Archive for the ‘Skin Diseases’ Category
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.
Narrow-band UVB quells disease, boosts Vit. D.
As I wander around the internet, from time to time I find articles that I hope my readers find of some value. This article from the December 2009 issue of Skin and Allergy News is one of the first articles I have come across linking Vitamin D production with UVB Narrow Band. This article was written by Bruce Jancin.
Home UVB phototherapy for Psoriasis
Home UVB phototherapy for Psoriasis
Alex Anstey - professor - Royal Gwent Hospital, Newport NP20 2UB - alex.anstey@gwent.wales.nhs.uk - Research, doi:10.1136/bmj.b1542
Is as safe and effective as outpatient treatment, but provision is poor. Psoriasis is a common chronic inflammatory skin condition that causes substantial disability in affected people and their families. In the linked randomised controlled trial (doi:10.1136/bmj.b1542), Koek and colleagues assess whether home ultraviolet B (UVB) phototherapy is as safe and effective for psoriasis as conventional UVB phototherapy given in the outpatient department.
Different, Just like me. A Vitiligo Story
Today I received an email from Lori Mitchell whose daughter April Mitchell has had Vitiligo for many years. April’s one of the few who have come to grips with the challenge and embraced it.
See the Video >> Beauty through the Eyes of April Mitchell << CLICK HERE >>
Cheryl and I have met April and Lori at several Vitiligo conferences over the years. Lori has written a book called “DIFFERENT - Just Like Me”
April and Lori are remakable people in an ever changing world.
Please watch the video!
Chris
Graft vs Host Disease and UVB Narrowband UVBNB
AUTHOR: DUARTE, Ida; VOLTARELLI, Paula; LAZZARINI, Rosana and BEDRIKOW, Roberta Buense. Phototherapy in the graft versus host disease. An. Bras. Dermatol. [online]. 2008, vol.83, n.5, pp. 425-429. ISSN 0365-0596. doi: 10.1590/S0365-05962008000500005.
BACKGROUND: Graft versus host disease is one of the obstacles to successful bone marrow transplantation. It often affects the skin. Phototherapy has been used because of its strong local immunomodulatory activity and it is an option for adjuvant therapy for skin lesions of graft versus host disease resistant to conventional therapy.
OBJECTIVE: To make a descriptive analysis of treating graft versus host disease with phototherapy (PUVA or narrowband UVB). Methods - Nine patients with cutaneous manifestation of acute or chronic graft versus host disease were studied. The first choice therapy was PUVA, applied in six patients, and three were treated with narrowband UVB. The sessions were held three times a week and therapeutic response was evaluated after 12 sessions.
RESULTS: All patients with acute graft versus host disease showed improvement, with the disappearance of erythema and edema. In those with chronic graft versus host disease, there was good response to therapy with regression of lichenoid lesions and better mobility of patients with the sclerodermoid form. Two patients had severe progression and died.
CONCLUSION: Phototherapy showed to be effective in treating skin manifestations of acute and chronic graft versus host disease. PUVA allows control of the disease. The narrowband UVB is an option for patients who cannot take systemic medications.
Is Home phototherapy comparable to in-clinic treatment?
SOURCE: Kristina Fiore, Staff Writer, MedPage Today
Published: May 08, 2009
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
TITLE: Home phototherapy is comparable to hospital-based ultraviolet B treatment for psoriasis patients, researchers have found.
In a randomized controlled trial, home phototherapy was as safe and effective as hospital-based treatment, Mayke Koek, M.D., of the University Medical Center Utrecht in the Netherlands, and colleagues reported online in BMJ.
“We regard home ultraviolet B phototherapy to be a worthy alternative to standard outpatient ultraviolet B phototherapy for patients with psoriasis,” the researchers concluded.
They explained that many patients who could benefit from phototherapy don’t get it because of time constraints: treatment typically involves going to the hospital three times a week for eight to 10 weeks.
Also, some dermatologists believe that home phototherapy is inferior to hospital treatment and carries more risks, such as inaccurate dosimetry, phototoxicity, and unsupervised continuation of irradiation. The researchers said there is little evidence for this.
So the present study looked at 196 psoriasis patients from 14 hospital dermatology departments in the Netherlands who received either home- or hospital-based phototherapy.
Home therapy patients used a TL-01 home phototherapy unit, while those who came to the hospital for treatment received standard, narrowband ultraviolet B phototherapy.
The researchers found that home phototherapy was as safe and effective as outpatient phototherapy, both clinically and in terms of quality of life.
A total of 82% of patients treated at home reached a treatment effect as measured by the self-administered psoriasis area and severity index (SAPASI), compared with 79% of those treated in an outpatient setting.
Likewise, 70% reached treatment effect as measured by the clinically assessed psoriasis area and severity index (PASI), compared with 73% of outpatients.
The treatment effects were significant across all groups (P<0.001).
As for safety concerns, the researchers found that patients treated themselves at home more frequently than they would have been treated at the hospital. But the cumulative dose they received by the end of treatment was only slightly higher than hospital-treated patients.
They found that regardless of treatment, 87% of patients had at least one occurrence of mild erythema, while 58% reported burning sensations, 39% had severe erythema, and 6% had blistering. No differences were observed between groups.
“Our results refute the widespread fear of more acute safety risks with ultraviolet B phototherapy used at home,” the researchers said.
They also found that the burden of undergoing phototherapy was significantly lower for patients treated at home (P<0.001).
Quality of life increased equally, regardless of treatment, but those treated at home were more likely to rate their experience with the therapy as “excellent” (42% versus 23%, P=0.001).
The researchers concluded that phototherapy administered at home is “equally safe and equally effective, both clinically and for quality of life, as ultraviolet B phototherapy administered in an outpatient setting.”
In an accompanying editorial, Alex Anstey, M.D., of Royal Gwent Hospital, called the study “pragmatic” and said an economic assessment of different phototherapy service models is now needed.
“This should include the costs of the equipment, costs of teaching patients how to use the equipment, and costs for a clinical governance system within which home phototherapy can operate,” Dr. Anstey said.
He added that dermatologists “should reflect on the shortcomings of current phototherapy services, where many patients are excluded because they live too far from their local unit. The case for home provision of UVB phototherapy for psoriasis is most persuasive in sparsely populated areas.”
Phototherapy with Narrowband vs Broadband UVB
Author: Berneburg M, Röcken M, Benedix F.
Department of Dermatology, Eberhard Karls University, DE-72076 Tuebingen, Germany. Mark.Berneburg@med.uni-tuebingen.de
Phototherapy with ultraviolet (UV) radiation of wavelengths between 280 and 320 nm (UVB) is a safe and effective treatment for a variety of diseases. In addition to standard broadband UVB (bUVB), narrowband phototherapy with fluorescent bulbs emitting near monochromatic UV around 311 nm (nUVB) has become an important treatment for diseases such as psoriasis, atopic dermatitis and vitiligo. In addition to these indications, the number of diseases for which nUVB phototherapy is reported to be effective is continuously growing. The differential effects of nUVB phototherapy in comparison to other UV wavelengths as well as established and new indications for this treatment modality are reviewed.
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