I decided to do some web surfing and have learned that she might be on the right track.

Elsewhere in this blog at http://www.uvbnarrowband.com/index.php/2010/01/uva1-phototherapy-is-it-effective I did write about UVA-1 and its apparent success with Granuloma Annulare.

First a little reading about the disease.

A little reading from several sites provided this information.
For some images of the disease; See http://tinyurl.com/granuloma-annulare

Overview

Granuloma annulare is a long-term (chronic) skin disease consisting of a rash with reddish bumps arranged in a circle or ring.

Causes
Granuloma annulare most often affects children and young adults. It is slightly more common in girls. The condition is usually seen in otherwise healthy people. Occasionally, it may be associated with diabetes or thyroid disease. Its cause is unknown.

Symptoms
Granuloma annulare usually causes no other symptoms, but the rash may be slightly itchy. Patients usually notice a ring of small, firm bumps (papules) over the backs of the forearms, hands, or feet. Occasionally, multiple rings may be found. Rarely, granuloma annulare may appear as a firm nodule under the skin of the arms or legs.

Treatment
I did find an article at http://tinyurl.com/4phduov discussing the use of UVB Narrow Band with Granuloma Annulare and this study concluded that:

• Mayo Clinic: http://www.mayoclinic.com/health/granuloma-annulare/DS00793
• Medline: http://www.nlm.nih.gov/medlineplus/ency/article/000833.htm
• WebMD: http://www.webmd.com/skin-problems-and-treatments/granuloma-annulare
• Google Health: https://health.google.com/health/ref/Granuloma+annulare

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.

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

The interesting thing is that many folks go to the Dead Sea for the treatment of Psoriasis and this has caused the belief that the Dead Sea Salt is the contributor to the clearing of their Psoriasis, the conclusion that I draw based on the article below and others that I’ve read is that it’s not the salt but the sunlight which contains a reasonable proportion of UVB/UVB NB, possibly because of the filtering effect of the mists and atmosphere around the Dead Sea that contribute to the healing/clearing.

Of course the secondary my more mercenary conclusion says, don’t waste your money on a trip to the Dead Sea, just purchase a UVB Narrow Band system for your home or just head to your doctor’s UVB311/UVB NB Clinic and save lots of cash!

I’d be interested in your comments!

Here’s one article from the British Journal of Dermatology (ISSN 0007-0963 ) from 2005 that concluded “In this population the addition of pretreatment Dead Sea salt soaks to NB-UVB did not result in a clinically important improvement in clearance of psoriasis.”

Document title: A randomized controlled comparison of the efficacy of Dead Sea salt balneophototherapy vs. narrowband ultraviolet B monotherapy for chronic plaque psoriasis

Author(s): DAWE R. S. ; YULE S. ; CAMERON H. ; MOSELEY H. ; IBBOTSON S. H. ; FERGUSON J.
from the Photobiology Unit, Department of Dermatology, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, ROYAUME-UNI

Abstract: Background Dead Sea (DS) salt solution soaks are used in combination with narrowband ultraviolet B (NB-UVB) to treat psoriasis in many centres, particularly in continental Europe. No previously published controlled study has assessed DS salt + NB-UVB balneophototherapy.

Objectives: To compare DS salt balneophototherapy with NB-UVB monotherapy for chronic plaque psoriasis. Methods Sixty patients with chronic plaque psoriasis participated in this paired, controlled study, with pretreatment DS salt soaks randomly allocated to each participant’s right or left study limb. Psoriasis severity was assessed with a Scaling, Erythema and Induration score by a blinded observer. Assessments were weekly during the therapy course, and thereafter 8-weekly until relapse or for up to 1 year after clearance.

Results: The mean area under the psoriasis severity-time curves during treatment was not detectably lower with DS salt balneophototherapy than with NB-UVB monotherapy (P = 0.099). The psoriasis severity score fell slightly more from beginning to end of courses with DS salt balneophototherapy than with NB-UVB monotherapy (P = 0.019). There was no detectable difference in times to relapse.

Conclusion: In this population the addition of pretreatment DS salt soaks to NB-UVB did not result in a clinically important improvement in clearance of psoriasis.

Other reading

1. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2678696
2. http://pt.wkhealth.com/pt/re/bjdr/abstract.00002300-200509000-00024.htm;jsessionid=K9QJPTxdckT2wddJJJx3CxndDt51Qyzryl6b0M110nXVB9LTPlst!331639832!181195628!8091!-1
3. http://www.ncbi.nlm.nih.gov/pubmed/10792225

I think you’ll draw the same conclusion or maybe not if you read the article at Click Here where the author says  “The ultraviolet radiation at the Dead Sea is attenuated relative to Beer Sheva as a result of the increased optical path length and consequent enhanced scattering. The UVB radiation is attenuated to a greater extent than UVA and the shorter erythema UVB spectral range decreased significantly compared with the longer therapeutic UVB wavelengths” – Life sure is complex!

Since the publishing of the article on May 7th by the British Medical Journal on the effectiveness of UVB Treatment in the home, the Internet has been buzzing with articles written by a host of reviewers on the subject. Most are simply referring to the original article but many are commenting. Most if not all of the postings I’ve seen on various blogs and publications show strong support for the use of UVB Narrowband Therapy in the home.

This of course is like music to my ears. Many of you know that I run a business offering UV Phototherapy Products for use in the home. See www.HomePhotoTherapy.com. So of course I’m a little biased.

The actual heading of the article is “Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: pragmatic multicentre randomised controlled non-inferiority trial (PLUTO study)”

The finding by the researchers who followed 196 patients was “Ultraviolet B 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. Furthermore, ultraviolet B phototherapy at home resulted in a lower burden of treatment and led to greater patients’ satisfaction. “

This statement flies in the face of many dermatologists that say that they believe that treatment at home is the wrong approach because they believe that patients will not be compliant at home. It’s interesting to note that many of the derms who make such ridiculous statements have phototherapy systems in their offices or clinic and they draw some of their income for the sale of time in their own phototherapy systems. I guess it shows that even doctors like to make a dollar.

Treatment at home is ultimately much less expensive to the patient and the insurance company than in-clinic treatment. Typical home equipment can range from $600.00 to $7000.00 with most folks spending perhaps $2500.00 on a home system. In clinic rates can vary from a low of $25.00 to a high of $90.00 PER TREATMENT. I we take an average of let’s say $40.00/treatment with three treatments a week then that’s $120.00/week and in 20 weeks ($2400.00), the typical home system would be paid for. That does not include the costs of parking, car mileage, time of work.

Visit www.HomePhotoTherapy.com to see some home systems. Remember most folks over a lifetime require treatment sometimes several times a year, perhaps for a lifetime.

The absolute best way to have UV Treatment is in the home.

<Link to original article>

Phototherapy employing sunlight and plants that contain natural psoralens was first used for vitiligo thousands of years ago, and it continues to be a first-line treatment today. Investigators conducted a randomized, double-blind trial to compare two of the most popular forms of phototherapy for vitiligo in 50 patients with nonsegmental vitiligo who received either PUVA or narrowband UVB (NB-UVB) therapy (25 patients in each group).

After treatment (maximum, 144 sessions), subjects in both groups had significant reductions in the extent of vitiligo-involved body surface area. Although between-group differences were not statistically significant, improvement occurred more rapidly and tended to be greater with NB-UVB. After 48 treatments in patients who received that many sessions, the median percentage of improvement in affected body-surface area was slightly more than 20% in the PUVA-treated patients and more than 50% in the narrowband-treated group. The color of the repigmented skin matched excellently the color of uninvolved skin in all NB-UVB recipients but in only 44% of PUVA recipients. Erythema occurred more often with PUVA phototherapy than with NB-UVB therapy (in 96% vs. 68%, respectively). The PUVA recipients received a median of 47 treatments and the narrowband UVB patients, a median of 97; the authors suggest that this is because of the greater efficacy and fewer adverse effects experienced by NB-UVB recipients.

Comment: This study clearly demonstrates that for vitiligo repigmentation, NB-UVB is safer and more effective than PUVA. Other randomized, controlled trials have shown at least some efficacy with targeted phototherapy, topical and systemic steroids, topical calcineurin inhibitors, and calcipotriene combined with PUVA. A number of reports show success with surgical repigmentation procedures, as well. Although we are making progress in treating this vexing disease (especially with calcineurin inhibitors and phototherapy), we still have a long way to go. At best, 75% of patients respond, and in most instances, this response is only partial. A breakthrough in the management of this disease would be greatly welcomed by both patients and doctors. An accompanying editorial provides a nice evidence-based review of existing therapies for vitiligo.

— Craig A. Elmets, MD

Published in Journal Watch Dermatology June 1, 2007

AUTHOR: .Tjioe M, Gerritsen MJ, Juhlin L, van de Kerkhof PC.
Department of Dermatology, University Medical Center Nijmegen, The Netherlands. M.Tjioe@derma.azn.nl
Narrow band UVB is succeeding psoralen and UVA irradiation as the main treatment of vitiligo vulgaris in several European countries. Vitamin B12 and folic acid deficiency in some vitiligo patients has prompted researchers to investigate the efficacy of these vitamins in the treatment of vitiligo. In the present controlled study we investigated the value of narrow band UVB phototherapy in the treatment of vitiligo and the possible additive effect of vitamin B12 and folic acid. Twenty-seven patients with long-term stable vitiligo were included and randomized in a “UVB only” (UVB) or “UVB combined with vitamin B12 and folic acid” (UVB+) group. Patients were irradiated thrice weekly for one year, whilst repigmentation was carefully monitored. In 92% (25/27) of the patients up to 100% repigmentation was seen. Repigmentation was notable in lesions on the face, neck and throat, lower arm, chest, back and lower legs, whilst repigmentation on the hands, wrists, feet and ankles proved to be minimal. Maximum repigmentation rates did not differ significantly between the UVB group and the UVB+ group. Our study reconfirms that narrow band UVB phototherapy is an effective treatment for vitiligo and shows that co-treatment with vitamin B12 and folic acid does not improve the outcome of treatment of vitiligo with narrow band UVB phototherapy.

PMID: 12430737 [PubMed - indexed for MEDLINE]