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.
UVA-1 may have the edge over UVBNB in treating Scleroderma
TITLE: A randomized controlled study of low-dose UVA1, medium-dose UVA1, and narrowband UVB phototherapy in the treatment of localized scleroderma.
Kreuter A, Hyun J, Stücker M, Sommer A, Altmeyer P, Gambichler T.
Department of Dermatology and Allergology, Ruhr-University Bochum, Bochum, Germany.
BACKGROUND: In previous trials, UV therapy has been demonstrated to be effective in the treatment of localized scleroderma (LS). To date, a randomized comparison study to evaluate the efficacy and safety of different, commonly used phototherapeutic modalities in LS is still outstanding.
OBJECTIVE: The aim of this study was to compare the safety and efficacy of
- low-dose (LD) UVA1,
- medium-dose (MD) UVA1, and
- narrowband (NB) UVB phototherapy in the treatment of LS.
METHODS: Sixty four patients with LS were consecutively included in a prospective, open, randomized controlled 3-arm study. Severity of LS was determined by means of a clinical score, and clinical improvement was also monitored by histopathologic analysis and 20-MHz ultrasound.
RESULTS: A total of 27 patients were treated with LD UVA1 (20 J/cm2), 18 patients received MD UVA1 (50 J/cm2), and 19 patients were treated with NB UVB dependent on their skin type. Phototherapy was performed 5 times weekly for 8 weeks. Two of the 64 patients included in this trial discontinued therapy. Skin status significantly improved in all patients who finished the treatment protocol, resulting in a reduction of the clinical score in all groups (LD UVA1, 7.6-5.0 [P < .001, 95% confidence interval 1.6-3.4]; MD UVA1, 11.1-6.6 [P < .001, 95% confidence interval 2.5-6.2]; NB UVB, 7.3-4.9 [P < .001, 95% confidence interval 1.6-3.2]). The reduction of the score was accompanied by an improvement of the visual analog scale for itching and tightness, histologic score, and 20-MHz ultrasound. MD UVA1 was significantly more effective than NB UVB (P < .05). There were no significant differences between LD UVA1 and NB UVB and the former and MD UVA1 (P > .05).
LIMITATIONS: We had a relatively small study sample and nonblinded assessment of primary outcome.
CONCLUSION: Phototherapy, as previously reported in several noncontrolled trials, is an effective therapeutic option in LS, with a favorable risk/benefit ratio. UVA1 phototherapy should be considered among the first approaches in the management of LS.
Link to PubMed Article: << Click Here >>
NOTE: Amjo does offer UVA-1 Products at www.HomePhotoTherapy.com
Ultraviolet UVA-1 Phototherapy (UK Study)
An older study (2003) highlights UVA-1 (340-400 nm) Ultraviolet Therapy.
The original work was completed by Dawe RS. at the: Photobiology Unit, Department of Dermatology, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. r.s.dawe@dundee.ac.uk
Long-wavelength ultraviolet A (340-400 nm; UVA1) therapy is currently available in only a few dermatology departments. Equipment capable of delivering this waveband has been available since 1981, but it is only over the past decade that increasing numbers of studies assessing the potential of this as a therapy have been published. High-dose UVA1, which requires expensive and space-occupying apparatus, is effective as a monotherapy for acute flares of atopic dermatitis, but it has not yet been formally assessed as an adjunct, rather than as an alternative to conventional therapies including potent and very potent topical corticosteroids. Low-dose (which can be administered using a standard phototherapy cubicle fitted with appropriate lamps) and medium-dose UVA1 may be less effective for this indication. Another condition for which UVA1 is effective, and is particularly promising because we have no reliably effective treatment already, is localized scleroderma. It also appears to be effective in systemic lupus erythematosus (although it is not yet clear when it is indicated, and its safety needs to be assessed in more patients) and in polymorphic light eruption (although there have been no studies suggesting that UVA1 will have any advantages over standard prophylactic phototherapies). Open studies and case series suggest that UVA1 may prove beneficial for various other diseases, including cutaneous T-cell lymphoma, lichen sclerosus, keloids, systemic sclerosis and hand dermatitis. In the centres where it is available, UVA1 has already proved a useful addition to the range of phototherapies previously available. However, much more research is needed to confirm its efficacy for many of its potential indications, and to determine when and how it should be used.
Original Article << Click Here >>
Can I get a sun burn from UVB Narrow Band?
The answer is yes but it’s more of a challenge than with UVB Broadband. One of the best features of UVB Narrow Band is that it has an excellent “therapeutic” effect with less risk of a sunburn. How can that be? The answer is quite simple. Our skin is sensitive to all forms of ultraviolet light and from a sunburn viewpoint, our skin is most sensitive to UV light between about 290 nm (nano meters) and 305 nm. Take a look at the graph below.
The Green area is UVB NB and only a small amount of the UVB NB energy is inside our skin's most sensitive wavelengths.
Clinical studies have shown that the peak therapeutic effectiveness of UVB to be between 295 to 313 nm and that wavelengths below (shorter) than roughly 300 nm are more likely to cause a strong erythemal response or severe burning. UVB Narrow Band is in the 311-313 nm range and causes less burning than shorter wavelengths.
The area under the blue curve is UVB BB (Broadband) and as one can see, a significant amount of the energy of UVB BB is inside the area of the curve defining our skin’s tendency to burn.
UVB NB is not totally foolproof but one does have to work harder to get a sunburn!
More info: << Click Here >>
UVB Narrow Band - A Description
Narrow Band Ultra Violet B Light is a relatively new technology on the vitiligo front. In the past, most doctors have used the PUVA system, which involved the use of Ultra Violet A light exposure and the taking of Psoralen pills. However, side effects for many people were unbearable. Narrow Band UVB light panels and cabinets solve the problems of over-exposure to ultraviolet by maximizing delivery of narrow-band UVB radiation (in the 311-312 nanometer range, the most beneficial component of natural sunlight) while minimizing exposure to superfluous UV radiation.
Gratitude? Is there ever enough to go round?
Cheryl and I operate Amjo Corp for fun and profit. If there’s no profit, I can assure you there’s no fun either! We started Amjo in 1998, you can read about us at www.amjo.net. Every now and again, someone wakes us up by thanking us for what we do. This weekend that just passed by was just such a moment. The gentleman who wrote the letter/email below suffers from severe dermatitis on his hands and he recently purchased a National Biological Corp Hand/Foot II unit from us through his insurance company and this is what he was kind enough to write.
Hi Chris,
I want to thank Cheryl for the wonderful service I received from her. She had a tough and challenging time dealing with my insurance and medical provider. I want you to know how much I appreciated her professionalism and kindness she showed me in dealing with them to get me a light box. I could only wish that there were more people in the medical industry that had Cheryl’s drive to help those of us that don’t understand and haven’t the knowledge of the system to do it as well as Cheryl did. Kudos to Cheryl and yourself for having such a great staff to help us.
Thanks again for everything
RP in California
It feels good to be thanked for the job we do every day.
UVA/UVA1 phototherapy and PUVA photochemotherapy…
UVA/UVA1 phototherapy and PUVA photochemotherapy in connective tissue diseases and related disorders: a research based review.
Breuckmann F, Gambichler T, Altmeyer P, Kreuter A.
Department of Dermatology, Ruhr-University Bochum, 44791 Bochum, Germany. Frank.Breuckmann@ruhr-uni-bochum.de.
BACKGROUND: Broad-band UVA, long-wave UVA1 and PUVA treatment have been described as an alternative/adjunct therapeutic option in a number of inflammatory and malignant skin diseases. Nevertheless, controlled studies investigating the efficacy of UVA irradiation in connective tissue diseases and related disorders are rare.
METHODS: Searching the PubMed database the current article systematically reviews established and innovative therapeutic approaches of broad-band UVA irradiation, UVA1 phototherapy and PUVA photochemotherapy in a variety of different connective tissue disorders.
RESULTS: Potential pathways include immunomodulation of inflammation, induction of collagenases and initiation of apoptosis. Even though holding the risk of carcinogenesis, photoaging or UV-induced exacerbation, UVA phototherapy seems to exhibit a tolerable risk/benefit ratio at least in systemic sclerosis, localized scleroderma, extragenital lichen sclerosus et atrophicus, sclerodermoid graft-versus-host disease, lupus erythematosus and a number of sclerotic rarities.
CONCLUSIONS: Based on the data retrieved from the literature, therapeutic UVA exposure seems to be effective in connective tissue diseases and related disorders. However, more controlled investigations are needed in order to establish a clear-cut catalogue of indications.
Original PubMed Link << Click Here >>
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
Vitiligo Blog Found
Recently I became aware of a blog that’s been running for some time, the blog focuses on Vitiligo and the author whose name is not published on the blog does have a couple of articles on UVB NB used in Vitiligo Treatment. The blog can be found at http://www.vitiligoskindisorder.com. The UVB NB article that I found is http://www.vitiligoskindisorder.com/treating-vitiligo-with-puva-vs-narrowband-uvb/
I’ll keep reading this blog for a while but it would be nice to know who is publishing it and why?
Treating Pruritus: Some folks are just itching to try UVB Narrow Band
With tongue in cheek I penned the title above. I have to admit the first time I heard that “just itching” line was from a person with Psoriasis who had a serious itch associated with his disease. In this case, I am using to attract readers with generalized pruritus. It would seem that HIV Positive patients with pruritus can be helped with UVB311 or UVB Narrowband Therapy.
There are several scientifi articles one can find on the nest. I suggest us search for Pruritus AND UVB Narrow Band for more help at Bing or Google.
I came across a medical paper at:
http://www3.interscience.wiley.com/journal/118530749/abstract?CRETRY=1&SRETRY=0#ss9
Title: “Generalized pruritus treated with narrowband UVB”
Authors: Dilek Seckin, MD, Zeynep Demircay, MD, and Ozlem Akin, MD
From Department of Dermatology, Marmara University School of Medicine, Altunizade, and Department of Dermatology, Maltepe University School of Medicine, Maltepe, Istanbul, Turkey
Background: Narrowband UVB phototherapy has been increasingly used in a variety of dermatological diseases. We planned to evaluate its efficacy in generalized pruritus in this prospective study.
Methods: Forty-six patients were included and then divided into two groups: group 1 and group 2 consisted of patients with uremic pruritus and “idiopathic pruritus”, respectively. Phototherapy was given three times a week. Efficacy assessments were made by means of visual analog scale (VAS) and pruritus grading score.
Results: Thirty-five patients completed the treatment. Mean VAS decreased from 8.2 ± 1.5 to 3.6 ± 3 in group 1 and from 7.1 ± 2.3 to 2.3 ± 2.8 in group 2 (P < 0.0001). Mean percentage of change in VAS was 54.2% (95% CI 32.6–75.9) and 67.9% (95% CI 53.8–81.9) in group 1 and group 2, respectively. Mean number of treatments was 22 in both groups. Mean cumulative UVB dose was 24,540 mJ/cm2 and 20,801 mJ/cm2 in group 1 and group 2, respectively.
Conclusion: Narrowband UVB is an effective and well-tolerated treatment option for patients with generalized pruritus.
Links to other articles
HIV & Pruritus: See http://cat.inist.fr/?aModele=afficheN&cpsidt=2823520
From: http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102210196.html
I found “A 38-year-old Japanese man suffered from hemophilia B and had become infected with HIV through the administration of coagulation factor concentrates. The patient had exhibited small, firm, well-demarcated, skin-colored papules (usually 1-8 mm) symmetrically distributed on the trunk, extremities and face. Intense pruritus usually began with the appearance of the lesions. Scratching led to excoriations, prurigo-like lesions and marked post-inflammatory hyperpigmentation. The serum eosinophil count was elevated, but IgE was normal. Biopsy specimens showed a moderately intense perivascular infiltrate composed of mononuclear cells without eosinophils. The lesions and pruritus failed to respond to the topical administration of corticosteroids, crotamiton cream or emollients, or to oral antihistamines or dapsone. Light treatment was given 8 times for 1 month using an ultraviolet B (UVB) lamp. The severity of the pruritus diminished after a few treatments. New prurigo-like eruptions disappeared with UVB treatment. The lesions and pruritus responded only to UVB phototherapy. While the mechanism is not known, UVB phototherapy may provide relief of AIDS-related pruritus.”