PUVA Research Articles

Home Narrowband UV-B Treatment for Psoriasis

This cohort study describes and identifies patient characteristics associated with use of in-office narrowband UV-B (NBUVB) or systemic therapy following home NBUVB machine receipt.

Psoriasis and skin cancer - Is there a link?

A chronic auto-immune-mediated disease Psoriasis is associated with manycoexisting or co-occurringconditions, which include a significant risk of malignancies, especiallyskin tumours. Numerous studies were done to understand whether psoriasis itself, comorbidities related to psoriasis, or psoriasis treatment might increase the risk of neoplasms. We reviewed the relation between psoriasis and cancer risk, also the significance of inflammation in cancer The various classes of drugs used to treat psoriasis, including biologics like tumour necrosis factor (TNF) inhibitors; and how they increase cancer risk are deliberated. Literature was collated for the past five years from the data bases like PubMed, Medline, Google Scholar, etc. Literatures discussing the skin cancer linked to psoriasis were reviewed. Possible mechanisms associated between inflammation and psoriasis; skin cancer was explained in the context of the several psoriasis medications that increase the likelihood of skin cancer. The risk of cancer in other cutaneous auto-inflammatory diseases is also elucidated. It is frequently observed that increased doses of PUVA therapy, immunosuppressive medications, and lifestyle changes alter the aetiology of the tumours. This review is conceptualized to shed the light on probable mechanisms involved in these connections as well as the chance of cancer in psoriasis patients.

Светотерапия кожных заболеваний: нестареющая классика

The review paper provides brief analysis of phototherapy methods used in various dermatoses. Phototherapy can be prescribed in combination with drugs or used solo. Phototherapy methods based on using the medium-wavelength (UVB) and long-wavelength (UVA) ultraviolet radiation are most commonly used in clinical practice: PUVA therapy and narrow-band UVB (311 nm) therapy, as well as treatment with excimer light with the wavelength of 308 nm. Photodynamic therapy combining photosensitizer, oxygen and visible light also gradually takes leading positions in aesthetic medicine and dermatology.

Phototherapy: Theory and practice.

Despite the development of highly effective biologics for skin diseases such as psoriasis or atopic dermatitis, UVA and UVB therapy, alone or in combination, are still essential components of various guidelines. Phototherapy is not only a first-line treatment and highly effective for a number of skin diseases, but is also economical and has few side effects. The targeted use of UVA and UVB, if necessary, in combination with the photosensitizer psoralen in the context of PUVA therapy, enables the dermatologist to effectively treat a wide variety of skin diseases. Indications for phototherapy include epidermal diseases such as atopic dermatitis, psoriasis and vitiligo, as well as photodermatoses, mycosis fungoides, graft-versus-host disease and deep dermal diseases such as scleroderma. This article reviews the physical principles, molecular mechanisms, current treatment regimens, and individual indications for phototherapy and photochemotherapy.

Porphyria: A metabolic disorder

Porphyrias are heterogenous group of metabolic disorders arising from defects in the heme biosynthetic pathway, each being characterized by a specific partial enzyme deficiency. Also, a flawed gene that control the action of enzyme in the heme synthesis creates a lack of heme and build up of porphyrin. Porphyria can be triggered by environmental factors such as; infections, cigarette smoking, antibiotics, etc. Porphyria can be classified into acute porphyria that causes neurological symptoms, and cutaneous porphyria that cause photosensitivity, affecting the skin. In cutaneous porphyria, the two distinct pattern of skin disease seen are the immediate photosensitivity and vesiculo-erosive skin disease. Symptoms include; abdominal pain, muscle weakness, hallucination, pain in the back or chest, burning pain on the skin, red or brown urine. Long term complication include paralysis, skin scarring, permanent hair loss, gall stones, breathing difficulties, dehydration. It can be diagnosed using blood, urine and stool samples, urine estimation of porphobilinogen is also done. Treatment of porphyria include; administration of heme arginate, regular blood removal, low doses of antimalarial drug, narrow band UVB therapy, avoidance of triggers. It can be prevented by avoiding factors that precipitate it such as; stress, fasting, infection, alcohol.

006 Comparison of alitretinoin vs. psoralen plus ultraviolet A as first-line treatments for chronic severe hand eczema: results from the ALPHA trial

Abstract Severe chronic hand eczema resistant to topical corticosteroid treatment is an important cause of morbidity and occupational disability. There is uncertainty regarding the best treatment approach and currently no treatment pathway is generally accepted by UK dermatologists. The primary aim of the ALPHA trial was to compare alitretinoin and immersion psoralen plus ultraviolet A (PUVA) as a first-line therapy in terms of disease activity at 12 weeks after the planned start of treatment. We conducted a prospective, multicentre, open-label, two-arm parallel group, adaptive randomized controlled trial. The natural logarithm of the Hand Eczema Severity Index (HECSI) + 1 at 12 weeks after the planned start of treatment was chosen as the primary endpoint so the relative effect of treatment could be estimated. In total, 514 participants were required to detect a fold change of 1.3 (5% two-sided significance level, 80% power, 20% attrition). Participants were randomized 1 : 1 by minimization to alitretinoin or immersion PUVA for 12–24 weeks. The intention-to-treat population consisted of 441 participants: 220 (49.9%) allocated to alitretinoin and 221 (50.1%) to immersion PUVA. In total, 212 (96.4%) alitretinoin participants and 196 (88.7%) immersion PUVA participants received at least one dose. There was a statistically significant benefit of alitretinoin compared with immersion PUVA at 12 weeks, with an estimated fold change of 0.66 [95% confidence interval (CI) 0.52–0.82; P < 0.001]. There was no evidence of a difference at 24 or 52 weeks. Of those allocated to alitretinoin and immersion PUVA, 59% and 61%, respectively, were observed to achieve a clear/almost clear assessment during the trial period. Alitretinoin was more cost-effective than immersion PUVA. Limitations include differences in treatment compliance and differential missing data levels. In total, 145 (65.9%) alitretinoin participants and 53 (24.0%) immersion PUVA participants were observed to comply (≥ 80% received and no treatment breaks of > 7 days during first 12 weeks). Thus, twice-weekly attendance for PUVA was not received by most participants. However, this represents standard of care with ALPHA run as a pragmatic trial using standard-of-care settings for the interventions. A further limitation was that assessment of long-term effects of randomized treatments was complicated by permitted use of second-line treatments after the treatment phase; therefore, trial conclusions are for randomized treatments as first-line therapies. We conclude that, as a first-line therapy, patients on alitretinoin showed more rapid improvement and superiority than those treated with immersion PUVA at week 12, but this difference was not observed at later time points. Future studies will need to further address the long-term benefits of treatments given and complex treatment pathways.

A comparative study of narrowband-ultraviolet B plus intralesional normal saline versus narrowband-ultraviolet B with platelet rich plasma in treatment of vitiligo

Background: Treatment of vitiligo remains a challenge and there is no universal consensus about optimal treatment. Platelet rich plasma contains several growth factors and is being used as an effective treatment of several dermatological disorders. Now it is clear that along with melanocytes, keratinocytes and fibroblasts are also involved in pathogenesis of vitiligo. The aim of this study was to compare the effect of narrowband-ultraviolet B (NB-UVB) with platelet rich plasma versus NB-UVB and intralesional normal saline in treatment of vitiligo. Methods: A prospective observational study was done between March 2016 to August 2017 on patients of vitiligo attending BRD Medical College, Gorakhpur. A total of 80 patients were enrolled with symmetrical lesions. For each patient one side was treated with NB-UVB along with intralesional platelet-rich plasma (PRP) and other side with NB- UVB plus intralesional normal saline was given. Intralesional PRP and intralesional normal saline was given on an interval of every 2 weeks for 4 months and patients were receiving NB-UVB therapy thrice weekly on alternate day. Results: We found that combination of PRP with NB UVB had statistically significant improvement as compared to NB UVB alone with pigmentation detected in 60% patient in combined site versus 20% in NB UVB plus intralesional normal saline. Conclusions: Intradermal PRP injections along with NB-UVB are efficacious, safe, cheap and easy technique in treatment of vitiligo it is more efficacious when compared to NB-UVB therapy. It also shortens the duration of NB-UVB therapy.

Dupilumab-associated mycosis fungoides: a cross-sectional study.

Treating atopic dermatitis (AD) with dupilumab, a monoclonal antibody that inhibits interleukin-4 (IL-4) and interleukin-13 (IL-13), may be associated with the progression of mycosis fungoides (MF).This study aimsto examine the associations between the length of dupilumab treatment, age and sex, and the onset of MF.An institutional data registry and literature search were used for a retrospective cross-sectional study. Only patients with a diagnosis of MF on dupilumab for the treatment of AD and eczematous dermatitis were included.The primary outcome was the length of dupilumab exposure, age, sex, and the onset of MF. Linear correlations (Pearson) and Cox regression analysis were used to assess the correlation and the risk.A total of 25 patients were included in this study. Five eligible patients were identified at our institution. In addition, a PubMed review identified an additional 20 patients. At the time of MF diagnosis, the median age was 58, with 42% female. Disease history was significant for adult-onset AD in most patients (n = 17, 65.4%) or recent flare of AD previously in remission (n = 3, 11.5%). All patients were diagnosed with MF, and one patient progressed to Sézary syndrome while on dupilumab, with an average duration of 13.5months of therapy prior to diagnosis. Tumor stage at diagnosis of MF was described in 19 of the cases and ranged from an early-stage disease (IA) to advanced disease (IV). Treatment strategies included narrow-band UVB therapy, topical corticosteroids, brentuximab, pralatrexate, and acitretin. Male gender, advanced-stage disease, and older age correlated significantly with the hazard of MF onset and a shorter time to onset during dupilumab treatment.Our results suggest a correlation between the duration of dupilumab treatment and the diagnosis of MF, the higher MF stage at diagnosis, and the shorter the duration of using dupilumab to MF onset. Furthermore, elderly male patients appeared to be more at risk as both male gender and older age correlated with a hazard of MF diagnosis. The results raise the question as to whether the patients had MF misdiagnosed as AD that was unmasked by dupilumab or if MF truly is an adverse effect of treatment with dupilumab. Close monitoring of these patients and further investigation of the relationship between dupilumab and MF can shed more light on this question .

A CASE SERIES OF PATIENTS WITH CUTANEOUS T‐CELL LYMPHOMA TREATED WITH COMBINATION MOGAMULIZUMAB AND OTHER THERAPIES AFTER SINGLE AGENT MOGAMULIZUMAB

Introduction: Mogamulizumab (moga) is an anti-CCR4, monoclonal antibody approved as monotherapy for the treatment of relapsed/refractory mycosis fungoides (MF) and Sezary syndrome (SS). Combination therapies are frequently utilized in cutaneous T-cell lymphoma (CTCL), in part due to the variation in response across blood, nodal, and skin compartments. Little is known about moga in combination with other therapies. Methods: We conducted a single institution retrospective analysis of MF/SS patients who were treated with moga in combination with other systemic therapies, including peginterferon alpha-2a (IFNα), bexarotene, extracorporeal photopheresis (ECP), and oral methotrexate between March 2019 and March 2023. Baseline characteristics and clinical outcomes were recorded and summarized. Responses were assessed by Olsen staging criteria (Olsen et al., 2022). Results: We identified 9 patients treated with moga combination therapy at our institution (Table 1). Six of 7 patients transitioned from mono to combination therapy due to progressive disease or stable disease with uncontrolled symptom burden. Median time to next treatment was 157.5 days (range 42-330) for moga monotherapy. The best response observed in the 8 patients to single agent moga was classified as: 4 (50%) partial responses (PR), 3 (37.5%) stable disease (SD), and 1 (12.5%) progressive disease (PD). We identified a total of 7 different treatment combinations in our 9 patients (6 systemic therapies and 2 skin-directed), which included IFNα (n = 4), bexarotene (2), ECP (2), total skin electron beam radiation (TSEB) (2), narrow band ultraviolet-B therapy (NBUVB) (1), IFNα + ECP (2), and oral methotrexate (1). Multiple patients received more than one combination treatment. Among the combination therapies, the median time to next treatment was 137 days (range 24-224 days) with 2 out of 6 patients having ongoing responses to moga + IFNα +/- ECP. The patient with PR on moga + IFNα received 7 prior therapies. His skin involvement improved from T4 to T1 but significant disease in the blood persisted (B2). He continues moga + IFNα now 846 days later. Conclusions: Mogamulizumab has improved outcomes for MF/SS patients, but global complete responses are rare with the best responses seen in blood. In our series, the addition of IFNα provided clinical benefits to patients with SD or PD on single agent moga. One patient achieved a lengthy partial response despite persistent disease seen in peripheral blood samples. We speculate the combination of moga + IFNα may augment antibody-dependent cellular cytotoxicity thereby improving efficacy of moga. Additionally, combinatorial approaches may improve responses in skin, nodes, and viscera where lower responses are observed to single agent moga. Further investigations of moga combinations are needed. Keywords: Combination Therapies, Cutaneous non-Hodgkin lymphoma No conflicts of interests pertinent to the abstract.

Vitamin D Receptor Expression in Chronic Plaque Psoriasis Before and After Narrowband Ultraviolet B Phototherapy.

Psoriasis is a multifactorial disease. It is a combination of genetic, immunological, and environmental factors. Vitamin D receptor (VDR) is a nuclear receptor that regulates epidermal cell growth through the inhibition of proliferation and induction of keratinocytes terminal differentiation. Aim of the study was to investigate the effect of Narrow-band UVB (NB-UVB) therapy on VDR expression in the skin of psoriasis patients. Forty patients with different severities of psoriasis were assessed using the psoriasis area and severity index (PASI) score. Lesional and non-lesional skin biopsies were obtained from each patient before NB-UVB therapy, and then a third lesional biopsy was performed after completing 24 sessions of NB-UVB. Immunohistochemistry for VDR was performed on all specimens. There was a significant decrease in VDR expression in psoriatic lesions compared to that in non-lesional skin before treatment. A statistically negative correlation was detected between the degree of VDR expression before treatment and PASI score, family history, and duration of psoriasis. There was a significant increase in VDR expression at the sites of psoriasis lesions post-NB-UVB therapy compared to pretreatment lesional skin. VDR expression was down-regulated in psoriatic lesions compared to non-lesional skin, and NB-UVB therapy improved VDR expression in psoriasis skin lesions.

Vitiligo: Prevalence, Clinical Patterns, and Efficacy of Narrow Band Ultraviolet B Phototherapy

Background: Vitiligo denotes an acquired primary, usually progressive, melanocytopenia of unknown etiology, and clinically manifested by circumscribed achromic macules often associated with leukotrichia. Objective: The objective was to assess the prevalence and various clinical patterns of vitiligo and to study the efficacy of narrow-band ultraviolet B (NB-UVB) radiation. Materials and Methods: A prospective case series study was carried out at dermatology outpatient department (OPD), of tertiary care center in Central India on 50 patients of Vitiligo, who were diagnosed clinically, age ranging from 5 to 70 years of age. A thorough history and clinical examination as per institutional protocol was done for all the patients included in the study. Patients were exposed to NB-UVB rays in a phototherapy unit (Dermaindia Spiegel Series) with a standard protocol. Two scores designed for the assessment of vitiligo are Vitiligo Area Severity Index and Wallace Rule of Nines. Results: During the period of two years, 6638 patients were seen in dermatology OPD, out of which 129 patients were having vitiligo clinically. Thus, the prevalence of vitiligo was 1.9% in our study. The mean age in male was 40.4 years and that of female was 30.85 years. The female-to-male ratio was 2:3. 6% had a positive family history of vitiligo. The most common site affected was leg (pretibial region) (48%). Two patients (4%) were in Category– 0, 12 patients (24%) were in Category– I, 24 patients (48%) were in Category-II, and 12 patients (24%) were in Category– III, when graded according to their improvement. Forty-five patients (90%) had vitiligo vulgaris, two patients (4%) had segmental vitiligo, and one patient (2%) each of acrofacial vitiligo, lip-tip vitiligo, and focal vitiligo. On comparing the level of significance before treatment and after 2 months of treatment, after 4 and 6 months of treatment, and before treatment and at the end of treatment, it was found that the results were statistically highly significant. Thus, indicating that the improvement in the disease after NB-UVB therapy is statically significant. Conclusion: Our study found 1.9% prevalence of vitiligo among patients attending OPD. On comparing the level of significance, before treatment and at the end of treatment, it was found that the results were statistically highly significant with respect to improvement. Side effects were minimal in our participants. Thus, our study concludes that NB-UVB radiation is an effective and safe therapy for vitiligo.

Nb-UVB and PUVA therapy in treating early stages of Mycosis Fungoides: A single-center cross-sectional study.

Mycosis fungoides (MF) and Sezary Syndrome are the most common forms of cutaneous T-cell lymphoma. Early-stage MF is known to have an indolent behavior, and the EORTC guidelines recommend treating patients with skin-directed therapies, such as phototherapy, instead of systemic therapies. Phototherapy is a popular therapeutic option, with two commonly used light sources-PUVA and narrow band-nb UVB. PUVA is less commonly used due to its potential carcinogenic role, but it has systemic effects, while nb-UVB has mostly skin-limited effects. There is ongoing debate regarding the role of UVB light, and in 2021, the Cutaneous Lymphoma Italian Study Group reached a consensus on technical schedules for NB-UVB and PUVA for MF. This study aims to analyze and compare the efficacy of the two phototherapy options in treating early-MF patients. The study included patients diagnosed with stage IA/B MF in the last 10 years, who had at least 12 months of follow-up data and a minimum of 24 phototherapy sessions (PUVA or nb UVB) and treated with topical steroids apart from phototherapy. Results showed that the two phototherapy options were similarly effective in treating early MF, with no significant differences in clinical response, although PUVA was associated with more adverse effects. The study provides valuable insights into the use of phototherapy in early MF, and the results can be used to guide treatment decisions and improve patient outcomes.

Generalized purpuric lichen nitidus treated successfully with narrowband UVB therapy

AbstractA 66‐year‐old Finnish man suffered from asymptomatic, purpuric skin lesions extending from his ankles and dorsal feet to the trunk and forearms. Based on a skin punch biopsy and the clinical picture, the diagnosis of generalized purpuric lichen nitidus, which is an exceedingly rare form of lichen nitidus, was made. The condition responded well to narrowband UVB phototherapy.

Altered levels of lymphocyte enhancer-binding factor-1 modulates the pigmentation in acral and non-acral lesions of non-segmental vitiligo patients: a follow-up-based study in North India.

Lymphocyte enhancer-binding factor-1 (LEF1) is responsible for melanocyte proliferation, migration and differentiation and its downregulation may result in depigmentation in vitiligo. Narrowband UVB (NB-UVB) phototherapy is known to enhance melanocyte migration from hair follicles to lesional epidermis; hence, it may have a role in the upregulation of LEF1. We intended to assess the expression of LEF1 both before and after NB-UVB therapy and correlate it with the extent of re-pigmentation. In this prospective cohort study, 30 patients of unstable non-segmental vitiligo were administered NB-UVB phototherapy for 24weeks. Skin biopsies were obtained from acral and non-acral sites in all patients, both prior to initiation and after completion of phototherapy and LEF1 expression was measured. Amongst the 16 patients who completed the study, at 24weeks, all patients achieved > 50% re-pigmentation. However, > 75% re-pigmentation was achieved in only 11.1% of acral patches, whereas it was achieved in a significantly higher number of non-acral patches (66.6%) (p = 0.05). A significant increase was observed in the mean fluorescent intensity of the LEF1 gene in both acral as well as non-acral areas at 24weeks as compared to baseline (p = 0.0078), However, no difference was observed between acral and non-acral lesions in the LEF1 expression at 24weeks or the change in LEF1 expression from baseline. LEF1 expression modulates the re-pigmentation of vitiligo lesions after treatment with NBUVB phototherapy.

ВИТИЛИГО: СОВРЕМЕННЫЕ ПРЕДСТАВЛЕНИЯ ОБ ЭТИОЛОГИИ, ПАТОГЕНЕЗЕ И ПОДХОДЫ К ЛЕЧЕНИЮ ЗАБОЛЕВАНИЯ

The scientific review presents modern views on the etiology, pathogenesis, approaches to the treatment of vitiligo as a multifactorial skin disease associated with depigmentation of its individual areas. The current opinions of specialists on the genetic, autoimmune, oxidative, neuroendocrine and melanocytorrhagic causes of the disease are given. The medical technologies used (PUVA therapy, UV therapy, laser therapy, etc.) and pharmacotherapeutic approaches to the treatment of vitiligo are considered and justified, taking into account their effectiveness and side effects. Highlighting and describing the characteristic features of the pharmacotherapy of vitiligo. it should be recognized as justified and expedient a multimodal therapeutic effect simultaneously on several links of the pathological process of the disease, which can be achieved by the development of a combined drug, for example, on the basis of an immunomodulator, antiphlogistics, an antioxidant and a source of melanin, suitable in terms of efficiency and safety. The detailed analysis of modern pharmacotherapy of vitiligo presented in the article showed that it seems expedient and relevant to develop a target drug with a multifunctional action that effectively affects several pathogenetic links of the disease simultaneously and involves the combination of pharmacologically active components, including melanin or its precursor. This article reveals both the multifactorial features of the occurrence of vitiligo and the methods of treating this disease, thus it may be of interest to specialists in various fields of medicine and pharmacy.

Phototherapy combined with systemic agents for mycosis fungoides

The choice of tactics for managing a patient with mycosis fungoides is determined by the stage of the disease. In the early stages of mycosis fungoides, a treatment approach using external therapy and various ultraviolet irradiation spectra (UVB-311 nm and PUVA therapy) is preferable. With insufficient efficiency and / or short remissions in some patients, it is possible to use combined methods in the early stages: PUVA therapy or UVB-311 nm therapy. in combination with systemic therapy, including interferon (IFN) 2b preparations, methotrexate and retinoids. The results of original studies demonstrate an increase in the overall response rate when combining PUVA therapy with IFN- or retinoids in patients with stages IB-IIB. The effectiveness of combined treatment regimens using UVB-311 nm remains insufficiently studied.

Особенности синтеза витамина D при PUVA-терапии у пациентов с псориазом

The possibility of combining the inhibition of keratinocyte proliferation during PUVA therapy with the immunomodulatory effect of vitamin D. Objective. To evaluate the possibility of vitamin D synthesis during PUVA therapy and the clinical efficacy of treatment (CET) of the combined use of PUVA therapy and vitamin D in patients with psoriasis. Patients and methods. The study included 25 male and female patients with psoriasis of any severity, aged 18 years and older, undergoing PUVA therapy. The patients were divided into two groups: group 1 (n = 15) did not take vitamin D; group 2 (n = 10) took cholecalciferol 4,000 IU per day for the entire course of treatment. The course of treatment ranged from 5 to 20 sessions, the exposure was carried out three hours after taking the photosensitizer, the procedures were performed every other day. Before the beginning and at the end of treatment, the severity of psoriasis was assessed by the PASI index, CET was evaluated, and the level of vitamin D in the blood was determined by chemiluminescent immunoassay (ECLIA) according to the level of its metabolite calcidiol (25(OH)D). Statistical data processing was performed using the IBM SPSS Statistics 23.0 software (USA). Results. Before treatment: in group 1, vitamin D ranged from 8.0 to 24.0 ng/mL, mean value – 15.933 ± 4.0622 ng/mL, PASI ranged from 4.6 to 26.8, mean value – 12.23 ± 7.85; in group 2, vitamin D ranged from 10.0 to 30.0 ng/mL, mean value – 18.000 ± 4.400 ng/mL, PASI ranged from 4.60 to 16.01, mean value – 7.840 ± 3.691. In all patients, calcidiol began to increase after the 5th PUVA therapy procedure. After treatment: in group 1, vitamin D ranged from 16 to 30 ng/mL, mean value – 22.267 ± 4.284 ng/mL (p < 0.01), PASI ranged from 2.100 to 5.600, mean value – 2.801 ± 1.252 (p < 0.01), CET ranged from 62.056 to 92.120%, mean value – 78.132 ± 10.843% (p < 0.01); in group 2, vitamin D ranged from 25 to 58 ng/mL, mean value – 36.800 ± 9.360 ng/mL (p < 0.01), PASI ranged from 0.0 to 4.600, mean value – 2.231 ± 1.452 (p < 0.01), CET ranged from 79.432 to 99.764%, mean value – 87.724 ± 9.684% (p < 0.01). Discussion. Photochemical reactions during PUVA therapy result in double bond interactions in biomolecules and a hydroxylation process, which may be a method of synthesis of cholecalciferol and calcidiol. Conclusion. The increase in calcidiol during PUVA therapy allows using this method both for the regulation of keratinocyte proliferation and for the synthesis of vitamin D to enhance immunomodulation. Key words: vitamin D, calcidiol, calcitriol, previtamin D, psoralenes, psoriasis, PUVA therapy

Ultraviolet A Combined with Narrow‐Band Ultraviolet B is an Effective Treatment Modality for Early Folliculotropic Mycosis Fungoides and Early Mycosis Fungoides Refractory to Narrow‐Band Ultraviolet B: A Retrospective Cohort Study

Background. Psoralen plus ultraviolet A (PUVA) is the preferred phototherapeutic modality for early‐stage folliculotropic mycosis fungoides (FMF), and for early‐stage non‐FMF refractory to narrow‐band ultraviolet B (NBUVB). However, PUVA has a problematic safety profile. Literature on the treatment with the combination of UVA and NBUVB for MF is sparse. Objective. To evaluate the effectiveness of UVA combined with NBUVB for early‐stage MF, specifically for FMF and NBUVB‐refractory non‐FMF, in adult and pediatric patients. Methods. A retrospective analysis was conducted for patients treated with UVA combined with NBUVB at our center, during 1/2008–8/2022. Results. The cohort included 51 patients: 35 adults and 16 pediatric patients. The overall response rate (ORR) of 39 patients with early‐FMF (25 adults and 14 children) was 95%, and the complete response (CR) was 62%. No significant differences in ORR/CR rates were noted between adult and pediatric patients. Of 12 patients with non‐FMF (10 adults and 2 children), the ORR was 83% and the CR was 50%. In 17 patients (8 FMF and 9 non‐FMF), prior NBUVB therapy resulted in partial response/stable disease; yet, UVA + NBUVB led to CR in 9 patients (4 FMF and 5 non‐FMF). Side effects were minimal. Conclusion. Combined UVA and NBUVB is a good alternative to PUVA for adult or pediatric patients with early‐stage MF , with FMF or non‐FMF refractory to NBUVB.

Ayurvedic management of vitiligo

Vitiligo is a kind of skin disease characterized by white hypopigmented patches. Although this disorder is not life-threatening, but has a serious cosmetic problem that affects the individual's emotional, psychological, and social well-being. A nine-year-old female child was diagnosed with Shvitra (~vitiligo) two years back who was presented with complaints of increasing area and number of depigmented patches of skin. She has taken PUVA (~Psoralen Plus Ultraviolet A), a type of radiation treatment, and corticosteroids but found no result. Then, an Ayurvedic treatment protocol was designed based on the signs and symptoms. The protocol includes Samshodhana (~eliminative) and Prashamana (~palliative) therapies with a combination of powdered herbal drugs having Raktaprasadaka (~improves the quality of blood), Raktashodhana (~blood purification), and Tridoshahara (~balances three regulatory functional factors of the body) action along with Bakuchi taila (~Psoralea corylifolia L.) for local application. The treatment protocol was found to be effective in the restoration of skin color.

An Open-Label Non-Randomized Preliminary Noninferiority Study Comparing Home-Based Handheld Narrow-Band UVB Comb Device with Standard Hospital-Based Whole-Body Narrow-Band UVB Therapy in Localized Vitiligo.

Narrow-band ultraviolet B (NB-UVB) is the standard therapy for vitiligo. The objective of this study is to compare the safety and clinical efficacy of a handheld NB-UVB comb device with the standard whole-body NB-UVB therapy in localized stable vitiligo. Thirty-one vitiligo patients were allocated to either daily therapy with a home-based handheld comb device (group A, n = 17) or thrice-weekly hospital-based whole-body NB-UVB therapy (group B, n = 14) for 4 months, based on their preference. The primary and secondary outcomes were assessed at each follow-up, and appropriate statistical tools were used for analysis. Of the 31 patients enrolled, 26 patients (study groups A/B: 15/11) completed the study. Primary outcome: Median percentage repigmentation of the representative patch in groups A and B were 51.35% and 63.85%, respectively (P = 0.64). The median size reduction of the representative patch in both groups was statistically significant (P < 0.05). The mean difference between "per protocol analysis" and "intention to treat" showed noninferiority. Secondary outcomes: Both groups were comparable on Lund and Browder score, patient global assessment and investigator global assessment scores, adverse events, color match, and change in the quality of life. The comparison group had a significantly greater number of missed sessions (P = 0.02). The majority of patients had a "good" response in both groups. Handheld NB-UVB comb device daily with a fixed dose of fluence was found to be noninferior with better compliance to standard whole-body NB-UVB therapy.