Successful Treatment of Cutaneous Manifestations of Blau Syndrome with UVA-1 Phototherapy in a Paediatric Patient

Sarcoidosis is a systemic non-caseating granulomatous disease of unknown aetiology. Cutaneous manifestations are present in approximately 10-30% of the patients with the systemic form. Therapy is indicated in case of disabling symptoms, organ dysfunction or cosmetically distressing manifestation. Despite different therapeutic possibilities, cutaneous sarcoidosis remains exceptionally difficult to treat. Light and laser therapy may be a promising alternative. In this systematic review, we summarised the available treatments according to the literature concerning light and laser therapy for cutaneous sarcoidosis. Publications written in English and German, published between January 1990 and July 2016 in the database PubMed, MEDLINE, Embase, and Scopus were analysed. Light therapy with intense pulsed light, photodynamic therapy, and ultraviolet A light therapy, as well as laser therapy with pulsed dye laser, YAG laser, and Q-switched ruby laser were described. The results are based on individual case reports and small case series. Randomised controlled studies are lacking.

Researchers Identify Best Times For Effective Light Therapy

Various cutaneous conditions manifest at the sites of prior herpes zoster (HZ) infections. Among these conditions, granulomatous dermatitis, such as granuloma annulare (GA) and nonspecific granulomatous reactions, are frequently reported.1 Presently, consensus is lacking on the management of post-HZ granulomatous dermatitis. While topical corticosteroids are commonly used, according to the existing literature, some groups have reported cases that were refractory to corticosteroids.2 In this report, we describe a case of post-HZ granulomatous dermatitis that exhibited successful resolution following UVA1 phototherapy. The case was a 71-year-old man who had been treated for an IgG4-related disease with oral prednisolone (6 mg/day). He was referred to our department because of a pruritic skin lesion on his back. Physical examination revealed crusted papules with central umbilication and red halo in a single dermatome, leading to the diagnosis of HZ (Figure 1a). He received valacyclovir treatment. One month later, he presented with flat-topped red papules clustered at the previous HZ skin lesion (Figure 1b). A skin biopsy showed interstitial granulomatous dermatitis, as observed through hematoxylin and eosin staining (Figure 1c). Immunostaining for varicella zoster virus antigens was negative. Therefore, the patient was diagnosed with post-HZ granulomatous dermatitis. Although the lesion was left untreated for 2 months, it did not exhibit spontaneous remission. Consequently, UVA1 phototherapy (Therabeam® UVA1; USHIO) was initiated (30 J/cm2 for the first irradiation, followed by 60 J/cm2 for the subsequent two irradiations, once every 2 months). After 6 months, the lesion was markedly improved (Figure 1d). Previous studies have suggested that post-HZ granulomatous dermatitis may be caused by an immune reaction against a persistent viral envelope glycoprotein or altered tissue antigens.1, 2 UVA1 phototherapy is reportedly effective for granulomatous diseases such as GA.3 However, to the best of our knowledge, this is the first documented case in which UVA1 phototherapy successfully treated post-HZ granulomatous dermatitis; however, we cannot entirely exclude the possibility of spontaneous remission, five cases of which were previously documented in the cited literature.2 Nonetheless, frequency of spontaneous remission among granulomatous diseases is not well-studied. Among the UV subcategories, UVA1 possesses the capability to reach the deep dermis.4 As the lesions of most granulomatous diseases, including post-HZ granulomatous dermatitis, involve the deep dermis, this characteristic may account for its therapeutic efficacy. UVA1 has been reported to induce the apoptosis of T cells and suppression of proinflammatory cytokines, while also modulating fibroblasts and collagen metabolism.4 These effects may alleviate granuloma formation and matrix degradation. The cumulative dose of UVA1 phototherapy in this report (150 J/cm2) was lower than that in previously reported GA cases (2925 J/cm2 on average).3 However, another report showed that relatively low-dose irradiation (158 J/cm2 on average) was also effective for GA.5 Thus, the optimal dosage regimen is yet to be established. We have presented a case of post-HZ granulomatous dermatitis that demonstrated successful treatment through UVA1 phototherapy. Despite its limitation to a solitary case, UVA1 can be regarded as a novel therapeutic alternative for post-HZ granulomatous dermatitis. None. None. None declared.

Phototherapy is often used in combination with other antipsoriatic treatments in an attempt to improve efficacy and reduce patients' cumulative exposure to radiation. Although this aim has been achieved with some combinations, the additional therapies often introduce a potential risk of other tolerability and safety problems. The efficacy of tazarotene reported in clinical trials to date suggest that this drug may help to improve the efficacy of phototherapy, and perhaps reduce the ultraviolet light exposure required without introducing additional, clinically significant problems. Preliminary results from the first 10 patients in a clinical trial investigating such combination therapy are reported here. They demonstrate that the addition of tazarotene to UVB phototherapy increases the percentage of patients achieving treatment success (> or = 50% global improvement in psoriasis) from 60% to 100% at Day 81. The UVB plus tazarotene combination achieved consistently greater reductions in the elevation and scaling of difficult-to-treat psoriatic plaques than UVB phototherapy alone or UVB phototherapy plus vehicle gel. The tazarotene combination therapy also achieved initial treatment success in less than half the time needed with phototherapy alone (median of 32 vs. 67 days). Combining UVB phototherapy with tazarotene treatment appears to offer a valuable therapeutic option that is more efficacious and faster than UVB phototherapy alone.

There is considerable evidence to indicate that depressive disorders may be associated with changes in regional cerebral blood flow (rCBF), and that successful treatment may reverse these changes. We studied patients with seasonal affective disorder (SAD) using 99Tcm-hexamethylpropylene amine oxime (99TCm-HMPAO) single photon emission tomography (SPET) to examine the effect of light therapy on rCBF. Ten depressed patients (8 females, 2 males) with a mean (+/- S.D.) age of 33.5 +/- 11.3 years underwent 99TCm-HMPAO SPET studies before and after light therapy. The treatment response was evaluated using the Structured Interview Guide for the Hamilton Depression Rating Scale-Seasonal Affective Disorders Version (SIGH-SAD). A patient was considered responsive to light therapy if the post-treatment SIGH-SAD score was reduced by 60% or more in comparison to the pre-treatment score (responders, n = 5; non-responders, n = 5). Pre- and post-treatment SIGH-SAD scores and SPET data were compared in each patient. An improvement in depressive symptoms after light therapy was associated with an increase in rCBF in the frontal and cingulate regions as well as the thalamus. Such changes were not seen in non-responsive subjects.

Introduction Non-24-hour sleep-wake rhythm disorder (N24SWD) is a circadian rhythm disorder characterized by an inability to entrain to the 24-hour environment. It can occur in both blind and sighted individuals- usually with a longer sleep period, advanced temperature rhythm, and higher sensitivity to light than normal controls. Current therapies, derived from treating N24SWD in the blind and the human phase response curve, typically involve timed melatonin administration. It is more complex in sighted individuals, requiring multiple time cues such as light, melatonin, social interactions, feeding, and activity. We present two cases of non-24 sleep-wake disorder in sighted individuals who were successfully treated with circadian entrainment. Report of case(s) Report of Cases: Case 1: Sighted 31-year-old unemployed male with ADHD, presented with an irregular sleep pattern. He reported a lack of routine, prolonged dim basement computer use, and a circadian rhythm appearing longer than 24 hours. Actigraphy and sleep diaries confirmed N24SWD. Comprehensive measures, including timed light and melatonin therapy, blue light blocking glasses, and activity scheduling, led to a subjective "miraculous" improvement, with follow-up actigraphy confirming resolution. Case 2: Sighted 23-year-old female with autism and affective disorders presented with shifting sleep times alternating with prolonged video-game use. Actigraphy and sleep diaries were consistent with N24SWD. Following a prescribed schedule with light therapy, timed melatonin, and activity scheduling led to circadian alignment, confirmed by sleep diaries and patient report. Conclusion Effectively managing N24SWD in sighted individuals is challenging, as evidenced by limited treatment success and total cases documented in the literature, including challenges in long-term patient adherence. This case series highlights two successful instances of entrainment using a combination of timed melatonin, bright and low light therapy and activity scheduling, supported by actigraphy and diaries reflecting adaptation. These cases provide insights into contributors to the development of N24SWD and methods for resolving them. Support (if any)

Rapid and stable fixation of dental implants is crucial for successful treatment. Herein, we examined whether the simultaneous treatment of titanium implants with ultraviolet (UV) and alendronate (ALN) synergistically improved the bone-to-implant contact. We assessed the invitro effects of UV radiation-treated (UV+/ALN-), ALN-soaked (UV-/ALN+), and UV radiation/ALN-treated (UV+/ALN+) titanium implants on cell proliferation, cytotoxicity, cell adhesion, and osteoblast differentiation using MG-63 osteoblast-like cells by the assays of MTS, live/dead, scanning electron microscopy (SEM), alkaline phosphatase (ALP) activity, and alizarin red S (AR-S) staining, respectively. Furthermore, invivo bone formation at the bone-implant interface efficiency determined using a rabbit tibia implantation. Implants were divided into 3 experimental groups (UV+/ALN-, UV-/ALN+, UV+/ALN+) and the non-treated control (UV-/ALN-) group and transplanted into the proximal tibia of rabbits. At 1, 2, 4, and 8weeks post-operation, bone formation at the bone-implant interface was evaluated by micro-computed tomography and histological analysis. MG-63 cells cultured on UV+/ALN+ implants showed significantly higher cell proliferation, ALP activity, and calcium mineralization than those cultured on other implants (P<0.05). Furthermore, SEM observation showed the highest increase in cell attachment and growth on the UV+/ALN+ implants. In vivo, experimental groups at all time points showed greater peri-implant bone formation than the control group. At 8weeks post-implantation, in the UV+/ALN+ group, significantly higher bone formation was observed than the UV+/ALN- or UV-/ALN+ group, respectively (P<0.05). Treatment of titanium surfaces with UV and ALN may synergistically enhance osteoblastic differentiation and mineralization invitro and enhance bone formation at the bone-implant interface invivo. These data suggest that UV and ALN treatment may improve the osseointegration of titanium implants.

Connective-tissue disorders, which include lupus erythematosus, morphoea/scleroderma and dermatomyositis, are characterized by cutaneous manifestations that are sometimes resistant to conventional therapy. Light treatments, which include phototherapy, photodynamic therapy (PDT) and photopheresis, are routinely utilized in the treatment of dermatological conditions and may provide unique mechanisms of action in the treatment of these connective-tissue disorders. The objective of this study is to conduct a review of the literature that describes the use of phototherapy, PDT and photopheresis in the treatment of lupus erythematosus, morphoea/scleroderma and dermatomyositis. A MEDLINE search was conducted to find articles that discuss treatment of connective-tissue diseases with light therapies and more than 30 publications that discuss light therapy for these diseases were identified. These range in design from case reports to randomized, prospective trials. Study outcomes and details were summarized and presented within each connective-tissue disease by light therapy modality, which includes phototherapy, PDT and photopheresis. Although there is a known association between photosensitivity and connective-tissue diseases, light therapies, when used appropriately, may be legitimate therapeutic options for recalcitrant cutaneous manifestations in lupus erythematosus, morphoea/scleroderma and dermatomyositis.

We report the successful treatment with ultraviolet B phototherapy of a patient with HIV-associated eosinophilic pustular folliculitis. We were able to observe the clinical and therapeutic course for about one year and three months. This 35-year-old homosexual Japanese man presented with disseminated, discrete, follicular, erythematous papules with intense pruritus over his face, neck, chest wall, and upper back. Initially, the eruption responded to therapy with topical or oral indomethacin and oral H1 antihistamine. However, the eruption was highly prone to recurrence, and it gradually failed to respond to these therapies. The eruption became chronic and persistent and manifested the excoriated, prurigo-like nodules that are typical of reported pruritic papular eruption, suggesting that this skin disease and HIV-associated eosinophilic pustular folliculitis are two forms of the same disease entity. UVB phototherapy in small doses was very effective for the persistent eruption, and no recurrence of the eruption was noted during or since the six-month maintenance therapy (once a week at a dose equivalent to 0.75 of the minimal erythema dose) (9 months total). No unfavorable side effects have been observed during or after the UVB phototherapy (cumulative UVB doses of 2,320 mJ/cm2).

Recurrence of morphea after successful ultraviolet A1 phototherapy: A cohort study

Current Perspectives on the Management of Seasonal Affective Disorder

To the Editor, The introduction of phototherapy has substantially changed the therapeutic response of localized scleroderma (LS). Systemic agents have been proposed for the treatment of LS, some with potential side effects and varying degrees of success. There is sufficient evidence in the literature to demonstrate that low dose (20 J/cm) and medium dose (50 J/cm) UVA1 phototherapy is beneficial in LS. The development of a metal halide lamp emitting high levels of UVA1 radiation (340–400 nm) was first described in 1981 (1), but the therapeutic potential for UVA1 phototherapy did not emerge until 1992 with the first successful report of treating patients for acute exacerbations of atopic dermatitis. It has now been shown to soften thickened plaques, increase skin elasticity and reduce lesional skin thickness in scleroderma (2–4). Recently (4), low-dose UVA1, mediumdose UVA1 and narrowband UVB phototherapy were compared demonstrating comparable efficacy of narrowband UVB and low-dose UVA1 but medium-dose UVA1 being more effective. In systemic sclerosis (SSc), studies of UVA1 are limited. Improvement has been documented in acrosclerosis in those patients with SSc (5). There is no documentation of treatment of other features of SSc by phototherapy in the literature. We describe a case of successful treatment of microstomia with UVA1 phototherapy in a patient with SSc. Case report

UVB phototherapy of the pruritic papular eruption of the acquired immunodeficiency syndrome

Parathyroid allotransplantation without immunosuppression

Does early response predict subsequent remission in bipolar depression treated with repeated sleep deprivation combined with light therapy and lithium?