Broadband UVB Phototherapy Research Articles

A retrospective review of phototherapy in children, at a tertiary paediatric dermatology unit.

To examine the efficacy, tolerability and safety of phototherapy in children, in whom there is currently a paucity of data. Retrospective review of children under 18 years who received narrowband UVB (NB-UVB), broadband UVB (BB-UVB) phototherapy or psoralen with UVA (PUVA) photochemotherapy between 2003 and 2017 at a tertiary Paediatric dermatology centre in Southampton, UK. 100 children aged 6-17 years were included. The majority of children had psoriasis (74), atopic dermatitis (10) or vitiligo (8), with others having rarer dermatoses. Grade 2 erythema or above occurred in 46% of all included children and 42% (36/86) of those receiving NB-UVB; however, grade 3 and 4 reactions were infrequent and only 3 children stopped treatment due to burning. NB-UVB was particularly effective in those with psoriasis; 55/65 (85%) significantly improved, and 72% had not relapsed after 2 years. However, its effectiveness in atopic dermatitis was less convincing; in a small group of children, 6/10 (60%) significantly improved, but 66% relapsed within 3 months. Our analysis demonstrates that NB-UVB is effective in children with psoriasis and vitiligo, with potential to achieve extended periods of remission in psoriasis. Its usefulness in atopic dermatitis is less clear. The long-term safety of NB-UVB in children is still unknown, but it appears to be a well-tolerated treatment and should be considered in children for a variety of inflammatory dermatoses before progressing to immunosuppressive therapies.

Vitamin D status in psoriasis patients during different treatments with phototherapy

Background Phototherapy (broadband UVB (BUVB), narrowband UVB (NBUVB) and heliotherapy) is commonly used treatment modalities for widespread psoriasis. Vitamin D3, cholecalciferol, is produced in the epidermis by ultraviolet radiation (290–315 nm) of 7-dehydrocholesterol. 25-hydroxyvitamin D [25(OH)D], and 1,25-dihydroxyvitamin D [1,25(OH) 2D] are the major circulating metabolites. Sun exposure is the strongest factor influencing 25(OH)D. The similar wavelength spectrum of UVB responsible for D vitamin synthesis (BUVB, 280–315 nm) has been successfully used for years to treat psoriasis. Purpose The aim was: (1) To increase the knowledge about the effects of phototherapy on vitamin D production during treatment of psoriasis. (2) To examine if there were differences between the effect of BUVB, NBUVB and heliotherapy on vitamin D synthesis in psoriasis patients. Methods Serum concentrations of 25(OH)D, 1,25(OH) 2D, PTH, calcium and creatinine, measured before and after phototherapy in white Caucasian patients with moderate to severe active plaque psoriasis, were aggregated from three studies. Results Psoriasis improved in all patients, with a reduction in PASI ((Psoriasis Area and Severity Index) score of about 75% on all regimes. Serum 25(OH)D increased and PTH decreased after the phototherapy. The increase in 25(OH)D was higher in the BUVB treated patients compared with NBUVB. There was no correlation between the dose of UVB and the increase of 25(OH)D. Conclusion UVB and heliotherapy improved the psoriasis score, increased the serum 25(OH)D levels and reduced the serum PTH concentrations. Vitamin D production in psoriasis patients increased less with NBUVB than with BUVB phototherapy.

Pilot study of folate status in healthy volunteers and in patients with psoriasis before and after UV exposure

Ultraviolet radiation, UV, is widely used for treatment of psoriasis. UV radiation may destroy blood folates in test tubes, but clinical data are scarce. Folate deficiency may increase the risk of cardiovascular diseases, colorectal carcinoma, magaloblastic anemia, pregnancy and birth complications, depression and dementia. The aim of the present study was to investigate the influence of solar radiation, sunbeds and/or broadband UVB phototherapy on the levels of serum and erythrocyte folate in patients with psoriasis or healthy volunteers. Serum and erythrocyte folate status in patients with psoriasis and healthy volunteers was measured before and after exposure to solar radiation, broadband UVB or use of sunbeds. In some cases plasma homocysteine and serum 25-hydoxyvitamin D (25(OH)D) were also measured. Serum and erythrocyte folate levels in healthy volunteers and in psoriasis patients were not influenced to any statistically significant extent after exposure to solar radiation, to single or to multiple UV treatments. However, a slight decay of blood folates and an increase of plasma homocysteine levels were observed in psoriasis patients after exposure to UV radiation. Exposure to sun or sunbeds does not have any significant effect on the levels of blood folate of healthy humans. High doses of broadband UVB phototherapy may slightly decrease blood folates in psoriasis patients. Further studies, using proper, adequate 5-methyltetrahydrofolate methodology, are needed to clarify the influence of broadband phototherapy on folate degradation and the consequences of these on the health of psoriasis patients.

A review of home phototherapy for psoriasis

Phototherapy is a mainstay in the treatment of psoriasis and other photoresponsive dermatoses and home phototherapy has broadened therapeutic options. 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. 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. 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. 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.

Targeted Broadband Ultraviolet B Phototherapy Produces Similar Responses to Targeted Narrowband Ultraviolet B Phototherapy for Vitiligo: A Randomized, Double-blind Study

Narrowband ultraviolet B (NB-UVB) phototherapy, with a 308-nm xenon chloride excimer laser, and targeted UVB phototherapy have produced encouraging therapeutic results for vitiligo. However, very few studies employing broadband UVB exist. Moreover, there has been no direct comparison study between broadband UVB and NB-UVB for the treatment of vitiligo. The aims of this study were to compare the repigmenting efficacy of targeted broadband UVB phototherapy with that of NB-UVB in an equi-erythemogenic manner. Twenty identical vitiliginous lesions from 10 patients were randomly allocated to receive either targeted broadband UVB or targeted NB-UVB phototherapy. UV fluences were started at 50% of the minimal erythema dose detected within the vitiliginous patches, then increased gradually, in the same manner, to ensure equi-erythemogenic comparison. Treatments were carried out twice weekly for 12 weeks. The results show that grade 1, i.e. 1-25% repigmentation, to grade 2, 26-50% repigmentation, occurred in 6 of 10 subjects. Responses in terms of repigmentation, de-pigmentation, or lack thereof, were similar between lesions receiving broadband and NB-UVB phototherapy. Onset of repigmentation occurred as early as 4 weeks of treatment in most subjects. Treatments were well tolerated, with only minimal erythema and hyperpigmentation. The study was carried out in a small number of patients with skin types III, IV and V. The irradiation device was a targeted UVB device and thus the results may not be applicable to other light sources, such as the excimer laser or total-body irradiation cabinets. In conclusion, targeted broadband UVB produces similar clinical responses to targeted NB-UVB in the treatment of the non-segmental type of vitiligo.

Targeted Broadband UVB Phototherapy forthe Treatment of Localized Vitiligo.

Several new treatments appear to have higher success rates than previous therapies for the treatment of vitiligo, and targeted phototherapy is an alternative that may prove to be time-efficient and an effective therapeutic option for the management of this condition. The aim of this study was to evaluate the efficacy of targeted broadband UVB phototherapy for the treatment of localized vitiligo. Fifty-three vitiliginous patches on thirty-five patients (16 males, 19 females) were treated using a targeted broadband UVB phototherapy device. Treatment was started at 70% of the minimal erythema dose, and then gradually increased. Lesions were treated twice a week for a maximum of 60 treatment sessions. Subjects tolerated treatment well. Forty-one of the fifty-three patches (77.4%) achieved repigmentation on ≤75% of the treated areas. Best results were obtained on the face and neck; 20 of the 24 patches (83.3%) concerned achieved ≤75% repigmentation. The least response was on the hands and feet; 3 of 6 patches (50%) showed ≤75% repigmentation. The results were better for focal type than segmental type vitiligo. Targeted broadband UVB phototherapy appears to be highly effective at restoring pigmentation in patients with localized vitiligo.

The Minimal Erythema Dose of Broadband Ultraviolet B in Taiwanese

The purpose of this study was to determine the cutaneous response to UVB radiation in Taiwanese subjects. The relationships among minimal erythema dose (MED) of broadband UVB, Fitzpatrick's skin phototype, and skin color were examined in 61 healthy Taiwanese volunteers. Thirty-one females and 30 males were enrolled. Overall, the mean MED was 142.3 mJ/cm(2); there was no significant gender difference. The mean MEDs of subjects with Fitzpatrick skin types II, III, IV and V were 122.9 mJ/cm(2), 136.2 mJ/cm(2), 148.3 mJ/cm(2) and 165.0 mJ/cm(2), respectively. Both the mean MEDs and the lower MED limits increased with skin phototypes. To identify patients with abnormal photosensitivity, physicians could use these lower limits as reference values. In addition, different starting doses of broadband UVB phototherapy could be used for different skin phototypes.

The challenge of follow-up in narrowband ultraviolet B phototherapy

The use of narrowband ultraviolet (UV) B phototherapy to treat psoriasis and other disorders has increased markedly since the TL-01 lamps were introduced in the 1980s. While broadband UVB phototherapy has generally been considered to be a relatively safe treatment, some concern has been raised about the potential increased skin cancer risk with narrowband UVB. The likelihood of a patient who is free of nonmelanoma skin cancer (NMSC) at the start of phototherapy developing a malignancy after a certain follow-up period will be dependent not only on the carcinogenic potential of the treatment but also on the age-conditional probability of natural occurrence. We were interested to explore the potential difficulty of designing studies to separate these two events. Methods Mathematical models were developed that combined age-conditional probabilities of developing NMSC due to natural causes with the risk of inducing these cancers from narrowband UVB phototherapy in order to estimate the excess number of cancers resulting from this therapeutic intervention in a cohort of patients. Within-department studies will be most unlikely to demonstrate that the number of NMSCs observed in follow-up studies is significantly different from that expected in an untreated population, even for a follow-up period of 20 years. Determination of the carcinogenic potential associated with narrowband UVB will require large multicentre studies typically involving several thousand new patients per year and followed up for 10 years or more.

Abstract No. 3 Is there a skin cancer risk with narrowband ultraviolet B phototherapy? Preliminary data from the second phase of the Dundee follow-up study

We do not know whether narrowband ultraviolet B (NB‐UVB, TL‐01) phototherapy carries any increased risk of skin cancers. Follow‐up of 126 patients treated with NB‐UVB in Germany (Weischer M, Blum A, Eberhard F et al. No evidence for increased skin cancer risk in psoriasis patients treated with broadband or narrowband UVB phototherapy: a first retrospective study. Acta Derm Venereol (Stockh) 2004; 84: 370–4) did not detect any increased skin cancer risk. Our follow‐up study (with linkage to Scottish Cancer Registry data complete to 1998) showed greater than expected (compared with age‐ and sex‐matched Scottish population) numbers of basal cell carcinomas (BCCs) in those treated with NB‐UVB (Man I, Crombie IK, Dawe RS et al. The photocarcinogenic risk of narrowband UVB (TL‐01) phototherapy: early follow‐up data. Br J Dermatol 2005; 152: 755–7). Whether the modestly increased standardized incidence rate (SIR) of 213 (95% confidence interval, CI 102–391) was due to treatment or factors such as ascertainment bias was not clear. Analysis of data from the next phase of this follow‐up study, with linkage to the Scottish Cancer Registry complete to December 2002, is ongoing. The summary phototherapy records of 4050 patients treated with NB‐UVB between 1985 and 2002 were examined. The median duration of follow‐up was 5·8 years (up to 16·7) from end of first NB‐UVB course. We now have 26 633 person‐years of follow‐up data. The most frequent primary diagnoses were: psoriasis (55%), atopic dermatitis (15·4%), polymorphic light eruption (7·7%) and chronic urticaria (3·9%). Indirect standardization, adjusting for age and sex, was used to compare numbers of skin tumours identified with numbers expected in the general Scottish population. We did not find significantly more melanomas [SIR 164 (95% CI 60–357), P = 0·16] nor squamous cell carcinomas [SIR 173 (95% CI 79–329), P = 0·08] than expected. More BCCs than expected were registered in patients who had received NB‐UVB and psoralen plus ultraviolet A [SIR 184 (95% CI 128–255), P = 0·0007] and who had received only NB‐UVB [SIR 211 (95% CI 135–314), P = 0·0007, n = 3082]. So far, these findings are reassuring. A possible explanation for the excess BCCs is a causative association between NB‐UVB exposure and BCC development. Alternatively, more BCCs may have been registered in our treated patients because of careful surveillance leading to more BCCs being detected earlier and treated with modalities leading to a histopathological diagnosis (and, therefore, registration). However, only with more prolonged follow‐up of patients who have received high cumulative numbers of treatments might a definite skin cancer risk become detectable. Therefore, we should remain cautious as we cannot dismiss the possibility that NB‐UVB is carcinogenic in humans.

Treatment of localized vitiligo with targeted broadband UVB phototherapy: a pilot study

Narrowband ultraviolet B (UVB) phototherapy and 308 nm excimer laser have produced encouraging therapeutic results for vitiligo. Repigmentation of various degrees was obtained in different studies. Twenty-nine vitiliginous lesions from six patients were treated with targeted, broadband UV-B phototherapy. UV fluences were started at 50% of the minimal erythema dose, then increased gradually. Treatments were carried out twice weekly for 12 weeks. Some degree of repigmentation occurred in all subjects. Responses varied among the different anatomic locations, with acral lesions achieving the least improvement. Onset of repigmentation was as early as 3 weeks of treatment in some subjects. Treatments were well tolerated, with only minimal erythema and hyperpigmentation. This study was carried out in a smaller number of patients with skin types III and IV. The irradiation device was a broadband UVB device, and thus the results may not be similar to those obtained from a more monochromatic system such as an excimer laser. Targeted broadband UVB is an efficacious and safe modality for the treatment of localized vitiligo.

No Evidence for Increased Skin Cancer Risk in Psoriasis Patients Treated With Broadband or Narrowband UVB Phototherapy: A First Retrospective Study

No Evidence for Increased Skin Cancer Risk in Psoriasis Patients Treated With Broadband or Narrowband UVB Phototherapy: A First Retrospective Study

Pityriasis rubra pilaris, type IV

A 4-year-old girl presented with a 3-year history of demarcated, salmon-pink, hyperkeratotic plaques, which were symmetrically distributed on the elbows, knees, ankles, and dorsal aspects of the hands and feet. A diffuse, orange-pink palmoplantar keratoderma was also evident. Clinical and histologic findings were consistent with a diagnosis of pityriasis rubra pilaris (PRP), type IV (circumscribed juvenile). Type IV PRP develops in prepubertal children, is typically localized to the distal aspects of the extremities, and has an unpredictable course. Although ultraviolet (UV) radiation can potentially exacerbate PRP, our patient has improved with broad-band UVB phototherapy.

No evidence for increased skin cancer risk in psoriasis patients treated with broadband or narrowband UVB phototherapy: a first retrospective study.

Phototherapy of skin diseases such as psoriasis is an effective and safe treatment modality. However, increasing the risk of skin cancer by phototherapy is a serious concern. An increased skin cancer risk occurs after prolonged photochemotherapy (PUVA). In contrast, the role of broadband UVB or narrowband UVB therapy in skin carcinogenesis of humans with psoriasis is less clear. Therefore, we investigated the incidence of skin tumours in a total of 195 psoriasis patients, receiving broadband (n=69) or narrowband (n=126) UVB from 1994 to 2000 with follow-up until 2003. Data were raised from the regional interdisciplinary cancer centre of the University of Tuebingen, Germany and compared with the tumour incidences given for the German population. In this study, with 80% statistical power to detect a 6-7-fold increase in skin cancer with broadband UVB and 83% power to detect a 5-6-fold increase with narrow band UVB at p=0.05, only one patient developed skin cancer - an in situ melanoma. The tumour occurred within the same year that phototherapy was initiated. Thus, the present study does not provide evidence for an increased skin cancer risk for patients treated with either broadband or narrowband UVB phototherapy

Succesful Treatment of Pruritus in Pregnancy with Broadband UVB Phototherapy

Succesful Treatment of Pruritus in Pregnancy with Broadband UVB Phototherapy

Tazarotene combination treatments in psoriasis

In the hope of increasing efficacy and improving safety, several combination regimens involving tazarotene gel have been explored for the treatment of plaque psoriasis. A number of large-scale studies have shown that the adjunctive use of a mid-potency or high-potency steroid can enhance both the efficacy and tolerability of tazarotene treatment. A small pilot study also suggested improved efficacy when used in combination with calcipotriene. Likewise, the adjunctive use of tazarotene can enhance the efficacy and potentially the safety of treatment with steroids, broad-band and narrow-band UVB phototherapy, and psoralens plus UVA bath therapy. (J Am Acad Dermatol 2000;43:S36-42.)

Calcipotriol Cream Combined with Twice Weekly Broad-Band UVB Phototherapy: A Safe, Effective and UVB-Sparing Antipsoriatric Combination Treatment

Background: Calcipotriol has been combined with a number of systemic antipsoriatric treatments, improving efficacy or reducing the systemic treatment required. Although studies on calcipotriol and UVB have also been performed, there are no data on the UVB-saving effect of calcipotriol combined with broad-band UVB to reduce overall UVB exposure, while maintaining efficacy. Objectives: To assess the efficacy and safety of calcipotriol cream (50 μg/g) combined with twice weekly broad-band UVB and to determine if this treatment would require fewer UVB treatments and lower cumulative UVB irradiance when compared to a standard 3 times weekly broad-band UVB regime in patients with extensive psoriasis. Methods: This multicentre, prospective, randomised, parallel-group, vehicle-controlled, single-blind (investigator) study consisted of a 1-week wash-out phase, 12-week treatment phase and 12-week follow-up phase. Broad-band UVB equipment was standardised and calibrated prior to the study. The UVB starting dose was based on the patient’s minimal erythema dose. Assessments included PASI, extent, severity and investigator and patient’s overall assessments of the psoriasis. Results: Fewer exposures (12 vs. 19) and less cumulative UVB irradiance (1,570 vs. 5,430 mJ/cm²) were required by the calcipotriol + twice weekly UVB group to achieve 80% reduction in PASI (p < 0.001). Similarly, fewer exposures (22 vs. 25) and less cumulative UVB irradiance (4,147 vs. 9,670 mJ/cm²) were required by this group to achieve total clearance (p < 0.001). There was no difference in the PASI, patient’s and investigator’s overall assessments and number of adverse events recorded by either group for both the treatment and follow-up phases. Conclusion: Calcipotriol cream + twice weekly broad-band UVB phototherapy is an effective and safe antipsoriatric treatment, resulting in fewer UVB exposures, lower cumulative irradiance and a saving of time.

No additional effect of calcipotriol ointment on low-dose narrow-band UVB phototherapy in psoriasis

Background: Broad-band UVB phototherapy has appeared to be effective in clearing psoriatic lesions. After the advent of calcipotriol ointment, promising results have been obtained by combining these two therapeutic modalities. Also, an additional effect of narrow-band UVB phototherapy on treatment with calcipotriol ointment has been demonstrated. Objective: Our purpose was to compare treatment with low-dose narrow-band UVB phototherapy both with and without calcipotriol ointment. Methods: We included 53 patients suffering from plaque-type psoriasis. All patients underwent low-dose narrow-band UVB phototherapy. Nearly half of the patients were randomized to apply calcipotriol ointment (50 μg/g) twice daily on the affected skin. The Psoriasis Area and Severity Index (PASI) was used to evaluate psoriatic lesions. Results: In this study we showed that low-dose narrow-band UVB phototherapy is effective in the treatment of psoriasis and that calcipotriol ointment does not improve treatment outcome. Conclusion: Calcipotriol ointment does not improve treatment with low-dose narrow-band UVB phototherapy. (J Am Acad Dermatol 1999;41:991-5.)

A randomized comparison of narrow-band TL-01 phototherapy and PUVA photochemotherapy for psoriasis

Background: Although PUVA treatment of psoriasis is more effective than conventional or broad-band UVB phototherapy, two small studies have suggested that narrow-band or TL-01 phototherapy may have a therapeutic effect equal to PUVA. If confirmed, this would be of considerable importance as TL-01 therapy is likely to be considerably safer in the long term than PUVA. Objective: The purpose of this study was to compare PUVA with narrow-band (TL-01) phototherapy in psoriasis. Methods: We studied 100 patients with plaque-type psoriasis who were randomly allocated to twice-weekly treatment with PUVA or narrow-band UVB. Results: Clearance of psoriasis was achieved in a significantly greater proportion of patients treated with PUVA (84%) than with TL-01 (63%) ( P = .018), and with significantly fewer treatments (median number of treatments for clearance with PUVA, 16.7; with TL-01, 25.3; P = .001). Only 12% of those treated with TL-01 were clear of psoriasis 6 months after finishing treatment compared with 35% for PUVA ( P = .002). Conclusion: When given twice weekly, PUVA is more effective for psoriasis than narrow-band UVB phototherapy. (J Am Acad Dermatol 1999;41:728-32.)

Mechanisms of ultraviolet (UV) B and UVA phototherapy.

Ultraviolet (UV) radiation has been used for decades with great success and at a constantly increasing rate in the management of skin diseases, becoming an essential part of modern dermatologic therapy (Krutmann et al, 1999). For phototherapy, irradiation devices emitting either predominantly middlewave UV (UVB, 290-315 nm) or longwave UV (UVA, 315-400 nm) radiation are employed. In former years, patients were treated with broad-band UVB, broad-band UVA, or combination regimens. Broad-band UV phototherapy, however, is being replaced more frequently by the use of irradiation devices that allow treatment of patients' skin with selected emission spectra. Two such modalities which have their origin in European Photodermatology are 311 nm UVB phototherapy (which uses long-wave UVB radiation above 300 nm rather than broadband UVB) and high-dose UVA1 therapy (which selective employs long-wave UVA radiation above 340 nm). In Europe, 311 nm UVB phototherapy has almost replaced classical broad-band UVB phototherapy and has significantly improved therapeutic efficacy and safety of UVB phototherapy (van Welden et al, 1988; Krutmann et al, 1999). The constantly increasing use of UVA-1 phototherapy has not only improved UVA phototherapy for established indications such as atopic dermatitis (Krutmann et al, 1992a, 1998; Krutmann, 1996), but has also provided dermatologists with the opportunity to successfully treat previously untractable skin diseases, e.g., connective tissue diseases (Stege et al, 1997; Krutmann, 1997). These clinical developments have stimulated studies about the mechanisms by which UVB and UVA phototherapy work. The knowledge obtained from this work is an indispensable prerequisite to make treatment decisions on a rationale rather than an empirical basis. Modern dermatologic phototherapy has started to profit from this knowledge, and it is very likely that this development will continue and provide dermatologists with improved phototherapeutic modalities and regimens for established and new indications. This review aims to provide an overview about current concepts of the mode of action of dermatologic phototherapy. Special emphasis will be given on studies that have identified previously unrecognized immunosuppressive/anti-inflammatory principles of UV phototherapy.