Narrowband UVB Research Articles

Telangiectasia Macularis Eruptiva Perstans Treated with Narrow-Band UVB Phototherapy and Heliotherapy during the COVID-19 Pandemic

Telangiectasia macularis eruptiva perstans (TMEP) is a rare disease, previously classified as a variant of cutaneous mastocytosis. While no gold standard of treatment exists, several treatments have been studied. We report a case of a 63-year-old woman who presented with long-standing asymptomatic telangiectatic macules beginning on the upper chest, back, and bilateral arms, with occasional pruritus and no other systemic symptoms. Skin biopsy, along with Giemsa stain, revealed findings consistent with TMEP. The patient underwent testing for serum tryptase level, which was within normal limits. The patient was started on topical steroids for two weeks and antihistamine therapy, with a noted decrease in pruritus but no change in cutaneous lesions. She was then advised to start phototherapy, and subsequently underwent a total of five sessions of narrow-band ultraviolet B phototherapy, after which she noted lightening of the lesions. Due to the COVID pandemic, the patient was shifted to heliotherapy with continued lightening of lesions after two months of thrice weekly sessions. This rare case is supportive of narrow-band ultraviolet B phototherapy and heliotherapy as promising treatment options for cases of TMEP.

Ultraviolet phototherapy for treatment of various dermatoses

Ultraviolet (UV) radiation has been applied to treat many chronic skin diseases. Based on the wavelength, UV radiation consists of three types, namely ultraviolet C (UVC), ultraviolet B (UVB), and ultraviolet A (UVA). The types of UV that are widely used in dermatology are narrowband ultraviolet B (NB-UVB), broadband ultraviolet B (BB-UVB), UVA1, and psoralen combined with UVA (PUVA). The interaction between UV and the skin determines the effectiveness of phototherapy. The biological effects of UV are used in the management of inflammatory skin diseases, malignancies, and various rare dermatoses. Apart from these benefits, UV increases the risk of photoaging and skin cancer. Therefore, further researches are necessary to enhance the effectiveness and safety of phototherapy. This literature review discusses the role of phototherapy in various dermatoses other than psoriasis and vitiligo.

Cyclobutane Pyrimidine Dimers Produced with Narrowband UVB Are on Average More Mutagenic than Those with Broadband UVB in Mouse Skin.

Although narrowband UVB (NB-UVB) has replaced broadband UVB (BB-UVB) because of its greater effectiveness in dermatological phototherapy, it is twice as carcinogenic as BB-UVB at an equivalent inflammatory dose. To clarify the basis of the different genotoxicities, we comparatively evaluated the mutagenicities in mouse skin of the two UVB types along with their efficiencies in the formation of cyclobutane pyrimidine dimer (CPD), which is a major mutagenic DNA photolesion specifically produced by UVR. We found that the mutagenicity averaged per single molecule of CPD was 2.5- and 1.8-fold higher in NB-UVB-exposed epidermis and dermis, respectively, which indicates that NB-UVB is more mutagenic for the skin than BB-UVB at doses producing an equimolar amount of CPD. Analysis of effective wavelengths for UV photolesion formation with each UVB source revealed a remarkable difference in the peak effective wavelengths for CPD formation: 15 nm longer for NB-UVB in the epidermis. Although the analysis of mutation profiles showed largely similar UV-specific signatures between the two UVB types, a relatively stronger preference for UVA-specific mutations was observed for NB-UVB. These results suggest that the difference in the effective wavelengths for CPD formation leads to the different mutagenicities and carcinogenicities between the UVB sources.

Combination of carboxytherapy with narrowband‐ultraviolet B in the treatment of recalcitrant areas of vitiligo: A randomized clinical trial

Carboxytherapy has been used in the treatment of autoimmune skin diseases such as psoriasis and morphea. Carboxytherapy has antioxidant effects, and leads to better tissue oxygenation, and release of growth factors. In this article, we decided to evaluate efficacy of combined carboxytherapy and narrowband-ultraviolet B (NB-UVB) compared to NB-UVB alone in the treatment of vitiligo. This is a prospective, split-body double-blind comparative study performed in patients with generalized stable vitiligo in acral areas and extremities referred to dermatology clinic of Afzalipour hospital in Kerman University of Medical Sciences. NB-UVB was performed three times a week in non-consecutive days for 4 months. In each patient, one lesion was randomly treated with carboxytherapy (weekly sessions for total of 16 sessions). Efficacy of treatment was evaluated by percentage of repigmentation of the lesions. Chi-square test and analysis of variance test (ANOVA) were used to compare efficacy of treatment based on demographic features of the patients and clinical features of the lesions, respectively. Twenty-eight patients with mean age of 32.35 ± 7.37 years old completed the study. At the end of the treatment, 37% of the patients in combination therapy group demonstrated more than 75% improvement compared to 0% in the monotherapy group (p=0.001). There was no significant difference between either demographic features of the patients (age, sex, and skin phototypes) or duration of disease with efficacy of the treatment in both groups. Combination of carboxytherapy with NB-UVB leads to higher percentage of repigmentation and patients' satisfaction compared to monotherapy with NB-UVB.

Hyperpigmented plaques and nodules in a young man

A man in his 20s presented with progressive pruritic hyperpigmented plaques that he had since age 16 years. Previous treatments included topical and systemic steroids and narrowband UVB. He denied fevers, chills, lymphadenopathy, weight loss, and night sweats. On examination he had large, round hyperpigmented plaques studded with small, darker papules and nodules involving the trunk, legs, and buttocks (Figs 1 and 2). Punch biopsy revealed a dense superficial and deep lymphocytic infiltrate with prominent perieccrine distribution (Figs 3 and 4).

Phototherapy in Pediatric Dermatology

Background: Phototherapy is a safe and effective treatment modality for skin diseases in children such as psoriasis, atopic dermatitis, pityriasis lichenoides, vitiligo, cutaneous cell lymphoma, pityriasis rubra pilaris, and other skin disorders. It is reported to be effective with less side effects compare to the administration of systemic medicine. Short and long term side effects should be taken into account when applying this model of therapy, especially in children. Purpose: To identify special considerations regarding the use of phototherapy modalities in the field of dermatology in children. Review: Phototherapy is the use of ultraviolet (UV) radiation for therapeutic purposes. The various wavelengths of UV radiation used for phototherapy have their own respective photochemical and photobiological properties. There are modality choices that have been proven to provide benefits in treating various skin diseases, including broadband UVB and narrowband UVB, psoralen UVA photochemotherapy (PUVA), ultraviolet A 1 (UVA1), and targeting phototherapy. Special considerations regarding the use of this treatment modality in the pediatric population increase with safety and treatment tolerance. Conclusion: Special considerations should be taken when providing phototherapy treatment options to children with skin disorders requiring phototherapy. The therapies are generally well tolerated and mostly have minor adverse side effects, such as sunburn.

Differences in the Effects of Broad-Band UVA and Narrow-Band UVB on Epidermal Keratinocytes.

Background: The sun is a natural source of UV radiation. It can be divided into three bands, UVA (315–400 nm), UVB (280–315 nm) and UVC (100–280 nm), where the radiation up to 290 nm is very effectively eliminated by the stratospheric ozone. Although UV radiation can have a beneficial effect on our organism and can be used in the treatment of several skin diseases, it must primarily be considered harmful. Methods: In the presented work, we focused on the study of the longer-wavelength UV components (UVA and UVB) on the human epidermal keratinocyte line HaCaT. As UVA and UVB radiation sources, we used commercially available UVA and UVB tubes from Philips (Philips, Amsterdam, The Netherlands), which are commonly employed in photochemotherapy. We compared their effects on cell viability and proliferation, changes in ROS production, mitochondrial function and the degree of DNA damage. Results: Our results revealed that UVB irradiation, even with significantly lower irradiance, caused greater ROS production, depolarization of mitochondrial membrane potential and greater DNA fragmentation, along with significantly lowering cell viability and proliferative capacity. Conclusions: These results confirm that UV radiation causes severe damages in skin cells, and they need to be protected from it, or it needs to be applied more cautiously, especially if the component used is UVB.

Involvement of Gut Microbiota in the Development of Psoriasis Vulgaris.

Objectives: Psoriasis is a common chronic recurrent dermatitis. Accumulating observations show gut microbiota dysbiosis in psoriasis. We intend to further investigate the relationship between intestinal microbiota and psoriasis development.Design: We first performed an epidemiological investigation on differences of gastrointestinal discomfort symptoms between patients with psoriasis and general population. Then variation of gut microbiota in patients with psoriasis (un)treated with acitretin plus narrow-band ultraviolet B (NB-UVB) was analyzed by 16S rRNA sequencing. We last compared recovery status and vital cytokines (lesion and intestine) of mouse psoriasiform models, which were transplanted with fecal microbiota from patients with psoriasis or healthy controls.Results: (1) About 85.5% of patients with psoriasis vs. 58.1% of healthy controls presented with at least one gastrointestinal symptom. The prevalence of investigated symptoms (e.g., abdominal distension and constipation) were significantly higher in patients, compared with controls (p < 0.05). Passing flatus and constipation were significantly correlated with psoriasis (p < 0.05 in both cases). (2) The abundance of Ruminococcaceae family, Coprococcus_1 genus, and Blautia genus were decreased with psoriasis improvement (p < 0.05, respectively), which had been demonstrated significantly increased in psoriasis. (3) Mice receiving psoriatic microbes transplantation showed delayed recovery of psoriasiform dermatitis and less reduction of interleukin (IL)-17A than those receiving healthy microbiota or blank control (p < 0.05 and p < 0.01, respectively).Conclusion: Multiple evidence we provided here preliminarily demonstrates the involvement of gut microbiota in the different degree of psoriasis activity. The strategy based on overall microbial communities is expected to be a promising supplementary for long-term management of psoriasis.

Narrow-band ultraviolet B therapy attenuates cutaneous T-cell responses in hapten-induced, experimental contact dermatitis in beagles.

In human medicine, narrow-band ultraviolet B (NB-UVB) phototherapy has been used to treat various T-cell-mediated skin diseases. However, the effect of NB-UVB on inflamed canine skin remains uncertain. To investigate the effect of NB-UVB phototherapy on the skin of dogs with hapten-induced contact dermatitis. Seven healthy beagles without skin problems. Dogs were irradiated with varying doses of NB-UVB to determine the minimal erythema dose (MED). After determining the MEDs of six dogs (excluding one of the seven whose skin did not show a visible reaction), we investigated the effect of NB-UVB on their inflamed skin by topically applying 2,4-dinitrochlorobenzene (DNCB), which causes type 1 helper T cell (Th1)- and cytotoxic T-cell (Tc)1-induced skin inflammation. We then irradiated the skin with NB-UVB. We analysed the treated skin samples via histopathological and immunohistochemical methods, and TdT-mediated dUTP nick-end labelling (TUNEL) to demonstrate apoptotic cells. We also analysed the cytokine gene transcription via real-time quantitative reverse transcription PCR. The NB-UVB MEDs caused mild inflammatory changes yet no severe epidermal exfoliations in the irradiated skin. In DNCB-treated skin irradiated by the NB-UVB MEDs, TUNEL-positive dermal apoptotic cells were increased significantly compared with those of DNCB-treated, nonirradiated skin. INF-γ and TNF-α transcription levels in DNCB-treated, irradiated skin were significantly lower than those in the DNCB-treated, nonirradiated skin. Phototherapy using NB-UVB MEDs attenuated cutaneous Th1 and Tc1 cytokine responses with minimal skin damage in a canine model of hapten-induced contact dermatitis.

Efficacy of narrow band UVB with or without OMP in stabilization of vitiligo activity in skin photo-types (III-V): A double-blind, randomized, placebo-controlled, prospective, multicenter study.

NB-UVB has long been the vitiligo management pillar with capability of achieving the main treatment outcomes; repigmentation and stabilization. Its stabilizing effect in dark skin has been debatable. However, randomized controlled trials regarding NB-UVB ability to control disease activity are lacking. To assess stabilizing effect of NB-UVB in comparison to systemic corticosteroids, the mainstay in vitiligo stabilization, in skin photo-types (III-V). This is a multicenter, placebo-controlled, randomized, prospective study. Eighty patients with active nonsegmental vitiligo (NSV) (Vitiligo disease activity (VIDA) ≥2) were randomized to either NB-UVB and placebo (NB-placebo) or NB-UVB and dexamethasone oral mini-pulse (OMP) therapy (NB-OMP) for 6months. Sixty four patients completed the study, 34 in the NB-OMP group and 30 in the NB-placebo group. Patients were evaluated fortnightly according to presence or absence of symptoms/signs of activity. In spite of earlier control of disease activity observed in the NB-OMP group, it was comparable in both groups by the end of the study period. Disease activity prior to therapy, but not extent, was found to influence control of activity in both groups. Thus, NB-UVB is a safe sole therapeutic tool in vitiligo management. Not only does it efficiently achieve repigmentation, but also it is a comparable stabilizing tool for systemic corticosteroids in spite of slightly delayed control. NB-UVB is the only well-established vitiligo therapy that can be used solely whenever corticosteroids are contraindicated or immune-suppression is unjustified. Nonetheless, its combination with corticosteroids expedites response and improves compliance.

Triple combination therapy of narrowband ultraviolet B, fractional carbon dioxide laser and topical bimatoprost 0.01% for non-segmental vitiligo on non-facial areas: A randomized half-body, double-blind, placebo-controlled, comparative study.

Combination therapy shows superior outcomes over monotherapy in treating vitiligo. Topical bimatoprost is a melanogenic agent effectively used to induce repigmentation. However, topical bimatoprost 0.01% has never been explored in non-facial vitiligo, and triple therapy of phototherapy, fractional laser and topical bimatoprost has never been examined. This study aims to investigate the efficacy and safety of triple-modality treatment, combining narrowband ultraviolet B (NB-UVB), fractional carbon dioxide (CO2 ) laser and topical bimatoprost 0.01% for stable non-segmental vitiligo on non-facial areas. Fifteen vitiligo patients with at least two symmetrical, comparable-sized lesions on non-facial regions were included. The paired lesions were randomized to receive a treatment regimen of twice-daily application of either bimatoprost 0.01% solution or placebo in combination with once-monthly fractional CO2 laser and twice-weekly NB-UVB therapy for 12 weeks. There were no statistically significant differences in the vitiligo surface area (VSA) and melanin concentration (MC) at baseline between treatment sides. After 12 weeks of treatment, the percentage change from baseline of MC on the triple-therapy side was significantly higher than that on the dual-therapy side, 27.17 ± 13.62% versus 22.82 ± 10.10% (p= 0.028). The change from baseline of VSA was also greater on the triple-therapy side; however, a statistically significant difference was not reached. Improvement grades of repigmentation and adverse events were similar on both sides. Triple therapy with NB-UVB, fractional CO2 laser and topical bimatoprost 0.01% tends to be safe and more effective as compared to dual therapy of NB-UVB and fractional CO2 laser in non-facial vitiligo.

A single‐blinded, randomized, controlled trial comparing efficacy between low‐fluence alexandrite 755‐nm picosecond laser and low‐fluence neodymium‐doped yttrium aluminum garnet (Nd:YAG) 1064‐nm picosecond laser for the treatment of ultraviolet B‐induced hyperpigmentation

Hyperpigmentation is a common concern of patients in dermatology clinics. Although there are many treatment options, lasers are considered a promising therapy for various hyperpigmentary conditions. This study aims to evaluate the efficacy of alexandrite 755-nm picosecond and neodymium-doped yttrium aluminum garnet (Nd:YAG) 1064-nm picosecond lasers for the treatment of ultraviolet B (UVB)-induced hyperpigmentation in Asians. A randomized, single-blinded study was conducted. UVB-induced hyperpigmentation was performed in three spots by narrowband UVB. After 2weeks, these three spots were allocated into 755-treated, 1064-treated, and control sites. Patients received weekly laser treatments for five sessions. Follow-ups were scheduled at 1 and 2months after the last session. Twenty patients attended the study. Overall, 755-nm and 1064-nm picosecond lasers showed a significant improvement in the mean lightness index (L*) compared to the control site, which started at Day49 and Day77, respectively. The mean L* of the 755-nm-treated site was also higher than that of the 1064-nm-treated site at Day105 (p≤0.001). Initially, the mean L*, physician's visual analog scale (VAS), and patient satisfaction with the 1064-nm picosecond laser were better than those with the 755-nm picosecond laser. Nevertheless, an inversion of the mean L* and VAS was noted at Day49, whereas the mean patient satisfaction was noted at Day77. In the subgroup analysis, a 755-nm picosecond laser effectively treated Fitzpatrick skin types (FPTs) III and IV. However, the mean L* of the 1064-nm picosecond laser was not significantly different from that of the control for FPT4. The alexandrite 755-nm picosecond and Nd:YAG 1064-nm picosecond lasers appear to be effective and safe modalities for treating UVB-induced hyperpigmentation. With the setting employed in this study, the outcome after the 755-nm picosecond laser treatment seemed superior to that of the 1064-nm picosecond laser treatment, especially for FPT4.

Lichen planus pigmentosus in a 7-year-old girl.

LPP is a rare variant of LP that is infrequently encountered in children. In a retrospective analysis of 316 pediatric patients with LP, only nine (2.8%) were diagnosed with LPP (4). Similarly, in a recent retrospective study of 76 pediatric patients with LP in South India, only one (1.3%) was diagnosed with LPP (6). It is commonly seen in middle-aged patients with high skin phototypes. LPP presents as chronic, acquired, violaceous to brownish-gray, oval macules, with poorly-defined borders (7). The lesions appear more frequently in the neck and face, but they can also affect the upper and lower extremities, and torso as well. LPP rarely affects the oral mucosa, scalp, palms, soles, and nails. Flexural involvement is seen in around 20% of cases with a concurrent photo-exposed distribution (5). LPP-inversus is a variant of LPP, limited to intertriginous and flexural areas, and sparing sun-exposed areas (3, 5). A skin biopsy will confirm the diagnosis. The histopathology findings include hyperkeratosis and vacuolar degeneration of the basal layer, dermal band-like or perivascular infiltrate, and melanophages. Superficial pigmentary incontinence can be seen (7). The main differential diagnosis of LPP is erythema dyschromicum perstans (EDP) or ashy dermatosis. EDP presents as non-pruritic, blue-gray macules and patches, with or without raised erythematous borders in photo-exposed areas and trunk. Histopathology reveals lichenoid features within the peripheral active border. A perivascular infiltrate and numerous melanophages can be seen. The clinical features and histopathology of LPP and EDP can overlap, so much so as to suggest that the two conditions can be part of the spectrum of a unique entity. Other differential diagnoses include post-inflammatory hyperpigmentation, pigmented contact dermatitis, fixed drug eruption, and urticaria pigmentosa, among others (2, 7). LPP treatment is difficult, with limited results in most cases. The available topical treatments include medium to high potency corticosteroids, calcineurin inhibitors (mostly tacrolimus 0.1% ointment) and skin lightening creams containing hydroquinone and retinoids in conjunction with an anti-inflammatory treatment (3, 7, 9). Some Authors (3) recommend that in order to prevent steroid atrophy, corticosteroids should be used for a short period (2-4 weeks). Later on they could be followed by a calcineurin inhibitor over a longer period (3-6 months). In recalcitrant or widespread cases, systemic treatments with or without topical therapy can be used. They include oral corticosteroids, dapsone, and isotretinoin (7, 9, 10). The use of narrow band ultraviolet B (NB-UVB) phototherapy in LPP has been recently reported. Complete resolution of lesions was achieved after 20 exposures and no adverse effect was observed (1).

Repigmentation by combined narrow‑band ultraviolet B/adipose‑derived stem cell transplantation in the mouse model: Role of Nrf2/HO‑1‑mediated Ca2+ homeostasis.

Vitiligo is a depigmentation disease commonly seen in clinical practice, mainly involving loss of functional epidermal pigment cells and hair follicle melanocytes. Narrow-band ultraviolet B (NB-UVB) has emerged as the first choice of treatment for vitiligo, but long-term exposure may have serious consequences. Recently, it was reported that adipose-derived stem cells (ADSCs) improve melanocyte growth and the efficacy of melanocyte transplantation. The present study aimed to examine the efficacy of NB-UVB/ADSC-transplantation combined therapy on a mouse vitiligo model and explore the underlying mechanisms by focusing on endoplasmic reticulum stress and cellular calcium (Ca2+) homeostasis. Vitiligo mice models were established by applying 40% monobenzone (MBZ) cream twice daily and treated with NB-UVB/ADSC combination therapy. Some treated mice were also given ML385, a nuclear factor erythroid 2 like 2 (Nr2) inhibitor. Histopathological changes were evaluated using a depigmentation evaluation score and observed with hematoxylin and eosin staining on skin tissues. ELISA was used to measure diagnostic markers in plasma. Flow cytometric assay was performed to quantify CD3+, CD4+ and CD8+ levels. Expression levels of associated proteins were detected with western blot and immunofluorescence. Treatment of mice with MBZ-induced depigmentation patches on the skin was accompanied with loss of redox balance and disruption of cellular Ca2+ homeostasis. Oxidative stress and Ca2+ unbalancing were improved after the mice were treated by NB-UVB/ADSCs transplantation combination therapy. ML385, strongly negated the protective effect of NB-UVB/ADSC transplantation combination therapy, indicating the critical role of Nr2 signaling. The findings improved the understanding of the pathogenesis of vitiligo and will guide future development of therapeutic strategies against it.

An Update on Narrowband Ultraviolet B Therapy for the Treatment of Skin Diseases.

The objective of this review is to provide an update on narrowband ultraviolet B (NB-UVB) as a treatment for various skin conditions. NB-UVB works by suppressing the cutaneous cell-mediated immune response and has been shown to be an efficacious and clinically tolerable treatment for a range of inflammatory dermatoses. A literature search was conducted by advanced searches of PubMed for NB-UVB treatment of dermatologic skin diseases with a focus on reports from 2010 to 2021, including both office-based and home-based phototherapy (HBPT). Data were prioritized based on studies with a high level of evidence using the Oxford Evidence-Based Medicine guidance.We found that NB-UVB continues to serve as an effective form of therapy for several cutaneous conditions, including vitiligo, psoriasis, atopic dermatitis, mycosis fungoides, and other inflammatory dermatoses. The recent introduction of Janus kinase inhibitors in combination with NB-UVB suggests future promise in the treatment of vitiligo. Despite its rise in popularity, a decline was seen in office-based NB-UVB treatment during the coronavirus disease 2019 pandemic. Options are available to deliver NB-UVB at home with comparable efficacy to office-based treatments. In conclusion, for a select group of patients and conditions, NB-UVB continues to serve as an effective treatment modality with minimal side effects, with HBPT serving as an option to improve patient compliance.

High-Throughput RNA Sequencing Reveals the Effect of NB-UVB Phototherapy on Major Inflammatory Molecules of Lesional Psoriasis.

ObjectiveTo identify the narrowband ultraviolet B (NB-UVB)-induced molecular mechanisms that may account for their anti-inflammatory efficacy, gene expression and transcriptome profiling, which were performed using advanced molecular techniques.MethodsThis research was conducted on patients with moderate-to-severe plaque-type psoriasis who received NB-UVB treatment. RNA sequencing (RNA-Seq) was conducted to assay the transcriptomes and identify the differentially expressed transcripts that had been enriched during the major pathway analysis.ResultsClinical improvement of psoriasis by NB-UVB therapy is linked to the suppression of the “immunological signaling pathways” and “cell cycle regulatory, growth and proliferation pathways” which are critical to the pathogenesis of the disease. In addition, these results were further substantiated by demonstrating that NB-UVB therapy has a significant effect on keratinocyte differentiation and affects the regulation of genes and inflammatory mediators that are related to cell proliferation and apoptosis. Moreover, NB-UVB phototherapy is also involved with the downregulation of toll-like receptors signaling in lesional psoriasis.ConclusionNB-UVB is an effective treatment for psoriasis. Our study supports the conclusion that the clinical effectiveness of NB-UVB therapy is based on the suppression of a broad range of inflammatory signaling pathways, gene expression of inflammatory cytokines and increased expressions of anti-inflammatory signaling pathways in psoriatic skin. This is the first study that applied advanced molecular techniques to investigate phototherapy as a new key to unlock genetic knowledge and create novel information. Ultimately, the goal is to increase medical knowledge and improve the patient care of psoriasis.

Woringer-Kolopp Disease, a Rare Dermatologic Malignancy Presenting in a Young Male

Abstract Pagetoid reticulosis (PR), also known as Woringer-Kolopp disease (WKD), is a rare variant of cutaneous T-cell lymphoma usually presenting as an isolated patch or plaque on the extremities. Immunohistochemical staining of T-cell markers can be variable, but as the name implies the epidermotropic lymphocytes consistently display a “pagetoid” appearance. Two variants of the disease are described: the localized type WKD and the disseminated type (Ketron-Goodman disease or KGD). We present the case of a 31 years old patient with no other known personal history, who is a dentist working with irritating chemicals such as orthophosphoric acid 36% and hydrofluoric acid 9.5%, who presented to our clinic for a rash consisting of papulo-vesicles with a diameter of 0,5-1.3 cm, intensely pruritic, firm to palpation, arranged on a diffuse erythematous background, located on the left hand on metacarpophalangeal (MCP) joints I-II, that had been evolving for about 1 year, with healing under local cortisone treatment but rapid relapse with local extension of lesions. Diagnosis is confirmed via a skin biopsy of the affected area followed by a cytologic examination. Histopathological appearance and immunophenotypic profile of the lymphoid infiltrate (CD3+, CD4-, CD8+) supported the diagnosis of PR, the localized form WKD. Treatment typically entails topical corticosteroids, alkylating agents, and retinoids but as an additional therapy in cases with localized form, narrowband ultraviolet B (NB-UVB) with remission of lesions and their recurrence, has also been chosen for our pacient.

Minimal Erythema Dose Determination in Holstein Friesian Cattle.

Cattle on pasture are continuously exposed to solar UV radiation, which has been associated with biological effects such as sunburn, photosensitization, squamous cell carcinoma, and cutaneous vitamin D3 production. The minimal erythema dose (MED) required to produce first-degree sunburn (erythema) is poorly researched in cattle. Since cattle are naturally covered with dense hair coats, the MED is influenced by the UV protection offered by the hair. The objective of this study was to determine the MED on intact-hair-covered (MED-H) and shaved white skin (MED-S) of Holstein Friesian cattle. Twenty-one Holstein Friesian cows and heifers were MED tested using a narrowband UV-B LED light (peak irradiance at 292 nm) on eight hair-covered and eight shaved areas over white skin previously unexposed to direct sunlight. Erythema was visually assessed after 24 h. The mean MED-H and MED-S were 5,595 and 329 J/m2, respectively. Heifers had a higher MED-H compared to cows, 7,600 and 4,969 J/m2, respectively. The mean UV transmittance of white cattle hair was 6.7%. MED-H was correlated with hair length (Spearman's rho = 0.76). A linear regression model showed that each millimeter of hair coat length increased the MED-H by 316 J/m2. In conclusion, this study provides a MED testing protocol for cattle and reports standardized values of MED for cattle on intact-hair-covered and shaved areas.

Comparison between 308‐nm excimer light alone versus 308‐nm excimer light and platelet‐rich plasma in the treatment for localized vitiligo

Monochromatic excimer light (MEL) is a safe and effective treatment for localized stable vitiligo. Previous reports of the combination of platelet-rich plasma (PRP) with narrowband ultraviolet B (NB-UVB) or excimer laser yielded conflicting results. This prospective, self-controlled, randomized, comparative study aimed to assess whether the addition of PRP to MEL therapy would be of an additive benefit in the treatment for localized stable vitiligo. Patients/Methods The current study included 36 patients with at least 2more or less symmetrical patches of localized stable vitiligo (72 patches). For each patient, each of the 2 vitiligo patches was randomly assigned to receive either MEL therapy (twice weekly) with bi-weekly intradermal PRP (group A) or MEL therapy alone (group B) for a maximum of 4months or till complete repigmentation. The degree of repigmentation was categorized as absent (0%), poor (1-25%), moderate (26-50%), good (51-75%), or excellent (>75%). Patients were asked about their level of satisfaction (not satisfied at all, partially satisfied, satisfied, or completely satisfied). Side effects were recorded, and follow-up for 3months was done. No statistically significant difference was observed between the 2groups regarding the degree of repigmentation, the patients' level of satisfaction, and the frequency of side effects (p=0.504, 0.490, and 0.912, respectively). At the end of the follow-up period, recurrence was observed in only 3 patients. The current study showed no statistically significant difference between using MEL alone or with intradermal PRP in the treatment for localized stable vitiligo.

Lichen ruber planus új terápiás lehetőségei

Lichen ruber planus/lichen planus (LP), is a chronic immune-mediated inflammatory disease that affects the skin, oral mucosa, genital mucosa, scalp and nails. Planar, purple, polygonal, pruritic, papules and plaques appear on the flexor surfaces of the wrists, forearms and legs. Mucosal lesions are often lacy, reticular, white lines known as Wickham striae. Topical corticosteroids are the first-line therapy for all forms of LP, for severe, widespread LP systemic corticosteroids, acitretine, oral immunosuppressants or narrowband UVB therapy should be considered. Cutaneous LP may resolve spontaneously within one or two years, while mucosal LP may be more persistent and resistant to treatment.