A review of home phototherapy for psoriasis

Posted on June 4, 2010 by Chris Cane

From Dermatology Online Journal

Volume 16, Number 2
February 2010

A review of home phototherapy for psoriasis�
Bridgit V Nolan1, Brad A Yentzer MD2, Steven R Feldman MD PhD2
Dermatology Online Journal 16 (2): 1

1. SUNY Upstate Medical University, Syracuse, New York
2. Center for Dermatology Research, Department of Dermatology; Wake Forest University School of Medicine; Winston-Salem, North Carolina. sfeldman@wfubmc.edu

Abstract

Background: Phototherapy is a mainstay in the treatment of psoriasis and other photoresponsive dermatoses and home phototherapy has broadened therapeutic options.

Purpose: To describe the history of home phototherapy, the technological advances in the safety and efficacy of the equipment available, and the associated issues of cost, convenience, adherence, and quality of life.

Methods: We conducted a literature review of home phototherapy, broad-band UVB, narrow-band UVB, and PUVA phototherapy using PUBMED. A Google search of home phototherapy equipment and technology was also undertaken.

Results: Technological advances in home phototherapy equipment have allowed for more treatment options and improvements in safety and efficacy. One randomized, controlled trial found results comparable to office-based phototherapy. Home phototherapy is convenient, cost-effective, and associated with better quality of life compared to outpatient phototherapy treatment. One trial found that adherence to home phototherapy regimens was better than to oral retinoids.

Conclusions: Home phototherapy is a well-tolerated, efficacious, economical and patient friendly therapeutic option. Advantages of home phototherapy include improved quality of life, greater convenience, lower cost, and less time lost from work and social activities. Dermatologists should strongly consider home phototherapy as a first-line treatment option for appropriately selected psoriasis patients. Continue reading →

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CIGNA Insurance enters the DARK AGES for folks with Vitiligo

Posted on May 10, 2010 by Chris Cane

As unbelievable as it may sound, CIGNA insurance took a major step backwards last month following AETNA’s lead (in 2004) to stop paying claims for patients with Vitiligo. Aetna stopped in 2004 for home phototherapy systems and last month CIGNA hit with both barrels and stopped covering Vitiligo for UVB Narrow Band Home Users and also for in-clinic UVB NB Therapy. I find it absolutely incredulous that a company can take such a giant step backwards.

CIGNA actually have the balls to say that Vitiligo is a cosmetic problem and not worthy of insurance coverage! What a load of crap!

The new policy can be found at http://uvbnarrowband.com//wp-content/uploads/pdfs/Cigna_Insurance_Coverage_2010.pdf. This is a true shame.

IN CLINIC PHOTOTHERAPY

Page 2 of 13

CIGNA does not cover phototherapy, photochemotherapy or excimer laser therapy for the treatment of localized or generalized vitiligo in any setting because such treatment is considered cosmetic and not medically necessary. Services that are cosmetic are not covered under most benefit plans.

HOME PHOTOTHERAPY

Page 8 of 13 says Not Medically Necessary/Cosmetic/Not Covered for E0691 through E0694 which are the HCPCS codes used by insurance firms for UV Phototherapy Products used in the home.

They seem to be quite emphatic.

All I can say is that this is a huge step backwards for folks with Vitiligo. Their earlier policy’s did cover Vitiligo!

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Vitiligo may offer natural defense against skin cancer.

Posted on May 5, 2010 by Chris Cane

Vitiligo may offer natural defense against skin cancer.

May 4, 2010 – By: Bill Gillette – Dermatology Times E-News

London — Results of a new study suggest that people with vitiligo may have natural protection against skin cancer, BBC News reports.

A University of London study of 4,300 people identified a common gene mutation that both increases the chance of vitiligo and cuts cancer risk. The finding, reported in the New England Journal of Medicine, is based on genetic testing of 1,514 patients with vitiligo and 2,813 without. Researchers identified a total of seven genes that were linked to vitiligo.

According to the study authors, about 70 percent of people in the general population have the gene combination that increases the risk of vitiligo while reducing the risk of malignant melanoma. Thirty percent have a different version that raises melanoma risk while lessening the chances of vitiligo.

The study notes that while everyone has one of the two variants, neither guarantees that either vitiligo or melanoma will actually develop — just as neither guarantees protection.

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Combined treatment with calcipotriol ointment and low-dose ultraviolet A1 phototherapy in childhood morphea.

Posted on April 26, 2010 by Chris Cane

Combined treatment with calcipotriol ointment and low-dose ultraviolet A1 phototherapy in childhood morphea.

Kreuter A, Gambichler T, Avermaete A, Jansen T, Hoffmann M, Hoffmann K, Altmeyer P, von Kobyletzki G, Bacharach-Buhles M.
Department of Dermatology, Ruhr-University Bochum, Bochum, Germany. a.kreuter@derma.de

Abstract

Various therapies for morphea have been used with limited success, including ones with potentially hazardous side effects. When morphea occurs in childhood it may lead to progressive and long-lasting induration of the skin and subcutaneous tissue, growth retardation, and muscle atrophy.

We report an open prospective study in which the efficacy of a combined treatment with calcipotriol ointment and low-dose ultraviolet A1 (UVA1) phototherapy in childhood morphea was investigated. Nineteen children (mean age 8.5 years, range 3-13 years) with morphea were exposed to UVA1 (340-400 nm) phototherapy at a dose of 20 J/cm(2) four times a week for 10 weeks. Forty phototherapy sessions resulted in a cumulative dose of 800 J/cm(2) UVA1.

In addition, calcipotriol ointment (0.005%) was applied twice a day. After 10 weeks, palpation and inspection showed a remarkable softening and repigmentation of formerly affected skin resulting in a highly significant (p < 0.001) decrease of the mean clinical score from 7.3 +/- 0.9 at the beginning to 2.4 +/- 0.9 (relative reduction 67.1%) at the end of combined therapy.

Our results indicate that a combined therapy with calcipotriol ointment and low-dose UVA1 phototherapy is highly effective in childhood morphea. Further controlled studies are necessary to investigate whether this combined therapy is superior to UVA1 phototherapy alone.

PUB MED Link: http://www.ncbi.nlm.nih.gov/pubmed/11438008

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Morphea – Medium-dose UVA1 phototherapy in localized scleroderma and its effect in CD34-positive dendritic cells.

Posted on April 26, 2010 by Chris Cane

I recently received a phone call from a man whose daughter has Morphea so I decided to do some hunting to learn a little more about the disease and I came across several articles. I chose to publish part of one of the articles I found here.

Medium-dose UVA1 phototherapy in localized scleroderma and its effect in CD34-positive dendritic cells.
Camacho NR, Sánchez JE, Martin RF, González JR, Sánchez JL.Department of Dermatology, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico 00936-5067

BACKGROUND: UVA1 radiation seems to be effective in morphea. CD34+ dendritic cells are significantly decreased in lesional skin of morphea patients.

OBJECTIVE: We evaluated the therapeutic effectiveness of medium-dose UVA1 phototherapy in localized scleroderma and its effect in the number of dermal CD34+ dendritic cells in skin biopsy specimens of these patients.

METHOD: Patients were irradiated with UVA1 (30 J/cm(2)) 30 times. Dermal CD34+ dendritic cells were counted before and after therapy.

RESULTS: There was clinical improvement after UVA1 irradiation. Dermal CD34+ dendritic cells significantly increased after UVA1 irradiation.

CONCLUSION: Medium-dose UVA1 therapy is effective in the treatment of localized morphea. Effectiveness is associated with an increase in the number of CD34+ dendritic cells in the dermis.

PUBMED Link: http://www.ncbi.nlm.nih.gov/pubmed/11606918

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Dermalume 2X – Double your Power – Double Your Fun!

Posted on April 5, 2010 by Chris Cane

dermalume-big1The folks at National Biological Corp leapfrogged the world recently introducing the Dermalume 2X. The new Dermalume 2X provides twice the power, twice the coverage of the typical single lamp handheld wand. The clever designers have been able to use two PL-S9W01 UVB Narrow Band lamps and double the coverage.

The new Dermalume 2X uses the National Biological Corp CPT or Controlled Prescription Timer to help the doctor and the patient work together for optimal treatment.

It’s interesting to see the sales of our Dermalight 80 drop slightly as our sales of the Dermalume ramp up.

The Dermalume 2X arrives ready for use in a handy briefcase type case allowing the user to easily pack it away between treatments and carry it with them while traveling.

The unit allows the user to treat only affected areas – and use comb to maintain consistent distance from skin or separate hairs for scalp psoriasis treatment.

The clever hinge allows multiple wand positions can be held where you want while the two lamps with the large output window allow for faster treatment. The DermaLume is shipped fully assembled with an optional comb attachment (includes) , goggles, and carrying case.

You can learn more about the Dermalume 2X at our website. Please visit http://www.homephototherapy.com/dermalume2X.htm for more information.





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Are Tanning Beds the same as UVB or UVB Narrowband ?

Posted on March 8, 2010 by Chris Cane

Bumped Up (2010-03-08)

In the begining “Yes” but now “Absolutely not!” The answer is no. Tanning beds generate UVA or Long Wavelength UV. UVA penetrates the skin very deeply while the shorter wavelengths of UVB do not. UVA is used in photoherapy when combined with a Psoralen drug and the therapy is called PUVA.

In tanning bed antiquity, the UVB content was much higher. Today, in the USA, the FDA has regulated that the UVB content in tanning beds must be very low! Because of regulations, tanning beds produce only 4.2% to 6.5% UVB in the USA and typically 1% to 3% in Europe. To read the US FDA Regulations <Click Here>. The level of UVB radiation is in the following statement “Performance requirements–(1) Irradiance ratio limits. For each sunlamp product and ultraviolet lamp, the ratio of the irradiance within the wavelength range of greater than 200 nanometers through 260 nanometers to the irradiance within the wavelength range of greater than 260 nanometers through 320 nanometers may not exceed 0.003 at any distance and direction from the product or lamp. UVB is commonly defined as 280 to 320 nanometers.

Tanning Salons can be a risk for the typical consumer as the output from these beds can vary greatly from bed to bed and treatment/tanning times must be adjusted based on lamp power. When a bed is re-lamped and you are not told then a sunburn is very likely.

UVA wavelengths pass through the epidermis to the hypodermis.

UVA wavelengths pass through the epidermis to the hypodermis Click on the image for a link to this photo's source.

Read this article http://www.pnas.org/content/101/14/4954.full which seems to indicate that UVA may be more dangerous than UVB. This is a complicated subject but it does appear that it is UVA that contributes to premature skin aging and is more likely to cause cancers of the skin.

UNDERSTANDING UV RAYS
“Most everyone is aware of the risks associated with UVB exposure, however there are real risks associated with UVA exposure including skin aging, DNA destruction and even skin cancer. Protecting your skin from UVA rays is just as important as protecting yourself against UVB rays.”  – A quote by Dr. Henry Lim, Vice President-Elect, American Academy of Dermatology and Chairman of Dermatology, Henry Ford Hospital, Detroit, MI.

Here’s another posting at this blog on the diferences twixt UVA and UVB. See PUVA vs UVB NARROWBAND.

Don’t be fooled by the non-medical advice of a tanning salon owner! Check with your dermatologist.

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Morphea – Some Background Information

Posted on February 26, 2010 by Chris Cane
Author: Jennifer V Nguyen, MD, Resident Physician, Department of Dermatology, Hospital of the University of Pennsylvania
Coauthor(s): Victoria P Werth, MD, Professor of Dermatology and Medicine, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, Philadelphia Veterans Affairs Medical Center; Nicole Fett, MD, Clinical Educator, Department of Dermatology, University of Pennsylvania School of Medicine

Introduction:

Morphea, also known as localized scleroderma, is a disorder characterized by excessive collagen deposition leading to thickening of the dermis, subcutaneous tissues, or both. Morphea is classified into plaque, generalized, linear, and deep subtypes according to the clinical presentation and depth of tissue involvement. Unlike systemic sclerosis, morphea lacks features such as sclerodactyly, Raynaud phenomenon, nailfold capillary changes, telangiectasias, or progressive internal organ involvement. Morphea can present with extracutaneous manifestations, including fever, lymphadenopathy, arthralgias, and central nervous system involvement, and laboratory abnormalities, including eosinophilia, polyclonal hypergammaglobulinemia, and positive antinuclear antibodies.1,2,3
Although rare, epidemiologic studies suggest 0.9-5.7% of patients with morphea progress to systemic scleroderma.2 The transition may be marked by the development of Raynaud phenomenon and nailfold capillary changes.
It would be silly and foolhardy of me to copy the entire article from the eMedicine website.
The article in its entirety can be found at http://emedicine.medscape.com/article/1065782-overview 
Amongst other treatments the article discusses:
UVA and UVA-1 Broadband UVA (320-400 nm, low-dose), long-wavelength UVA (UVA1; 340-400 nm, low- or medium-dose), and psoralen plus UVA (oral or bath) photochemotherapy have produced marked clinical improvement of morphea lesions in multiple case series and a randomized controlled trial. Because UVA1 wavelengths penetrate deeper into the dermis, this modality is particularly effective in the treatment of morphea. Low-, medium-, and high-dose UVA are all effective. Medium-dose UVA1 provides for better long-term results than low-dose UVA1 in morphea as shown by ultrasound assessment.26 Unfortunately, the availability of UVA1 is currently limited. Narrowband UVB therapy, although less potent owing to its limited dermal penetration, can also be beneficial. Regimens combining UV therapy with topical corticosteroids or calcipotriene may be superior to either method alone.42,43
To see the entire article on treatment at the eMedicine site, See http://emedicine.medscape.com/article/1065782-treatment 
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Replacing FSX72T12/UVB/HO (7RA-072) with UVB Narrow Band TL01 Lamps

Posted on February 14, 2010 by Chris Cane

Many people ask about replacing FSX72T12/UVB/HO (7RA-072) lamps in older National Biological Corporation Panosol II (UVB604) units. It’s a fairly easy job to do. We do supply instructions on how to install UVB NB TL100W/01 lamps in the older systems at time of shipment. All the customer need do is order lamps, provide us with the serial number of the UVB604 that the lamps will be installed in and we will ensure that the FDA records are updated to reflect hat the Panolsol II unit with that serial number has been upgraded to now use UVB Narrowband Lamps.

Best thing to do is email us (support@amjo.net) or give us a call 513-942-2770 and we can get the ball rolling for you.

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Polycythaemia Vera – Pruritus – TL-01 UVB Narrowband UVB311

Posted on February 12, 2010 by Chris Cane

Interesting day, I received two phone calls from people with Pruritus (extreme itching) associated Polycythaemia Vera, sometimes spelled Polycythemia Vera. I did some searching in my local library database and found a couple of useful articles.

TITLE: Narrowband (TL-01) ultraviolet B phototherapy for pruritus in polycythaemia vera.

SOURCE: MEDLINE

BACKGROUND: There are several reports of the efficacy of broadband ultraviolet (UV) phototherapy in the treatment of pruritus associated with polycythaemia vera.

OBJECTIVES: To evaluate whether narrowband (TL-01) UVB phototherapy is also effective in treating this condition.

METHODS: Ten patients with pruritus associated with polycythaemia vera were treated with narrowband (TL-01) UVB phototherapy. The first irradiation dose was 2/3 of the minimal erythema dose; the treatment schedule consisted of three irradiation sessions per week, with dose increments of 10% each session for skin types I and II, and 15% for skin types III and IV.

Continue reading →

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