308-nm Monochromatic Excimer Light Research Articles

A predictive model of the requisite minimal erythema dose between 308-nm monochromatic excimer light and 311-nm narrowband Ultraviolet-B light.

There are limited data in the relationship between the minimal erythema dose (MED) of 308-nm monochromatic excimer light (MEL) and 311-nm Narrowband UVB (NB-UVB). To establish a predictive model of the relationship between MEDs of both wavelengths. An MED test was performed on the back of 40 healthy Thai volunteers. One side was irradiated with 308-nm MEL, and the opposite side was irradiated with 311-nm NB-UVB. The correlation and a predictive model of the relationships were then analyzed. There was a positive correlation in the MED of both wavelengths (r=0.82, p < 0.001). A predicted MED of 308-nm MEL was based on Y=62.421 + 0.439X, where Y and X were a predicted MED of 308-nm MEL and an actual 311-nm NB-UVB, respectively. This model could predict an MED of 308-nm MEL by using an actual MED of 311-nm NB-UVB with a root mean square difference of 13.64%, and a mean bias difference of 0.63%. All volunteers were Fitzpatrick's skin phototype type IV. The predictive model might not generalize to other skin phototypes. We established a predictive model of the relationship between MED of 308-nm MEL and 311-nm NB-UVB with acceptable accuracy.

Comparison Between (311-312 nm) Narrow Band Ultraviolet-B Phototherapy and (308 nm) Monochromatic Excimer Light Phototherapy in Treatment of Vitiligo: A Histopathological Study.

Introduction: Recently, the monochromatic excimer light (MEL) of 308 nm wavelength has shown some advantages in comparison to narrow band ultraviolet B (NB-UVB) for the treatment of vitiligo. To histopathologically compare the early effects of NB-UVB and 308-nm MEL phototherapy on vitiliginous patches using H&E and HMB-45. Methods: Thirty subjects with non-segmental vitiligo lesions were treated twice a week for 6 weeks with 308-nm MEL, while NB-UVB was used to treat lesions contra laterally. Skin biopsies were taken from lesional areas before and after 6 weeks of treatment by either modality. It was prepared for light microscopy and immunohistochemical study (HMB-45). This study was performed as a clinical trial (Trial registration: http://www.pactr.org; Identifier: PACTR201705002279419) Results: All lesions before treatment had labeling index (number of pigmented cells/non-pigmented cells) of 0.0 (0%). After treatment the LI for MEL was 4.2 ± 2.6, while for NB-UVB LI it was 0.3 ± 0.7. MEL showed higher statistical significance regarding increase of basal pigmented cells, and significant decrease in vacuolated keratinocytes and basal membrane thickness than NB-UVB. Conclusion: Although NB-UVB is considered as treatment of choice for vitiligo, MEL is acknowledged as an effective treatment modality for vitiliginous lesions that induces more repigmentation than NB-UVB, and more rapidly, as confirmed by our study.

Monochromatic excimer light (308 nm) for the treatment of skin diseases

As a kind of monochromatic ultraviolet B, 308-nm monochromatic excimer light (MEL) is one of the first choice treatments for vitiligo. There is no significant difference in the therapeutic effect on vitiligo between 308-nm MEL and 308-nm excimer laser. Recent studies have shown that 308-nm MEL can also serve as the treatment of choice for some other chronic skin diseases, such as psoriasis, palmoplantaris pustulosis and alopecia areata. Furthermore, there have been case reports on the use of 308-nm MEL for the treatment of achromic naevus, mycosis fungoides, CD30 + lymphomatoid papulosis, lichen sclerosus, prurigo nodularis, localized scleroderma, granuloma annulare and plasma cell cheilitis. Compared with conventional phototherapy, 308-nm MEL has the advantages of less cumulative radiation dose and lower risks of skin cancers. The main adverse reaction to 308-nm MEL is transient erythema. The therapeutic mechanism of 308-nm MEL is still unclear. Key words: Skin diseases; Lasers, excimer; Vitiligo; Psoriasis; Alopecia areata

Successful treatment with 308‐nm monochromatic excimer light and subsequent tacrolimus 0.03% ointment in refractory plasma cell cheilitis

Plasma cell cheilitis is a chronic inflammatory disease that presents with erythema, erosions, ulcers and occasional nodules within the mucosa, including the lips. It is histopathologically characterized by dense plasma cell infiltration in the lamina propria of the mucous membranes. Several treatments for plasma cell cheilitis have been reported, including topical steroids, topical antibiotics or topical tacrolimus. However, 308-nm monochromatic excimer light (MEL) has never been reported as a treatment option, while it was reported to be very effective in treating erosive oral lichen planus. We report a 62-year-old man who had chronic plasma cell cheilitis on the lower lip, which was refractory to topical and systemic corticosteroid. The lesion and severe pain were significantly improved by the treatment with nine sessions of 308-nm MEL twice per week with a total dose of 1120 mJ/cm(2). However, the lesion gradually worsened after treatment frequency was reduced to once per month. Subsequent tacrolimus 0.03% ointment cleared the lesion completely in a month and no recurrence was observed a year later. Refractory plasma cell cheilitis and concomitant severe pain quickly responded to 308-nm MEL when administrated twice per week. Because the long interval between each MEL treatment seemed ineffective to improve the lesion, appropriate frequency and adequate total dose of MEL treatment may be necessary for a successful treatment.

Efficacy of narrowband ultraviolet B versus excimer radiation in repigmenting vitiligo after minigrafting on the distal arms

To the Editor: Vitiligo, a common pigmentary disorder, is often difficult to treat. Phototherapy, including narrowband ultraviolet (UV) B (NBUVB) radiation, psoralen and UVA radiation, and the 308-nm excimer laser, is often successful; however, acral lesions are usually resistant to treatment.1Njoo M.D. Spuls P.I. Bos J.D. Westerhof W. Bossuyt P.M. Nonsurgical repigmentation therapies in vitiligo: meta-analysis of the literature.Arch Dermatol. 1998; 134: 1532-1540Crossref PubMed Scopus (236) Google Scholar, 2Passeron T. Ortonne J.-P. Use of the 308-nm excimer laser for psoriasis and vitiligo.Clin Dermatol. 2006; 24: 33-42Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar A new 308-nm monochromatic excimer light (MEL) device (Excilite, National Biological Corp, Beachwood, OH) has been developed for the treatment of vitiligo that may be more effective in achieving repigmentation compared with older modalities.3Casacci M. Thomas P. Pacifico A. Bonnevalle A. Paro Vidolin A. Leone G. Comparison between 308-nm monochromatic excimer light and narrowband UVB phototherapy (311–313 nm) in the treatment of vitiligo–a multicenter controlled study.J Eur Acad Dermatol Venereol. 2007; 21: 956-963Crossref PubMed Scopus (93) Google Scholar We performed a pilot study to determine the efficacy of this device for acral vitiligo and its effect on punch grafts compared with standard phototherapy. Thirteen patients gave written informed consent for this study, which was approved by a local institutional review board. Patients had stable vitiligo on the forearms and hands, defined as no more than 10% reported change in lesion size over the previous 6 months, lack of improvement with topical immunomodulators or corticosteroids for 6 months, and not receiving more than 12 previous phototherapy treatments. Five 1.5-mm minigrafts were harvested from hip skin and placed in each of two target lesions per patient. One week after transplantation, the MEL device was used on one target lesion, while the other was treated with a hand-foot NBUVB device (Hand/Foot II NBUVB system, National Biological Corp) 3 times weekly for 12 weeks. Treatment assignments were based on a computer-generated randomization code. Initial dose was 200 mJ on both sides with an increase of 15% per treatment on the NBUVB side and 50 mJ on the MEL device side. The primary outcome measure was improvement in target lesion size performed by a blinded investigator using Scion Image J measurement software (National Institutes of Health, Bethesda, MD) on baseline and week-12 images. These images were taken under standardized conditions. The majority of the patients were Hispanic (61%) and had skin type III (46%) or IV (31%), mean age of 47 years (range 21-74 years), and mean duration of vitiligo of 15 years (range 4-44 years). Ten patients completed the trial. The remaining 3 did not have any adverse effects before dropping out. NBUVB gave a significant improvement (median = 13%, Wilcoxon P = .037) at week 12 (Fig 1) whereas the MEL device did not show significant improvement (median improvement 9%, Wilcoxon P = .169). There was no significant difference between standard NBUVB and the MEL device over time (baseline to 12 weeks) using multivariate repeated measures analysis of variance. Of the 37% of grafts surviving at week 12, maximum pigment spread was a mean 4.5 times the original graft size with NBUVB versus 2 times original graft size with the MEL device. This difference was not significant (Fig 2). There were no adverse events.Fig 2Vitiligo in patient 7 at 1 week after grafting (A) and showing improvement at week 12 after standard narrowband ultraviolet B therapy (B).View Large Image Figure ViewerDownload Hi-res image Download (PPT) This study confirms the difficulty of treating vitiligo in acral locations. Even after 12 weeks and 36 treatment sessions, target lesions improved only 9% to 13% with the MEL device, which was not better than standard NBUVB therapy. Maximum pigment spread from grafts did not show a significant difference either. Although this new device shows promise in other locations, acral vitiligo was relatively unresponsive.

Intrapatient Comparison of 308-nm Monochromatic Excimer Light and Localized Narrow-Band UVB Phototherapy in the Treatment of Vitiligo: A Randomized Controlled Trial

Background: Limited data are available about the use of 308-nm monochromatic excimer light (MEL) and localized 311-nm narrow-band ultraviolet B (NB-UVB) in the treatment of vitiligo. The aim of this study was to evaluate the efficacy of 308-nm MEL versus localized 311-nm NB-UVB in vitiligo patients. Methods: Eleven patients participated in this prospective intrapatient placebo-controlled randomized trial. In each patient, 3 lesions were selected and treated with NB-UVB, MEL and placebo during 24 sessions, respectively. Repigmentation was evaluated clinically and by objective surface measurement. Results: Twenty percent of the lesions treated with NB-UVB achieved repigmentation scores above 50%. None of the lesions treated with MEL achieved a repigmentation higher than 50% after 24 sessions. Conclusion: Localized 311-nm NB-UVB is effective in the treatment of vitiligo. It should be considered for localized vitiligo as it is easily accessible. In this study the efficacy of localized 311-nm NB-UVB was superior to 308-nm MEL.

Comparison between 308-nm monochromatic excimer light and narrowband ultraviolet B light phototherapy (311-313 nm) in the treatment of vitiligo: A multicenter controlled study

Comparison between 308-nm monochromatic excimer light and narrowband ultraviolet B light phototherapy (311-313 nm) in the treatment of vitiligo: A multicenter controlled study

Treatment of Folliculitis with Monochromatic Excimer Light (308 nm)

Background/Aims: 308-nm excimer light has been reported to be safe and effective in the treatment of chronic skin diseases. The aim of the study wasto prove the efficacy of 308-nm monochromatic excimer light in the treatment of recalcitrant and antibiotic-resistant folliculitis. Methods: Eight patients affected with folliculitis were enrolled and treated twice weekly with the 308-nm excimer light. The follow-up was 12 weeks from the end of the treatment. Results: A mean number of 13 sessions (range 10–20) was performed with increasing dosage according to the patient’s phototype and response. Remission, in terms of number and infiltration of papulopustular elements, was achieved in all patients after 4–16 therapeutic sessions. At the end of the follow-up period, recurrence of folliculitis was observed in 2 patients. Conclusions: These results suggest that the 308-nm excimer light is a valid therapeutic option for the treatment of resistant forms of folliculitis especially in difficult-to-treat areas.

Evaluation of 308‐nm monochromatic excimer light in the treatment of psoriasis vulgaris and palmoplantar psoriasis

The purpose of this study is to evaluate the efficacy and safety of 308-nm monochromatic excimer light (MEL) in the treatment of psoriasis vulgaris and palmoplantar psoriasis. Thirty-five patients with psoriasis vulgaris and 15 patients with palmoplantar psoriasis were recruited for this study. Thirty patients with psoriasis vulgaris completed a total of 16 treatments with 308-nm MEL twice a week, and 15 patients palmoplantar psoriasis completed 25 treatments administered once weekly. The clinical response to therapy and adverse effects were recorded. Patients with psoriasis vulgaris (n=30) showed a 74.6% improvement in the mean psoriasis area and severity index score after a total of 16 MEL treatments (2 x /week) with 36.7% of the patients (n=11) achieving clearance. Patients with palmoplantar psoriasis (n=15) showed a 52.5% improvement in the mean severity index score after a total of 25 MEL treatments (1 x /week) with only one patient (6.7%) achieving clearance. The MEL therapy was well tolerated with a low incidence of side effects, which included pruritus, erythema and blister formation. The 308-nm MEL can be utilized as an effective and safe treatment modality for patients with mild-to-moderate psoriasis vulgaris and palmoplantar psoriasis.

Efficacy of tacalcitol ointment and 308-nm monochromatic excimer light (308-nm MEL) in the treatment of persistent plaque psoriasis

Efficacy of tacalcitol ointment and 308-nm monochromatic excimer light (308-nm MEL) in the treatment of persistent plaque psoriasis

Comparison between 308-nm monochromatic excimer light and narrowband UVB phototherapy (311–313 nm) in the treatment of vitiligo—a multicentre controlled study

Comparison between 308-nm monochromatic excimer light and narrowband UVB phototherapy (311–313 nm) in the treatment of vitiligo—a multicentre controlled study

Comparison between 308‐nm monochromatic excimer light and narrowband UVB phototherapy (311–313 nm) in the treatment of vitiligo – a multicentre controlled study

Vitiligo is an acquired pigmentary disorder characterized by areas of depigmented skin resulting from loss of epidermal melanocytes. Recently, it has been shown that narrowband ultraviolet B (NB-UVB) phototherapy may be more effective than psoralen and ultraviolet A (PUVA) photochemotherapy in treating vitiligo, and that 308-nm monochromatic excimer light (MEL) may present some advantages as compared to NB-UVB for the treatment of vitiligo. AIM The aim of this study was to compare the effectiveness of NB-UVB phototherapy and 308-nm MEL in vitiligo patients. The study was done in a randomized, investigator-blinded and half-side comparison design. Twenty-one subjects with symmetrical vitiligo lesions were enrolled in this study. Vitiligo lesions on one body side were treated twice weekly for 6 months with 308-nm MEL, while NB-UVB phototherapy was used to treat lesions on the opposite side. At the end of the study six lesions (37.5%) treated with 308-nm MEL and only one lesion (6%) treated with NB-UVB achieved an excellent repigmentation (score 4) while four lesions (25%) treated with 308-nm MEL and five lesions (31%) treated with NB-UVB showed a good repigmentation (score 3). It appears that 308-nm MEL is more effective than NB-UVB in treating vitiligo lesions and it induces repigmentation more rapidly.

Topical tacalcitol and 308‐nm monochromatic excimer light: a synergistic combination for the treatment of vitiligo

To study and compare the efficacy of combined 308-nm monochromatic excimer light (MEL) therapy with tacalcitol vs. that of MEL 308-nm therapy alone in treatment of vitiligo. Thirty-eight patients with vitiligo were enrolled in a single-blind, within patient controlled clinical trial. Symmetrical or nearby lesions were randomly applied with either topical tacalcitol cream or vehicle. Each lesion was treated weekly with the 308-nm MEL, for a total of 12 sessions. Patients were examined at monthly intervals. The mean number of sessions and the cumulative dosage for initial repigmentation were calculated. Thirty-five patients were evaluated. Treatment with tacalcitol and MEL resulted in higher percentages for excellent repigmentation (25.7%) compared with vehicle and MEL (5.7%) (P<0.05). Percentages for total response were 71.4% and 60%, respectively (P>0.05). The mean+/-SEM cumulative dose and number of excimer light exposures for initial repigmentation were, respectively, 3.93+/-0.59 J/cm2 and 4.52+/-0.49 at the tacalcitol side, and, respectively, 4.99+/-0.68 J/cm2 and 5.3+/-0.52 at the vehicle side (P<0.05). Our results have shown that concurrent topical tacalcitol potentiates the efficacy of the 308-nm MEL in the treatment of vitiligo, and that this combination achieves earlier pigmentation with a lower total dosage.

Evaluation of a novel 308-nm monochromatic excimer light delivery system in dermatology: a pilot study in different chronic localized dermatoses

Recently, units have been developed that are capable of delivering large fluences of narrowband ultraviolet (UV) B selectively to cutaneous lesions within a reasonable time. To analyse the efficacy of a novel nonlaser 308-nm monochromatic excimer light (MEL) delivery system in various dermatoses usually treated by narrowband UVB phototherapy. Fifty-four patients with chronic and resistant localized dermatoses were enrolled in a prospective study: 17 with palmoplantar pustular psoriasis, seven with plaque-type psoriasis, four with nail psoriasis, eight with chronic atopic dermatitis of the hands, 10 with chronic nonatopic dermatitis of the hands and eight with alopecia areata. The 308-nm xenon chloride MEL delivery system (Excilite; DEKA, Florence, Italy) was used to produce an average incident dose rate of 50 mW cm(-2) at a tube-to-skin distance of 15 cm and with a maximum irradiating area of 512 cm2. The initial dose was based on multiples of a predetermined minimal erythema dose (MED), and subsequent doses were based on the response to treatment. Treatments were scheduled weekly for a maximum of 10 weeks. Clinical responses were evaluated using photographic documentation and (except for alopecia areata) clinical score. The MED ranged from 250 to 350 mJ cm(-2) (mean +/- SD 318.2 +/- 28.4). MEL at 308 nm was the most effective for palmoplantar pustular psoriasis with a mean improvement of 79% after a mean of 5.3 treatments and a mean dose of 11.8 MED per treatment. Plaque-type psoriasis was significantly less sensitive to treatment and nail psoriasis demonstrated no benefit from treatment. Chronic palmar atopic dermatitis was cleared in two patients and the mean improvement was 54% as compared with 46% in patients with chronic nonatopic dermatitis of the hands. Four complete regrowths among the eight patients with alopecia were observed after a mean of 5.1 treatments. The percentages of improvement had significantly decreased at the 6-month visit, and only four patients (24%) with palmoplantar pustular psoriasis still demonstrated a significant improvement. Common side-effects included intense erythema and, more rarely, blisters, but these were well tolerated. Our preliminary results confirm the efficacy of this novel 308-nm MEL delivery system, which appears to be effective and safe for palmoplantar pustular psoriasis. To a lesser extent, plaque-type psoriasis, chronic atopic and nonatopic dermatitis of the hands and alopecia may also benefit from this treatment.

Monochromatic excimer light (308 nm) in patch-stage IA mycosis fungoides

Recently, numerous studies have been reported concerning the treatment of early-stage mycosis fungoides (MF) with narrowband (311-nm) UVB, claiming a beneficial response. We have used for the first time a 308-nm monochromatic excimer light, a new kind of xenon-chloride lamp, in the treatment of patch stage IA MF. We treated 7 patch lesions in 4 patients with unequivocal clinicopathologic diagnosis of MF. All lesions achieved clinical and histologic complete remission. The number of weekly sessions varied from 4 to 11 (mean 6.5; median 5.5). The total UVB 308-nm irradiation dose ranged from 5 to 9.3 J/cm 2 (mean 7.1 J/cm 2; median 7 J/cm 2). All lesions remained in stable complete remission after a follow-up of 3 to 28 months. No remarkable side effects were reported. Our preliminary results suggest that monochromatic excimer light phototherapy is a possibly very useful treatment modality in patch stage IA MF.