Elidel and Protopic? Should I use them before UV Treatment

The following applies to Elidel (Pimecrolimus Topical), Protopic (Tacrolimus Topical) and some Corticosteroids prescribed for skin challenges.

A question that comes up quite often is “Should I use Protopic?” or perhaps “Should I use Elidel?” and then the question continues “… while using UVB Narrow Band?”.

Generally speaking, any drug or cream should be avoided and not be applied immediately before or during UVB Narrow Band treatment. Elidel and Protopic and most other things you apply to your skin, change the skin’s sensitivity to UV light. Some drugs increase your sensitivity (Psoralens & others) while others reduce your skin’s sensitivity (sun blocks and the like). All of these should be avoided UNLESS SPECIFICALLY PRESCRIBED by your Dermatologist.

I do recommend that if Protopic, Elidel or other Corticosteroid has been prescribed that you use it following UV treatment or on the alternate days. Do not apply these creams before treatment UNLESS SPECIFICALLY PRESCRIBED by your Dermatologist. It is not safe to apply these creams before treatment as they can increase your skin’s sensitivity to UV light and increase the risk of severe erythema (sunburn).

Do no assume that you know more than your dermatologist!

Avoid sunlight, sun lamps, tanning beds, and phototherapy treatments with UVA or UVB light. If you must be outdoors, wear loose clothing over the skin areas treated with Protopic. Do not use sunscreen on treated skin unless your doctor has told you to.

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Posted in Medical Articles, Skin Diseases, UVGuy's Ramblings | Tagged , , , | 2 Comments

Prurigo Nodularis and UVB Narrow Band

I have come across a few postings on various websites regarding the treatment of Prurigo Nodularis. This is a skin condition in which hard crusty lumps form on the skin that itches intensely. PN may itch constantly, mostly at night, or only when a light brush of clothing sets off a round of severe itch. For many, itching only ends when the PN is scratched to the point of bleeding or pain.

It does appear that UV can help. I have read in a couple of places that PN can be helped but I cannot find any definite articles or papers which provide conclusive evidence. I would appreciate hearing from anyone out there about Prurigo Nodularis and can be helped/cured with UVB Narrowband?

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Posted in Medical Articles, UVGuy's Ramblings | Tagged , , , | 2 Comments

How soon before I see results?

The three diseases that we see UVB NB prescribed for most often are Eczema, Psoriasis and Vitiligo. People being treated with UVB NB for Eczema and Psoriasis typically  see results very quickly while those with Vitiligo have a tougher row to hoe. With Vitiligo, we typically see re-pigmentation begin after forty to sixty treatments, remember with treatments usually ocurring three times a week we’re looking at 12 to 20 weeks before re-pigmentation begins. It usually begins with freckling in the white areas and then over time the freckles expand to cover the area. Treatment will most likely continue for a year or more to fill in all/most areas that will re-pigment.

Folks with Psoriasis and Eczema usually respond quickkly to treatment and begin to see results with in the first week or so and treatments then continue for a month or two with most people clearing within a few months.

Here’s a page at National Psoriasis Foundation on UVB Phototherapy
Excerpt from page “Several studies indicate that narrow-band UVB clears psoriasis faster and produces longer remissions than broad-band UVB. Narrow-band UVB may be effective with fewer treatments per week than broad-band UVB. Narrow-band UVB is also emerging as an alternative to PUVA, the light-sensitizing medication psoralen plus exposure to ultraviolet light A. Although not as effective as PUVA, narrow-band UVB is easier for people to undergo and may be safer over the long term. The use of narrow-band UVB may increase as doctors and patients learn more about its effectiveness and safety…” See http://www.psoriasis.org/treatment/psoriasis/phototherapy/uvb.php

With Eczema and Psoriasis, what do you do when clearing has happened?

  1. Wait for a re-occurence and start treatments again or
  2. Perform a weekly maintenance dose at perhaps 75% of the last treatment time.

In either case, check with your dermatologist or medical professional. As a reminder, please read our disclaimer.

 

 

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Posted in Skin Diseases, UVGuy's Ramblings | Tagged , , | 2 Comments

Guidelines for dosimetry and calibration in ultraviolet radiation therapy.

Guidelines for dosimetry and calibration in ultraviolet radiation therapy: a report of a British Photodermatology Group workshop.

The entire article can be seen by <Clicking Here>

uv_table_1

This report examines the dosimetry of ultraviolet (UV) radiation applied to dermatological treatments, and considers the definition of the radiation quantities and their measurement. Guidelines are offered for preferred measurement techniques and standard methods of dosimetry. The recommendations have been graded according to the American Joint Committee on Cancer classification of strength of recommendation and quality of evidence. Continue reading

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Narrowband UVB Phototherapy in New Zealand

I was wandering around the internet today looking for what’s new in UVB and I came across a posting by DermNet NZ. I thought that some of you would find it interesting.

They report, Compared with broadband UVB:

  • Exposure times are shorter but of higher intensity.
  • The course of treatment is shorter.
  • It is more likely to clear the skin condition.
  • Longer periods of remission occur before it reappears.

They also mention that “This range of UV radiation has proved to be the most beneficial component of natural sunlight for psoriasis. Narrowband UVB may also be used in the treatment of many other skin conditions including atopic eczema, vitiligo, pruritus, lichen planus, polymorphous light eruption, early cutaneous T-cell lymphoma and dermographism.”

The original can be found at http://dermnetnz.org/procedures/narrowband-uvb.html - Enjoy!

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Posted in Medical Articles, Skin Diseases, UVGuy's Ramblings | Tagged , , , , , | 1 Comment

Dermalight 80 – eBay Buyers Beware!

dermalight80100If you are considering purchasing a Dermalight 80 from one of the eBay vendors selling the European model and you live in the USA or other country using 60 Hz Power then read on! The 220V – 50 Hz model when used with a step-up transformer will not work reliably here in the USA. The problem is that the 50 Hz model will not work with 60 Hz power. we have learned this the hard way when we have shipped 50 Hz units to countries using 60 Hz power ourselves. When we have stopped shipping the 230V/50Hz (European Model) to Korea, Saudi Arabia and other countries with 60 Hz power. We now ship a US model with a step-up transformer to these countries. I recommend you read http://www.dermalight80.com/international.htm very carefully.

Continue reading

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Posted in Skin Diseases, UVGuy's Ramblings | Tagged , , , , | 1 Comment

A review of home phototherapy for psoriasis

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

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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Posted in Medical Articles, Skin Diseases | Tagged , , , | 2 Comments

Vitiligo may offer natural defense against skin cancer.

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.

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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