Archive for January, 2010
UVB NB vs PUVA Treatment for Mycosis Fungoides.
The full article publication is entitled “Efficacy of narrowband UVB vs. PUVA in patients with early-stage mycosis fungoides.” prepared by Ponte P, Serrão V, Apetato M. at the Department of Dermatology, Hospital dos Capuchos, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
Abstract:
Introduction Mycosis fungoides (MF) is a non-Hodgkin’s T-cell lymphoma of the skin that often begins as limited patches and plaques with slow progression to systemic involvement. Narrowband ultraviolet (UV) B therapy has been proven to be an effective short-term treatment modality for clearing patch-stage MF. The effect of psoralen plus long-wave ultraviolet A (PUVA) in the treatment of patch- and plaque-type MF has also been thoroughly documented. Objectives The purpose of this study was to compare the efficacy and safety of narrowband UVB and PUVA in patients with early-stage MF. Methods We analysed the response to treatment, relapse-free survival and irradiation dose in 114 patients with histologically confirmed early-stage MF (stage IA, IB and IIA). Results A total of 95 patients were treated with PUVA (83.3%) and 19 with narrowband UVB (16.7%). With PUVA, 59 patients (62.1%) had a complete response (CR), 24 (25.3%) had a partial response (PR) and 12 (12.6%) had a failed response. Narrowband UVB led to CR in 12 (68.4%) patients, PR in 5 (26.3%) patients and a failed response in 1 (5.3%) patient. There were no differences in terms of time to relapse between patients treated with PUVA and those treated with narrowband UVB (11.5 vs. 14.0 months respectively; P = 0.816). No major adverse reactions were attributed to the treatment. Conclusions Our results confirm that phototherapy is a safe, effective and well-tolerated, first-line therapy in patients with early-stage cutaneous T-cell lymphoma, with prolonged disease-free remissions being achieved.
UVA1 Phototherapy - Is it effective?
The article concludes “Besides topical and systemic therapy, UVA1 radiation is a good option of treatment in various skin diseases. It is one of the first-line treatments for several sclerotic diseases and it often improves pruritus considerably.”
I came across this study during an internet search when a customer called me about the use of UVA1. I have to admit I was surprise by the fact that the use of UVA1 has shown some good results with atopic eczema, scleroderma and other challenges.
The authors say
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Phototherapy Is Focus of New Psoriasis Guidelines
One of the realities we live with at Amjo is that many derms look at UV Phototherapy as a last resort. The typical derm would prefer to prescribe biologics and other ointments and salves, many of which expose the patient to higher risks than UVB Narrowband Phototherapy. The article below is one of the few that I’ve come across recommending UV Phototherapy.
The American Academy of Dermatology’s latest guidelines on the management of psoriasis and psoriatic arthritis focus on phototherapy.
Despite therapeutic advances in recent years, phototherapy remains an important treatment option for patients with psoriasis, according to Dr. Alan Menter, chairman of the division of dermatology at Baylor University Medical Center in Dallas, and his associates.
Vitiligo and Skin Cancer: Are you at risk?
Dr. James Nordlund
Today I was reading the Winter Newsletter from Vitiligo Support International and one of the articles was edited and vetted by Dr. James Nordlund here in Cincinnati.
An often-expressed concern of both vitiligo patients and dermatologists is whether having vitiligo increases one’s risk for non-melanoma and/or melanoma skin cancer and if ultraviolet light therapy is a safe treatment. Though there are limited, but growing data, on this subject, key observations have been made which can help both the individual with vitiligo and dermatologist to better assess this risk. To effectively address the question, the information has been separated into these categories.
- Do vitiligo patients in general have an increased incidence of skin cancer?
- Do vitiligo patients have an increased risk of non melanoma skin cancer (NMSC) in their depigmented lesions?
- Do vitiligo patients have an increased risk of melanoma and/or NMSC in their “normal” skin?
Melanin is the substance that gives the skin its color, with darker skin having higher melanin levels. Melanin acts as a sunscreen and protects the skin from ultraviolet light which helps prevent sunburn damage that could result in DNA changes and, subsequently, melanoma. The assumption by many has been that that because the depigmented skin affected by vitiligo has no melanin, that the patient would be more susceptible to some types of skin cancer.
Because there are no melanocytes in depigmented skin, it would be biologically impossible to develop in depigmented skin a melanoma the most serious type of skin cancer. The other forms, the so called basal epithelioma, could develop but are easily treated and are not life threatening.
Unfortunately there are no great statistical studies on cancer in vitiligo. However most research and/or observations indicate that while non melanoma skin cancers do occur in vitiligo patients, they are very rare and melanomas in the normal skin occur at most, in no greater incidence than within the normal population.
An interesting observation on this subject was reported in the book Vitiligo: A Monograph on the Basic and Clinical Science, by Seung-Kyung Hann and James J. Nordlund. Dr. Nordlund observed that in East African countries near the equator, where few work indoors and sunscreen is unavailable, that people with vitiligo not only do not appear to get skin cancer, they exhibit little sun damage to their skin. Other studies also agree that vitiligo patients generally do not demonstrate sun-induced skin damage, despite the lack of protective melanin in the skin.
Ultraviolet light, both natural sunlight and artificial light in PUVA, Excimer laser and narrowband UVB, is an important therapeutic tool for vitiligo. To date, most studies agree that light used in accordance with a supervised treatment plan is a safe, effective method for treating vitiligo. More long term studies will be needed to further assess any skin cancer risk from these treatments.
VSI would like to thank Dr. James J. Nordlund, Professor of Dermatology, Group Health Associates, Cincinnati, OH and Wright State School of Medicine, for his significant contributions to, and medical review of this article.
Narrowband UVB Repigments Vitiligo Lesions.
This is from an article written by Damian McNamara of Skin and Allergy News in an article published in February of 2008.
TORONTO — Narrowband ultraviolet B treatment is effective for repigmentation of vitiligo lesions, according to ratings from 50 patients and their physicians. The technique was particularly successful for lesions on the face and body and less helpful on the hands and feet.