Narrowband UVB Phototherapy Research Articles

The Efficacy of Combined “Oral Simvastatin Plus Narrowband UVB Phototherapy” Than “Phototherapy Alone” in Treating Skin Lesions in Patients with Vitiligo, a Double-Blind Add-On Randomized Controlled Clinical Trial

Background: A tailored therapy for vitiligo is crucial in enhancing patients' quality of life and decreasing the associated dimensions. In addition, statins play a significant function in modulating the immune system. Objectives: This study investigated the efficacy of oral simvastatin in treating skin lesions in patients with vitiligo. Methods: This interventional randomized clinical trial enrolled 50 vitiligo patients referred to Shahid Faghihi Hospital in Shiraz (Iran) in 2015. Participants were divided into control and intervention groups using block randomization. Participants in the control group received “NB-UVB phototherapy plus placebo,” and those in the intervention group received “NB-UVB phototherapy with 40, 60, and 80 mg simvastatin by a monthly increase in the drug dosage”. A reduction in the Vitiligo Area Scoring Index (VASI) score and side effects were measured for four months, and the results were compared between the two groups. Results: At the start of the study, the mean score for the disease severity was equal for both groups (P ˃ 0.05). However, the disease severity was significantly reduced in the following stages of the study in the simvastatin group compared to the placebo group (P = 0.0001). Conclusions: Oral simvastatin enhances the photothermal outcomes while exerting trivial side effects. Thus, combining oral simvastatin with phototherapy is recommended as a potent strategy for treating patients with vitiligo.

Evaluation of the efficacy of NB-UVB phototherapy and topical decapeptide versus NB-UVB phototherapy, topical decapeptide, and carbon dioxide laser in the treatment of stable vitiligo

Background: Vitiligo is an acquired disorder of autoimmune destruction of melanocytes. The management challenges include stabilizing the disease and devising methods for inducing repigmentation. Phototherapy and laser therapy offer promising results, along with topical treatments such as Basic Fibroblast Growth Factor (bFGF)-related topical decapeptide. Aims: This prospective interventional study aimed to assess and compare the efficacy of a triple combination therapy of fractional CO2 laser, Narrow Band-Ultraviolet B (NB-UVB) phototherapy, and topical decapeptide with dual combination of NB-UVB phototherapy and topical decapeptide in the treatment of stable vitiligo. Methods: Patients with stable vitiligo were enrolled for 15 months and divided into two groups: one receiving dual combination therapy and the other the triple combination therapy. Lesions were evaluated using a quartile-grading scale at regular intervals over 16 weeks. Vitiligo noticeability scale (VNS) was used by an independent observer (who was not a part of the study) and by the patient/attendant to eliminate any observation bias. Statistical analysis was done using Pearson chi-square test. Results: Of the 32 enrolled patients, the triple combination therapy demonstrated superior repigmentation outcomes compared to dual therapy, with statistically significant differences observed at all assessment intervals. Side effects were mild and transient. Conclusion: The study highlights the efficacy of triple combination therapy in treating stable vitiligo, particularly for patients with refractory vitiligo. Further research with larger sample sizes and longer follow-up periods is warranted to validate these findings and optimize treatment protocols.

A case of indeterminate cell histiocytosis with ETV3-NCOA2 translocation.

Indeterminate cell histiocytosis (ICH) is a rare histiocytic disorder characterized by a proliferation of CD1a+ and CD207/langerin- cells. Recent molecular analyses have identified ETV3-NCOA2 translocation as a possible aetiopathogenesis of ICH. Herein, we describe the first Japanese case of ICH with ETV3-NCOA2 translocation. A 79-year-old Japanese man presented with a 1-year history of pruritic erythematous papules and nodules on his trunk and extremities. Histological examination revealed a dense and diffuse sheets-like infiltration of medium-sized histiocyte-like cells from the epidermis to the deep dermis. Immunohistochemically, the atypical cells were positive for CD1a but negative for CD207/langerin. Fluorescence insitu hybridization using NCOA2 break-apart probes confirmed a chromosomal break occurring on NCOA2 monoallele in the tumor cells. Furthermore, ETV3 exon 4-NCOA2 exon 14 translocation was identified in formalin-fixed paraffin-embedded skin samples using reverse transcription polymerase chain reaction and subsequent direct DNA sequencing. He also presented with interspersed eczematous plaques on his trunk and reactive dermatopathic lymphoadenopathy without any infiltration of ICH. He was treated with topical corticosteroids and narrowband UVB phototherapy. Four months later, his ICH skin eruptions, eczematous plaques, and lymphoadenopathy gradually regressed. Our case supports the notion that the detection of ETV3-NCOA2 translocation can be useful for diagnosis of ICH.

A Retrospective Comparison Between Home and in-Office NB-UVB Efficacy for Patients With Mycosis Fungoides.

This study addresses the gap in research comparing the effectiveness between home and in-office narrowband ultraviolet B (NB-UVB) phototherapy for the treatment of mycosis fungoides (MF). Elderly and disabled patients with this condition disproportionally lack access to home units due to insurance denial. A retrospective review included patients diagnosed with MF or Sezary syndrome who underwent either in-office or home UVB between 2016 and 2023. Eighty-four patients used home NB-UVB, while 75 used in-office. Clinical characteristics, treatment response, and access were evaluated. Overall, there was no significant difference in response rates between home and in-office NB-UVB phototherapy. Subgroup analysis based on adjuvant treatment revealed a significant difference in clinical response rates for patients using NB-UVB with topicals (p = 0.008) and NB-UVB with multiple systemic therapies (p = 0.04). Financial and time constraints were the most common cause of treatment discontinuation for in-office patients (28%). The effectiveness of home NB-UVB treatment is comparable, if not superior, to in-office treatment, likely attributed to treatment ease in access and compliance. Medicare and other health insurance companies should expand coverage to include home-based phototherapy for patients with MF, a potentially fatal cancer with a relative paucity of effective alternate therapies.

Efficacy and safety of narrowband ultraviolet B phototherapy for prurigo nodularis: a tertiary center experience

BackgroundPrurigo nodularis is a chronic pruritic dermatosis and narrowband-UVB (NB-UVB) phototherapy is considered an effective and safe treatment option in patients with multiple comorbidities. ObjectiveIn this study, the authors aimed to evaluate the efficacy and safety of NB-UVB phototherapy in the management of prurigo nodularis and to compare response rates according to lesions localization. MethodsThirty prurigo nodularis patients who had been treated with NB-UVB phototherapy were included in this study. The data for this study were retrieved retrospectively from patient follow-up forms in the phototherapy unit. ResultsNB-UVB phototherapy led to a complete response (CR) in 24 (80%) patients while partial response (PR) was achieved in 6 (20%) patients. Regarding prurigo nodularis localization, the CR rate was statistically higher in those with diffuse and central involvement (p < 0.05). Erythema and/or pruritus were observed in 4 (13.3%) patients with prurigo nodularis. Study limitationsThis study is limited because it is single-centered and has a retrospective design. ConclusionsNB-UVB phototherapy is an effective and safe treatment option for prurigo nodularis patients especially those with multiple comorbidities and using several medications. Patients with diffuse and central involvement may respond better to phototherapy than those with peripheral involvement.

Phototesting for a variety of skin conditions before narrowband (TL-01) Ultraviolet-B

Background: For the majority of photo responsive skin disorders, narrowband ultraviolet-B (NBUV-B) phototherapy is currently regarded as the preferred option. The initial dosage of NBUV-B phototherapy is determined as a percentage of the minimal erythema dose (MED) at the majority of dermatology centers that offer phototherapy. This will shorten the time of therapy and lower the chance of burning while optimizing the therapeutic effect. Three times a week is the usual dosage for NBUV-B phototherapy treatment, which takes 18 to 30 sessions on average to clear the condition. For these types of treatment plans, a precise evaluation of the MED is necessary before starting treatment in order to prevent NBUV-B overdoses or underdoses. Aim: The objective of this study is to investigate the MED of 311nm NBUV-B phototherapy in a group of Libyan patients. Methods: For this prospective study, 150 patients with a range of skin conditions who saw the phototherapy unit at Bir Usta Melad Hospital of Dermatology and Venereology in Tripoli, Libya over an 8-month period were enrolled. Skin conditions include vitiligo, atopic dermatitis, and psoriasis are among those being researched. Using Fitzpatrick's questionnaire, skin types were assigned to each patient. Using a MED tester instrument (Dermalight® 80), 311 nm NBUV-B was applied to the right forearm. The test findings were recorded 24 hours later. Results: Of the patients studied, 82 (54.7%) were female and 68 (45.3%) were male. Their ages ranged from 10 to 60 years, with 30% of the sample falling between the ages of 31 and 40. The patients were clinically diagnosed with the following conditions: vitiligo 65(43.3%), psoriasis 61(40.7%), eczema 8(5.3%), pruritus 6(4%), and alopecia areata and lichen planus 5(3.3%) each. According to Fitzpatrick's categorization, the skin prototypes in the included series were 15(10%) patients of skin type III, 118(78.7%) patients of skin type IV, and 17(11.3%) patients of skin type V. Among the enrolled participants, the minimum necessary dose to elicit an erythema for NBUV-B ranged between 300 mJ/cm2 and 750 mJ/cm2, with the mean dosage was 484.7 ± 82.2 mJ/cm2. Conclusions: The average MED to 311nm NBUV-B in Libyan patients was around 500 mJ/cm2, which can be utilized to determine the initial dose and treatment regimen of phototherapy for various skin conditions.

Assessing the efficacy of narrowband UVB phototherapy using digital patient questionnaires and patient‐reported outcome measures (PROMs): An observational cohort study of patients with psoriasis and eczema

Assessing the efficacy of narrowband UVB phototherapy using digital patient questionnaires and patient‐reported outcome measures (PROMs): An observational cohort study of patients with psoriasis and eczema

The Effect of Phototherapy on Systemic Inflammation Measured with Serum Vitamin D-Binding Protein and hsCRP in Patients with Inflammatory Skin Disease.

Vitamin D plays a role in inflammatory skin disease, but the exact mechanisms and the clinical significance remain unclear. According to the free hormone hypothesis, it is the free concentration of 25-hydroxy vitamin D (25(OH)D) that is biologically active. Vitamin D-binding protein (DBP) acts as the major transporter of vitamin D in the circulation, and DBP concentration defines the free 25(OH)D levels. DBP levels are elevated in various inflammatory conditions, including psoriasis. Narrowband-ultraviolet B (NB-UVB) is the most widely used phototherapy and is an established first-line treatment for psoriasis and atopic dermatitis (AD), often used before proceeding to systemic treatment. The aim of this study was to investigate the influence of NB-UVB phototherapy on DBP and high-sensitivity C-reactive protein (hsCRP) levels, as markers of systemic inflammation, in inflammatory skin disease. Thirty adults (psoriasis (n = 20) and AD (n = 10)) were treated with NB-UVB. Serum DBP, hsCRP, total and free 25(OH)D, and 1,25-dihydroxy vitamin D (1,25(OH)2D) were measured before and after NB-UVB. Disease severity was assessed with Psoriasis Area and Severity Index (PASI), SCORing Atopic Dermatitis (SCORAD), and Visual Analogue Scale (VAS). DBP decreased in psoriasis patients and varied with no clear trend in AD patients. HsCRP decreased in both groups, but this did not reach statistical significance. PASI, SCORAD, and VAS improved, and vitamin D levels increased after NB-UVB. Sub-analysis indicated a better response to NB-UVB for patients with vitamin D deficiency and insufficiency compared to vitamin D-sufficient patients. The decrease in DBP after NB-UVB in psoriasis patients suggests a potential systemic anti-inflammatory effect of phototherapy. Measurement of vitamin D levels may potentially serve as a tool to identify patients who would derive the greatest benefit from NB-UVB phototherapy.

Adjunctive treatment of atopic dermatitis with novel at-home handheld narrow-band UVB phototherapy.

While conventional in-office phototherapy has long been utilized as a successful treatment for atopic dermatitis (AD), it is associated with potential barriers including inconvenience, poor adherence, time and financial expense. In this retrospective study, we examine the efficacy, adherence, and patient-satisfaction of using adjunctive at-home, self-administered phototherapy utilizing a novel handheld narrow-band ultraviolet B (NB-UVB) device for the treatment of refractory mild to severe AD. Included AD patients were initially trained on proper use of the device. These patients treated involved areas three times per week for a period of 12weeks. Phototherapy dosing protocol was based on skin type. The cohort included 52 patients, who were aged 20-69 and represented all skin types. They were initially categorized by disease involvement as mild, moderate, and severe. Patients were also queried to self-score their disease severity and level of satisfaction. Compared to baseline, at 12weeks, 48% percent of patients indicated that at least one site was Clear/Almost Clear, 38% stated that more than 50% of body locations were Clear/Almost Clear, and 28% reported that 100% (all) treated sites were Clear/Almost Clear. After using at-home hand-held NB-UVB for the study duration, 67% (35/52) of patients experienced disease improvement. Mean overall satisfaction was extremely high at 4.43 on a 5-point scale. Skin type, age, gender, and disease severity at inception did not significantly affect patient satisfaction scores. Overall adherence rate among participants across all groups was 73%. In this small retrospective study, at-home handheld NB-UVB phototherapy was found to be an effective, well-tolerated, adjunctive treatment method for patients with refractory AD, which was associated with a high level of patient satisfaction and adherence.

Comparative study of the efficacy of azathioprine, dapsone, and NB-UVB phototherapy as steroid-sparing modalities in generalised lichen planus.

Background Generalised lichen planus (GLP) is a chronic disease with an overall prevalence of 1% requiring longer treatment. Limited studies are available on GLP and its treatment in the literature, unlike oral lichen planus. Objective To determine the best steroid-sparing treatment modality for GLP by comparing the efficacy, response, safety, side effects, and remission with azathioprine, dapsone, and narrowband UV-B (NB-UVB) along with their impact on itching severity and life quality. Methodology Open-label, prospective, comparative, interventional study on generalised lichen planus patients treated with systemic steroids along with one of three steroid-sparing modalities. Totally 90 patients were studied including 30 patients each who received azathioprine (Group A), dapsone (Group B), and narrow band UVB (NB-UVB) (Group C), respectively, for 16 weeks. Itch severity index (ISI) and Dermatology life quality Index (DLQI) were assessed at baseline and week 24. All patients received oral prednisolone until there was no more active disease. Response was assessed in terms of occurrence of new lesions, flattening of lesions, post-inflammatory hyperpigmentation (PIH), and grading of lesions two weeks once for 6 months followed by six months of follow-up after treatment completion. Results Females outnumbered males in all 3 groups. Mean patient ages (34, 38, and 34) and the presence of one or more co-morbidities (50%, 42.3%, 37.5%) in Groups A, B, and C, respectively, were comparable. ISI and DLQI improvement at 24 weeks were greatest with NB-UVB, followed by azathioprine and dapsone in that order; the differences in improvement between groups showed high statistical significance. At week 24, occurrence of new lesions (0%, 0%, 3.8%), flattening (100% - all groups), PIH (100% - all groups), grade 3 lesions i.e. poor response, resolution of 20-50% of lesions (7.1%, 11.5%, 0%), grade 2 lesions i.e. partial response, resolution of 50-90% of lesions (35.7%, 76.9%, 8.3%) and grade 1 lesions i.e. complete response, resolution of >90% lesions (57.1%, 11.5%, 91.3%) were noted in Groups A, B and C, respectively; the differences in the extent of resolution of lesions between the groups were highly significant statistically. Remission was seen in 100%, 76.9%, and 87.5% in Groups A, B, and C, respectively, after six months. Limitations The sample size was small. Only 3 treatment options were compared in this study but many more options have been used for lichen planus. Long term follow-up is required. Conclusions NB-UVB with oral steroids showed a better response in terms of improvement in DLQI, ISI, disease control, and side effects than azathioprine and dapsone. Azathioprine showed a faster response and more prolonged remission. Dapsone showed poor response with multiple side effects.

Phototherapy for the treatment of atopic dermatitis in Singaporean children and adolescents.

Phototherapy has emerged as a safe yet effective form of treatment of atopic dermatitis (AD). Few studies have been done to evaluate the efficacy of phototherapy in Asian children. The aim of this study was to review the phototherapy experience in a cohort of Asian pediatric patients with AD at a tertiary dermatologic center in Singapore. A retrospective study of patients 18 years and below with AD who had undergone phototherapy at KK Women's and Children's Hospital, Singapore, over a 4-year period was performed. Sixty-two patients were identified, between ages 4 and 16 years (mean age 11 years) at the time of commencement of phototherapy. Thirty-five (60%) patients were males and 23 (40%) were females. Most patients had moderate to severe disease, with 60.3% of the patients with an initial body surface area (BSA) involvement of 31%-60% and 13.8% of the patients with an initial BSA involvement of 61%-90%. For patients who had undergone narrowband ultraviolet B (NBUVB) and combined ultraviolet A (UVA) and NBUVB phototherapy, the mean reduction of the Eczema Area and Severity Index (EASI) scores were 11.4 and 7.9, respectively. Common side effects experienced include xerosis, pruritus, erythema, and pain. Other reasons for cessation of therapy in the NBUVB group included time commitment difficulty (9.3%), hyperactivity (2.3%), and claustrophobia (2.3%). Two patients that had photochemotherapy (psoralen + UVA) [PUVA] suffered from post-UVA burns requiring cessation of treatment. More than half of the patients (56.9%) treated with phototherapy experienced treatment success with improvement in Investigator Global Assessment and EASI scores. 86.2% of the patients had good compliance to the treatment regime, 12% had poor-compliance, and 3.4% were lost to follow-up. Phototherapy is a useful treatment adjunct for moderate to severe AD in Asian children.

Treatment of oral graft-versus-host disease with intraoral nbUVB phototherapy.

There are limited treatment options available for hematopoietic stem-cell transplant patients (HSCT) with oral graft-versus-host disease (GVHD). Intraoral phototherapy is a novel, yet promising therapeutic regimen. To assess the safety and effectiveness of intraoral narrowband UVB (nbUVB) phototherapy in the treatment of oral GVHD. This case series evaluated 10 patients with refractory oral GVHD, who were treated at Northwestern Memorial Hospital with nbUVB between July 2019 and October 2023. Primary outcomes were to evaluate the safety and efficacy of phototherapy. Efficacy was measured by objective improvement in symptom scores and subjective improvement in patient reported symptoms. Safety was determined by the withdrawal due to adverse events. Total nbUVB exposure, number of treatments, and change in systemic immunosuppressive medications were also examined. The study cohort comprised 10 patients who developed oral GVHD at a median of 9.5months after HSCT. The total median dose of nbUVB was 36J/cm2, and the median number of sessions was 55. All 10 patients demonstrated some degree of improvement in symptoms. Notably, there was a reduction in the number of patients who reported symptoms of oral pain (83%), bleeding (67%), xerostomia (50%), and oral sensitivity (78%) after initiating phototherapy. There was also a statistically significant decrease in the levels of pain, erythema, and edema (p ≤ 0.001, < 0.001, 0.01, respectively). Most patients tolerated phototherapy well, but 1 patient withdrew from treatment due to adverse effects. Seventy-five percent of patients who were on immunosuppressive medications were able to decrease or stop these medications. This case series suggests that nbUVB phototherapy is well tolerated and efficacious in patients with oral GVHD.

Patient Burden of Nonsegmental Vitiligo: A US Real-World Survey of Dermatologists and Their Patients.

Vitiligo is a chronic autoimmune disease characterized by destruction of melanocytes, leading to skin depigmentation. Vitiligo can have a high quality-of-life burden and profound impact on psychosocial well-being. The objectives of this study were to describe the self-reported patient burden among patients with nonsegmental vitiligo with≤10% affected body surface area, summarize the physician-reported psychosocial and psychological impact of vitiligo on patient lives, and describe disease characteristics and treatment history, goals, and satisfaction. Data were drawn from the Adelphi Vitiligo Disease Specific Programme™, a real-world, cross-sectional survey with retrospective data collection of physicians and patients with vitiligo, collected in the United States between October 2021 and April 2022. Separate surveys for dermatologists and patients contained questions on clinical and demographic characteristics of patients with vitiligo and burden of vitiligo. Treatment history, goals, and satisfaction were assessed together with the impact of vitiligo on quality of life. Sixty-one dermatologists provided data for 326 patients with≤10% affected body surface area (adults, n=221; adolescents, n=105); 90 of those patientsalso responded to the survey. The most common treatments were topical corticosteroids, topical calcineurin inhibitors, and narrow-band ultraviolet-B phototherapy, with the main treatment goal being repigmentation. Physician-reported treatment satisfaction was 56%; 25% of patients reported frustration with treatment options. Physicians reported impact of vitiligo on everyday life in 46% of patients. Patients reported 12.7% overall work impairment; mean scores for Hospital Anxiety and Depression Scale anxiety and depression domains were 3.5 and 2.2, respectively, and mean Vitiligo-specific Quality of Life index score was 26.9. Patients with facial involvement experienced higher burden than those without. A high patient burden was reported by dermatologists and their patients with vitiligo who had≤10% affected body surface area, including psychosocial and psychological consequences. Thesefindings highlight an unmet need in the treatment of vitiligo.

Level of long noncoding RNA taurine upregulated gene 1 after narrow band-ultraviolet B phototherapy in vitiligo

Background Vitiligo is a skin disease that is characterized by depigmenting lesions as a result of melanocytes destruction. Long noncoding Taurine upregulated gene 1 (lnc TUG-1) is one of the long noncoding RNA (lnc RNA) family members. The role of lncRNA TUG1 in melanogenesis has been investigated in recent studies. Objective To investigate the impact of narrow-band ultraviolet B (NB-UVB) on lncTUG-1 expression in vitiligo. Patients and methods The first step of this work was a case control study that included thirty vitiligo patients and thirty healthy controls. four mm skin biopsies were taken from normal skin in healthy controls and from depigmenting lesions in vitiligo patients. The second step was a prospective single-arm interventional study in which patients were subjected to 12 weeks of NB-UVB phototherapy and biopsies were taken from repigmenting areas. Biopsies were kept frozen at −80°C till by real-time polymerase chain reaction was conducted to evaluate the lnc TUG-1 expression. Results The mean lnc TUG-1 expression in skin tissue biopsies of the vitiligo patients was significantly lower compared with control skin biopsies (0.307±0.202 ng/mg vs 1.03±0.063 pg/mg, respectively, P&lt;0.001). Although the level of lnc TUG-1 was not normalized, the mean value of lnc TUG-1 significantly increased after 12 weeks treatment with NB-UVB compared with its value before phototherapy (0.0687 ng/mg vs. 0.307 ng/mg, respectively, P&lt;0.001). Conclusion The lnc TUG-1 could be a possible player in the pathogenesis of vitiligo and repigmentation of vitiligo after NB-UVB phototherapy.

Risk of Skin Cancer in Patients with Psoriasis: Single-Center Retrospective Study Comparing Anti-TNFα and Phototherapy.

Background: The risk of developing non-melanoma skin cancers (NMSCs) in patients with psoriasis is highly debated, and, to date, there is no unambiguous consensus opinion. Psoriasis is known to be related to an increased likelihood of other comorbidities such as psoriatic arthritis, obesity, metabolic syndrome, depression, and cardiovascular disease. Regarding cancer risk, previous studies have reported a greater tendency for the development of cutaneous T-lymphomas and colon, breast, kidney, and lung cancers. Furthermore, data from network meta-analyses have shown that patients with psoriasis have a higher risk of developing squamous cell carcinomas (SCCs) and/or basal cell carcinomas (BCCs). Multiple factors may contribute to the development of NMSCs in psoriatic patients, ranging from immunosuppression induced by biologic agents to previous phototherapy. However, the extent to which each factor may impact this risk has not been entirely assessed. The aim of this study was to evaluate the risk of developing NMSCs in patients with psoriasis observed for at least 5 years, by directly comparing patients only treated with phototherapy and patients treated with anti-tumor necrosis factor α (TNFα) agents, naive to other systemic treatments or phototherapy. Methods: We conducted a single-center retrospective study at Siena University Hospital, Italy, on 200 adult patients with psoriasis divided into two groups: (i) group 1, including 100 patients treated with narrow-band UVB phototherapy (nb-UVB), and (ii) group 2, including 100 patients treated with anti-TNFα. The patients included in group 2 had to be naive to cDMARDs and biologics and treated with anti-TNFα continuously for 5 years without loss of efficacy. All patients were observed for 5 years and underwent annual dermatologic examinations to assess for the occurrence of BCC or SCC. Results: A total of 34 out of 100 patients treated with phototherapy had one BCC or one SCC and 10 out of 34 developed two skin cancers. In particular, five had both types (one BCC and one SCC), and five had two BCCs. Conclusions: The results of our study highlight how the risk of developing NMSCs is greater in patients undergoing phototherapy compared to those treated with anti-TNFα. It also draws attention to the consideration that patients with scalp psoriasis might need closer follow-up as they could be more at risk of developing NMSCs.

Tolerability of Narrow-band Ultraviolet-B Phototherapy for Different Dermatological Diseases in Relation to Co-medications.

Phototherapy is an efficient therapy for a variety of skin diseases. Various drugs can cause photosensitivity and impact tolerability of phototherapy. The tolerability was investigated of narrowband ultraviolet-B 311 nm therapy in dependence on the underlying disease and long-term co-medication. A total of 534 narrowband ultraviolet-B therapy courses were examined. Compared with psoriasis, adverse events were observed more frequently in eczematous diseases and, in some cases, other indications. About two-thirds of all courses were carried out in patients taking at least one photosensitising drug, according to the summaries of product characteristics. Phototherapy was more frequently associated with adverse events when medication was taken concomitantly. When considering the tolerability of phototherapy in dependence on individual substances or drug classes, no statistically significant result was shown after adjustment.

Retrospective Cohort Study Comparing Efficacy and Safety of Pharmacological Intervention and Phototherapy in Moderate to Severe Psoriasis Patients in a Real-World Setting

Abstract Methotrexate (MTX) is one of the first-line systemic treatment options in patients with moderate-to-severe plaque psoriasis and can be combined with narrow band UVB phototherapy (Nb-UVB). However, such a combination is rarely used for optimal duration due to safety and efficacy concerns. The aim of this study was to assess efficacy and safety of methotrexate (MTX) combination with low doses of Nb-UVB versus MTX monotherapy in patients with moderate-to-severe plaque psoriasis in a real-world setting. Retrospective psoriasis patient medical chart review was performed for the period from 2013 till 2019. The combination therapy group (Group 1, n = 74) received MTX 10 mg s/c once a week for four to six weeks and 311 nm UVB phototherapy according to the skin type and protocol of administration — three times a week; undergoing 10–24 procedures in the treatment course. The monotherapy group (Group 2, n = 57) was treated, using MTX as monotherapy 2.5 mg two times a day orally for five days (4–6 treatment courses in total). The combination therapy group achieved decrease of mean PASI at the end of the 2nd week of treatment by 38% vs monotherapy group 21%. Combination of low dose subcutaneous MTX and Nb-UVB therapy provides better treatment outcomes and normalisation of immunochemical parameters than for MTX monotherapy. This combination also showed a favourable tolerability profile.

Effectiveness of Narrowband Ultraviolet Light in Chronic Kidney Disease-Associated Pruritus.

Chronic kidney disease-associated pruritus (CKDaP) is a prevalent and challenging symptom in individuals suffering from advanced chronic kidney disease (CKD). Its underlying mechanism remains inadequately understood, leading to a limited array of unsatisfactory therapeutic interventions. Despite various attempts, identifying the most effective treatment remains inconclusive. Nevertheless, there is a growing interest in employing ultraviolet phototherapy, particularly for non-responsive patients, although its efficacy is not definitively established. To investigate the potential benefits of narrowband ultraviolet B (NB-UVB) phototherapy on individuals experiencing CKDaP, we report our experience with NB-UVB light in management of CKDaP in dialysis patients. The study group consisted of patients with end-stage chronic kidney disease who underwent hemodialysis. These patients received dermatological consultations and follow-ups for itching. They were all unresponsive to the conventional treatment (emollients and antihistamines). Screening laboratory examinations, including complete blood count, liver function test, thyroid function, electrolytes, and others, were also arranged to exclude systemic etiologies. The main potential pruritogens were dosed: calcium, phosphate, and parathyroid hormone. Itch intensity was evaluated with a numericalrating scale(0-10), based on the worst level ofitchingin the past two weeks.They had sessions of NB-UVB light (311 nm, TL01) twice per week. After UVB exposure, patients were advised to use topical emollients. A questionnaire was employed to document the extent, intensity, frequency, and sleep disruption experienced to evaluate the efficiency of the treatment, using a scale from 0 to 10. Results: In a group of 38 patients, the average age of the patients was 56 years (16-80); 63.2% were female and 36.8% were male. Median duration of pruritus was 4.7 years, and that of dialysis was 8.4 years. Pruritus was intermittent and diffuse in most cases, localized to the arteriovenous fistula site in two cases, and exacerbated by heat in all cases. Itch intensity was evaluated with a numerical rating scale (0-10) based on the worst level of itching in the past two weeks and showed a moderate average score (5/10). Xerosis was found in 63%, and scratch lesions such as excoriation in 34%. NB-UVB phototherapy was used twice per week on nonconsecutive days, with protection of the genital area and also the eyes using UVB-blocking goggles. The initial dose was 0.4 J/cm2and further doses were introduced according to the erythema response until a maximum of 2 J/cm2. No sunburn, hyperpigmentation, or blistering was noted. Emollients were maintained in patients with xerosis. Average number of sessions was 13 (6-24)and reduction of itch intensity was observed starting from the sixth session. Total improvement was obtained at the end of treatment duration except for three patients who required additional sessions. One patient had recurrence one year later. Conclusion: In conclusion, phototherapy represents a significant advancement in the treatment options for CKD-associated pruritus. Its positive impact on reducing itching and improving the quality of life for many patients is undeniable. However, to fully unlock its potential, ongoing research is needed to optimize dosing, understand relapse mechanisms, and identify the patients who will benefit most from this therapy.

Multiple Bowen's disease due to long-term narrow-band ultraviolet B phototherapy: A case report and literature review.

By presenting a case study on multiple instances of Bowen's disease and the consistent use of narrow-band ultraviolet B (NB-UVB) phototherapy over a three-year period, our aim is to enhance the comprehension of domestic clinicians regarding the disease. Additionally, we seek to review existing literature, encouraging dermatologists to consider clinical secondary primary lesion diagnoses. Our approach involves analyzing a diagnosed case of multiple Bowen's disease, examining clinical manifestations, histopathology, imaging results, and treatment methods related to NB-UVB phototherapy. We aim to facilitate discussion and understanding through a comprehensive literature analysis. An elderly male with a 30-year history of psoriasis vulgaris initiated continuous NB-UVB therapy three years ago. A year later, he developed red patches and plaques with distinct borders and scaly surfaces on his face, trunk, lower extremities, and scrotum. Histopathological examination confirmed Bowen's disease. Treatment involved liquid nitrogen cryotherapy, with no recurrence observed during the one-year follow-up. This case highlights that Bowen's disease, typically solitary, can manifest as multiple instances, especially in individuals with a history of psoriasis vulgaris. While NB-UVB stands as the primary treatment for psoriasis vulgaris, caution is warranted due to the potential risk of skin tumor induction with prolonged high-dose usage. Clinicians should be vigilant in monitoring and assessing the long-term implications of such therapies.

Juvenile-Onset Non-Poikilodermatous CD8+CD56+ Mycosis Fungoides

The most frequent primary cutaneous lymphomas observed in childhood and adolescence are mycosis fungoides (MF) and CD30-positive lymphoproliferative diseases. We report a 22-year-old female who presented with a 6-year history of multiple well-demarcated large roundish-oval scaly and reddish-brownish patches and plaques on the trunk and extremities. Histopathology revealed the focal parakeratosis and prominent epidermotropism of atypical lymphocytes, which were positive for CD8, CD56, and TIA-1 and showed a loss of CD7 and CD5 expression. T-cell receptor (TCR) gene rearrangement analysis (multiplex-PCR, BIOMED-2) of the lesional skin demonstrated the rearrangement of the gamma chain (tube A: 162 nt). Based on clinicopathological findings and a complete work-up, she was diagnosed with juvenile non-poikilodermatous C8+/CD56+ MF in stage IA. Resolution of the skin lesions was achieved by 16-week narrowband UVB phototherapy and clobetasol propionate 0.05% ointment. Juvenile-onset non-poikilodermatous CD8+CD56+ MF represents a very rare MF subtype and is associated with an indolent course. In order to avoid too aggressive diagnostics and treatments, clinicians should be aware of this rare and indolent MF variant in childhood and adolescence.