, alone and in combination with other common treatment modalities for PN.

Monochromatic excimer light (308 nm) in the treatment of prurigo nodularis.

Three hundred and eight nanometre excimer light has been reported to be safe and effective in the treatment of chronic skin diseases, but the range of potential applications has not been fully explored. Our objective was to assess the efficacy of monochromatic excimer light (MEL) in the treatment of prurigo nodularis (PN). Eleven patients were enrolled in this pilot study. Patients were treated weekly and an average of eight sessions of MEL was given. Follow-up was 4 months. Partial or complete clinical and histological remission was observed in all patients who completed the study (81%).

UVB de banda angosta para el prurigo nodular de difícil tratamiento / Narrow-band ultraviolet B in recalcitrant nodular prurigo

Introducción. La luz UVB de banda angosta (nb-UVB) ha surgido como nueva propuesta para el tratamiento del prurigo nodular. Objetivo: Describir nuestra experiencia en el uso de nb-UVB para el prurigo nodular de difícil manejo. Método: Análisis retrospectivo de cinco pacientes con prurigo nodular tratados con luz nb-UVB asociado a terapia estándar. Resultados: Se obtuvo respuesta favorable en los cinco pacientes, utilizando 23,4 mas 5,6 sesiones con una dosis acumulada de 44,5 J/cm2. El promedio de remisión fue de 4,2 mas 1,6 meses. Conclusión: La terapia nb-UVB parece constituir una alternativa eficaz para el tratamiento del prurigo nodular.

Introduction. Narrow band ultraviolet B (nb-UVB) has emerged as a new proposal for treatment of nodular prurigo. Objective. To describe our experience with nb-UVB in recalcitrant nodular prurigo. Method. Retrospective analysis of five patients treated with nb-UVB associated to standard therapy Results: We obtained a favorable response in all patients with 23.4 mas: 56 sessions, using a mean accumulative dose of 44.5 J/cm2. The mean duration of remission was 42 mas: 1.6 months. Conclusion. NS-UVB phototherapy appears to be an effective treatment for recalcitrant nodular prurigo.

Narrow-band ultraviolet B phototherapy in patients with recalcitrant nodular prurigo.

Management of nodular prurigo has been less than satisfactory. Conventional therapies such as systemic antihistamines and topical steroids have not been particularly successful. The effects of narrow-band ultraviolet B (NB-UVB) phototherapy in the treatment of various inflammatory dermatoses have been proven, however, no data exist on the efficacy and the duration of remission in NB-UVB monotherapy for nodular prurigo. The aim of this study was to evaluate the effect of NB-UVB phototherapy on recalcitrant nodular prurigo. NB-UVB phototherapy was performed once a week on 10 patients with recalcitrant nodular prurigo. The initial dose was 0.4 J/cm(2), and the dose was increased by 0.1 J/cm(2) for each treatment. The treatment was performed until the eruption was almost clear. In each patient, a mean cumulative dose of 23.88 J/cm(2) was applied over a mean of 24.3 irradiations. The mean maximum daily dose of ultraviolet B was 1.2 +/- 0.4 J/cm(2). NB-UVB phototherapy notably improved the eruption of nodular prurigo in all patients. Follow up at 1 year revealed that only one patient had relapsed. The remaining nine patients continued to derive long-term benefits. NB-UVB phototherapy appears to be an effective treatment for recalcitrant nodular prurigo, offering long-term benefits in the majority of those treated.

Papular dermatitis (subacute prurigo, "itchy red bump" disease): pilot study of phototherapy.

BACKGROUND: Some patients with a subacute or chronic pruritic erythematous papular eruption are refractory to treatment. We previously described a number of these patients with papular dermatitis or subacute prurigo. OBJECTIVE: The purpose of this study was to examine the effectiveness of different types of phototherapy for treatment of papular dermatitis. METHODS: We reviewed the medical records of 11 patients who were diagnosed with papular dermatitis and who underwent phototherapy within the last 5 years. RESULTS: Eleven patients had a total of 17 phototherapy courses: psoralen-UVA (PUVA; 9), UVA/UVB light (3), and UVB alone (5). Within the PUVA treatment group, three of nine patients experienced total clearing, and six of nine patients experienced partial improvement. Although patients in all groups relapsed with time, overall the PUVA-treated patients had the best response rate and the best chance of the condition remaining clear after treatment was stopped. CONCLUSION: PUVA may be an effective treatment for papular dermatitis. The frequency of relapse indicates that maintenance treatments may be necessary for long-term control of the disease.

Sequential combined therapy with thalidomide and narrow-band (TL01) UVB in the treatment of prurigo nodularis.

BACKGROUND: Prurigo nodularis (PN) is a chronic disease of which treatment choices are limited. Among them, thalidomide and phototherapy have been used with satisfactory results. Unfortunately, the possibility of side effects limits their use. OBJECTIVE: To evaluate the efficacy of a sequential combined treatment with thalidomide and ultraviolet B (UVB) therapy in order to minimize side effects and, thus, making possible a long-term treatment. METHODS: A prospective open trial combining thalidomide as initial therapy followed by narrow-band UVB (TL01) irradiation until complete or almost complete remission of the disease was achieved. RESULTS: An excellent response was obtained after an average of 12 weeks of thalidomide therapy and 32 UVB courses. CONCLUSIONS: Sequential combined therapy with thalidomide and narrow-band UVB therapy could improve the management of prurigo nodularis with minimal side effects, although it should probably be reserved to men and women over 50 years of age.