The World of UV Phototherapy

Posts Tagged ‘Pruritus’

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.”

This is a tough question as UVB Narrowband in some ways has become a panacea for many skin challenges. Here’s a partial list of diseases that I’m aware of where UVB Narrowband is one of the treatment options.

Alopecia
Atopic Dermatitis
CTCL (Cutaneous T-Cell Lymphoma)
Dermatitis
Eczema
Graft vs Host Disease (GVHD)
Lichen Planus
Mycosis Fungoides
Parapsoriasis
Pityriasis Lichenoides (PLEVA)
Pityriasis rosea
Pityriasis Rubra Pilaris
Pruritus associated with Polycythaemia Vera
Psoriasis
Scleroderma
Sebhorrheic dermatitis
Vitiligo

Link to entire article << Click Here >>

The first report of the use of ‘phototherapy’ in the treatment of skin disorders dates from 1400 BC from India when patients with vitiligo were given certain plant extracts (whose active ingredients included psoralens) and then exposed to the sun. The real interest in the use of ultraviolet (UV) irradiation in the treatment of various skin diseases started in the 19th century when Niels Finsen received the Nobel Prize (1903) for his therapeutic results with UV irradiation in lupus vulgaris, the only dermatologist ever to be awarded one. This marked the start of modern phototherapy. It was used in thermal stations for the treatment of tuberculosis, in the treatment of leg ulcers in wartime, and various other skin diseases. It was a very long journey from the use of plant extracts and sun exposure to treat vitiligo to the use of oral psoralens and total body UVA-irradiation cabins (PUVA) to treat various skin diseases. In a landmark development, in 1974 Parrish et al reported the useful role of high intensity UVA tubes in combination with oral psoralens in the treatment of psoriasis leading to what is now known as PUVA therapy.

The history of UVB phototherapy is not as old as the history of photochemotherapy. Wiskemann introduced irradiation cabin with broad band UVB tubes in 1978 for the treatment of psoriasis and uremic pruritus. However, broad band UVB phototherapy was less efficient for treating psoriasis than PUVA and so never achieved popularity. The breakthrough came after 1988 when narrow-band UVB (NB-UVB) phototherapy was introduced for the treatment of psoriasis by van Weelden et al and Green et al.

Link to entire article << Click Here >>

Excerpted from an article by: Sunil Dogra, Amrinder Jit Kanwar, Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India

Correspondence Address:
Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh - 160102, India
ajkanwar@sify.com