NB-UVB Treatment Research Articles

Outcomes Using Narrow Band UVB Phototherapy for Acute Skin Graft Versus Host Disease (GVHD) in Pediatric Allogeneic Hematopoietic Stem Cell Transplant Recipients

Acute graft-versus-host-disease (aGVHD) is a significant complication of pediatric allo- BMT. Narrow band UVB (nbUVB) therapy allows targeted treatment without systemic immunosuppression, but data is limited for pediatric patients. We retrospectively reviewed the charts of all pediatric allo-BMT patients from July 1, 2007- July 1, 2018. Seven patients (1 female, 6 male) with a median age of 12.9 years (range 3-20) received nbUVB therapy. Diagnoses included ALL (4), MDS (2), and NHL (1). Preparative regimens were TBI-based (5) or Bu/Cy (2). Donor sources included MSD (1), MUD (1), MMUD (4), and haplo (1). Three of the patients had unrelated female donors. All patients failed topical steroids prior to nbUVB. Treatment with nbUVB was initiated at a median of 48 days (range 44-77) post-BMT, requiring a median of 26 treatments (range 4-36) over a median of 11.5 weeks (range 3 – 17). One patient underwent a second trial of nbUVB due to recurrence. Complete response was noted in 75% of the 8 total nbUVB treatment courses with a mean cumulative dose of 364.5 J•cm−2 (range 234 – 1557). Partial response and no response each occurred in one treatment course (12.5%). Only two patients had aGVHD of other organs prior to nbUVB; however, all seven received IV/PO steroids during a portion of nbUVB treatment. Five patients remain alive without cGVHD at a median of 7 years (range 0.8-10) post-BMT. One patient with a TBI-based preparative regimen developed poikilodermatous radiation dermatitis 4 years post-BMT. No other additional treatment-related skin complications to date. Two patients developed overlap syndrome and cGVHD and died. There is scant published data regarding nbUVB use in pediatric aGVHD treatment. These results suggest that nbUVB is a highly effective second-line therapy for treatment of pediatric cutaneous aGVHD, and further research should be completed to elucidate its efficacy.

Secukinumab treatment in new‐onset psoriasis: aiming to understand the potential for disease modification – rationale and design of the randomized, multicenter STEPIn study

To date, biological treatments have been assessed in subjects with a long-term history of psoriasis and previous failures to systemic and topical therapies. In rheumatoid arthritis and other immune-mediated inflammatory diseases, early intensive systemic treatment prolongs treatment-free remission. We hypothesize that, by treating patients with psoriasis early with an effective systemic therapy, we may be able to alter the clinical outcome and the natural course of the disease. The STEPIn study (NCT03020199) investigates early intervention with secukinumab versus narrow-band ultraviolet B (nb-UVB) phototherapy in subjects with new-onset psoriasis. To determine whether early intervention with either nb-UVB treatment or secukinumab in subjects with new-onset plaque psoriasis might modify the natural course of the disease. One hundred and sixty subjects aged 18-50years with new-onset (≤12months) moderate-to-severe plaque psoriasis and naïve to systemic treatment and phototherapy will be randomized to secukinumab 300mg or nb-UVB. The Main Study has two treatment arms: Arm A1, subcutaneous secukinumab 300mg at baseline, Weeks 1, 2, 3 and 4, and every 4weeks thereafter until and including Week 52; Arm B1, one/two cycles of nb-UVB for 12weeks each (maximum 28-week break between cycles). After treatment discontinuation, patients will be followed up and monitored for disease activity up to Week 208. A Mechanistic Sub-study will assess immunological changes and pathogenic tissue-resident memory T cells in skin biopsies. STEPIn is the first study to investigate whether early intensive treatment in new-onset psoriasis can modify the long-term natural course of the disease and thus become a novel treatment strategy for patients with psoriasis.

Narrowband UVB treatment is highly effective and causes a strong reduction in the use of steroid and other creams in psoriasis patients in clinical practice.

BackgroundNarrowband NB-UVB phototherapy (NB-UVB) is an effective treatment for psoriasis, as demonstrated by clinical trials. However, due to required infrastructure and need for treatment attendance opinions on the value of offering this treatment in routine practice vary. AIMS: To provide high quality large-scale and long-term data on the efficacy of NB-UVB for psoriasis under real-world conditions in order to assist in management decisions.MethodsThe following resources were employed: (1) complete and prospectively recorded prescription drug records for a population of 420,000 marked by low demographic mobility, (2) prospectively recorded clinical treatment outcomes for all NB-UVB treatment episodes occurring in the local population; (3) complete dermatology electronic treatment records of all psoriasis patients, allowing cross-validation of diagnoses and treatment records. Using these data sets, we analysed all first-ever initial NB-UVB treatment episodes occurring over 79 months (n = 1749) for both clinical outcomes and the effect of NB-UVB on the use of topical treatments for psoriasis.ResultsAround 75% of patients both achieved a status of “clear/minimal disease” and used fewer topical treatments. NB-UVB treatment led to a strong reduction for both steroid creams (25%) and psoriasis-specific topicals, e.g. vitamin-D products (30%) during the 12-month period following NB-UVB treatment. The effects measured were specific as no effect of NB-UVB was noted on drug prescriptions unrelated to psoriasis. Results were independent of individuals administering and/or scoring treatment, as they were highly similar between four geographically separate locations.ConclusionsNB-UVB treatment is highly effective and leads to a remarkable reduction in the need for topical cream treatments for a period of at least 12 months.

Expression of low-density lipoprotein-related receptors 5 and 6 (LRP5/6) in psoriasis skin.

Low-density lipoprotein-related receptors 5 and 6 (LRP5/6) are transmembrane receptors with key functions in canonical Wnt signalling. Wnt ligands are thought to play an important role in innate immunity and psoriasis, and recent studies assigned LRP5/6 anti-inflammatory properties. The objective of this study was to investigate the expression of LRP5 and LRP6 in lesional and non-lesional skin in peripheral blood and in mononuclear cells of patients with chronic plaque type psoriasis compared with control individuals. To investigate the effect of UV-B radiation, LRP5/6 skin gene expression was analysed before and after narrowband UV-B treatment. Our results showed significantly decreased gene expression of LRP5 and LRP6 in lesional skin and in peripheral blood from patients with psoriasis compared with non-lesional skin and healthy control skin. Immunohistochemistry did not reveal differences in protein expression of LRP5/6. Narrowband UV-B treatment induced a significant increase in LRP5 and LRP6 gene expression in lesional skin. Decreased gene expression of LRP5/6 in lesional skin and upregulation after nb UV-B treatment suggest a possible role for LRP5/6 in psoriasis.

656 Changes of lesional and non-lesional skin microbiome in the treatment course of atopic dermatitis

Development of high-throughput sequencing has enabled to identify drastic changes of skin microbiota communities with AD flare. However, the changes in skin microbiome in the course of treatment are not completely characterized. The aim of this study is to observe the change of skin surface microbiota of AD patients along with the treatment course. We also examined the effect of narrow band UVB phototherapy to see the influence of UV exposure. Eighteen enrolled patients were divided into two groups based on treatment methods, narrow band UVB phototherapy and topical corticosteroid (NBUVB+TCS group) and topical corticosteroid only (TCS group). Skin swab and high-throughput sequencing of 16S ribosomal RNS bacterial gene were performed when subjects visited before, after 6 weeks of treatment and 3 weeks after discontinuation of treatment. Eleven subjects completed the study. Microbial diversity of lesional skin greatly increased after treatment. Proportion of S. aureus showed a significant positive correlation with eczema severity. Even though NBUVB treated patients didn’t exhibit additive effects in eczema improvement, they experienced continuous improvement after discontinuation of treatment. In summary, a drastic increase of microbial diversity and decrease of S. aureus composition was observed with eczema treatment. NBUVB treatment

The efficacy of narrowband UVB treatment in pediatric vitiligo: a retrospective analysis of 26 cases.

Narrowband UVB (Nb UVB) treatment is commonly used for the management of psoriasis and atopic dermatitis, and is less often used for vitiligo in children. The aim of this study was to evaluate the efficacy and short-term safety of Nb UVB phototherapy in children diagnosed with vitiligo retrospectively. A total of 26 patients younger than 18 years with the diagnosis of vitiligo and managed with Nb UVB phototherapy as documented in archive records were evaluated. Clinical response was assessed according to repigmentation of the lesions: good response when there was more than 75% repigmentation, moderate response when there was 25%-74% repigmentation, poor response when repigmentation was less than 24%, and unresponsive when there was no pigmentation and new lesions occurred. A total of 26 patients received Nb UVB treatment; 14 were girls and 12 were boys. The age at onset of the disease varied between 2 and 18 years, with a mean age of onset of 10.07 ± 4.53 years. Repigmentation rate of >75% was detected in 45.4% of cases. Nb UVB phototherapy seems to be a well-tolerated effective and safe treatment option in children, especially those unresponsive to topical treatment and those with widespread lesions. However, long-term risks such as photocarcinogenesis and photoaging should kept in mind.

Effect of Narrowband Ultraviolet B Therapy on Serum Vitamin D in Saudi Patients with Vitiligo

Objective: To evaluate the effect of NB-UVB therapy on serum levels of 25-hydroxyvitamin D [25(OH)D] in Saudi patients with vitiligo. Method: We estimated the levels of 25-hydroxy vitamin D [25(OH)D] before, and after NB-UVB radiation in patients with vitiligo who did not take vitamin D supplement. A comparison was done between subsets of patients concerning gender and duration of treatment of NB-UVB. Results: There were 39 patients with vitiligo. Females were 22 (56.4%) and males were 17 (43.6%).The mean vitamin D level before NB-UVB treatment was 29.575 ± 16.315 nmol/L. while vitamin D level was increased to 78.871 + 22.776 after treatment with significant differences (P < 0.0001). The males had mean vitamin D level 36.232 ± 19.505 nmol/L, while females had mean vitamin D level 24.431 ± 11.321 nmol/L at baseline. After NB-UVB treatment the males had vitamin D level of 78.888 ± 25.683 nmol/L. While females had mean vitamin D level78.859 ± 20.884 nmol/L. After 6 months of the NB-UVB treatment the delta change in vitamin D level was 38.888 ± 20.255 nmol/L while after 12 - 24 months of treatment with NB-UVB the delta change in vitamin D level was 60.252 ± 17.565 nmol/L (P = 0.001). Conclusion: Patients who received narrow band ultra violet B radiation at wave length 309 nm as treatment of vitiligo are less likely to need vitamin D supplement to correct their vitamin D deficiency. More studies are needed in order to confirm these results and to establish UVB as treatment modalities to correct vitamin D levels in patients who cannot absorb vitamin D either orally or parentally.

Narrow band ultraviolet B for the treatment of generalized lichen planus

Objective: Although various treatment options have been used in the treatment of lichen planus (LP), it is still challenging to choose the most effective one. Scarce data are available in the literature examining efficacy of NB-UV in the treatment of LP. Thus, we aimed to evaluate efficacy of NB-UVB for LP.Methods: Twenty-four patients with generalized LP who received NB-UVB treatments in between January 2011 and December 2014 were included in the study. Response types were classified into three groups which complete response refers to ≥90% reduction in the number of the lesions; partial response 51–89%; and no response ≤50%.Results: Sixteen patients responded to the NB-UVB treatment [5 partial (20.8%) and 11 complete (45.8%) remissions], whereas 8 patients (33.3%) did not respond to the treatment. A number of sessions and accordingly cumulative dose of UVB were significantly higher in responded group than in non-responders. When we compared these two groups according to duration of the disease, there was no significant difference.Conclusions: Two-thirds of patients with generalized LP favorably responded to NB-UVB treatment without any remarkable adverse events. This significant response rate coupled with safety should prompt further clarification of the place of NB-UVB in generalized LP.

HMB-45 Study before and after Narrow-Band (311 nm) Ultraviolet B Treatment in Vitiligo

MED) at 311 nm wavelengths. The patients underwent skin sampling from lesional and perilesional area before and after 30 sessions of treatment. The skin biopsies were sent to the laboratory for light microscopy and immunohistochemical study. The evaluation of HMB-45 was based on the quantitative method, measuring the number of positive stained cells. Clinical response was defined as repigmentation in three categories: more than 75%; between 40% and 75%; and less than 40%. The data were analyzed using SPSS (version 17). Results: Twenty-nine patients completed the study. The Wilcoxon test showed a meaningful relation between HMB-45 staining before and after NB-UVB treatment in perilesional skin. We did not find a meaningful relation between HMB-45 staining before and after treatment regarding the mean age, gender, mean duration of disease, and initial lesional area (P = 0.55, P = 0.41, P = 0.55, and P = 0.87, respectively). After 30 sessions of NB-UVB therapy, repigmentation was less than 40% in 8 (27.6%), 40 - 75% in 7 (24.1%), and more than 75% in 6 patients. Conclusions: The HMB-45 stain strength significantly changed after treatment in perilesional skin.

Effect of Narrow-Band Ultraviolet B Phototherapy and Methotrexate on MicroRNA (146a) Levels in Blood of Psoriatic Patients.

Background. Recently, some miRNAs have been proven to show aberrant expression in psoriasis and play a role in the pathogenesis of the disease. Objective. To find out whether NB-UVB or methotrexate treatment affects whole blood levels of human miRNA (146a) in patients with psoriasis and demonstrate its correlation with disease severity. Methods. Blood samples were obtained from healthy control and from psoriatic patients before and 12 weeks after treatment with NB-UVB, methotrexate. Quantification of human miRNA (146a) by Real Time PCR (RT-PCR). Results. Blood human miRNA (146a) levels were higher in patients with psoriasis than those in healthy controls (P = 0.001); it had no significant positive relation with PASI scores in patients (r = 0.2, P = 0.107). Real Time PCR showed that, after 12 weeks of treatment with NB-UVB phototherapy or treatment with methotrexate, there was significantly decreased level of miR146a (P = 0.001; P = 0.002, resp.). Conclusion. The expression of miRNA146a is increased in whole blood samples from psoriasis patients, so we can evaluate its possibility to work as a future therapeutic objective in the treatment of psoriasis. With these markers, it is able to screen therapeutics effect or changes to a further aggressive treatment for psoriasis.

Combined therapy of psoralen plus ultraviolet A followed by narrow band ultraviolet B photochemotherapy for early stage mycosis fungoides

Only a few clinical reports in the treatment of early mycosis fungoides (MF)(IA, IB, IIA stage) are available in the literature. The purpose of this study was to compare the efficacy and safety of narrow-band UVB and psoralen plus ultraviolet A (PUVA) photochemoterapy in 24 patients with early-stage MF, and explore a new approach for the treatment of early mycosis fungoides. A total of 24 identified early mycosis fungoides patients received PUVA, NB-UVB and a combined therapy of PUVA followed by NB-UVB (n = 9/6/9) irradiation. A retrospective study was carried out to analyze the sex, age of onset, TNM stage, treatment, and duration of treatment, and times of treatment, duration of maintenance treatment, effective and recurrence in these patients. The data were analyzed using SPSS 17.0 and a two-sided test at the α = 0.05 level of significance was conducted. Of the 24 patients studied, the average treatment was 104.5 (95% CI, 75.71-133.29) times. The average duration of treatment was 12.88 (95% CI, 9.90-15.85) months. The average maintenance treatment time was 11.08 (95% CI, 2.13-20.04) months. The effective rate (CR+PR) of PUVA treatment was 88.9%, recurrence rate was 11.1% (n = 9). In the NB-UVB treatment group, the effective rate was 100.0%, and the recurrence rate was 33.3% (n = 6). In the PUVA followed by NB-UVB (combination therapy) treatment group, the effective rate was 77.8% and the recurrence rate was 55.6% (n = 9). There were no significant differences among the three groups in terms of number of treatments, treatment duration, maintenance treatment duration, effective rate and recurrence rate (P > 0.05). PUVA and NB-UVB are effective and safe in the targeted therapy of early stage mycosis fungoides. The combined therapy of PUVA followed by NB-UVB can reduce the total PUVA dose and risk of developing skin cancer.

A prospective, bilateral comparator, placebo-controlled trial evaluating the efficacy of localized NBUVB treatment for plaque-type psoriasis

A prospective, bilateral comparator, placebo-controlled trial evaluating the efficacy of localized NBUVB treatment for plaque-type psoriasis

Psoralen–narrowband UVB phototherapy for the treatment of vitiligo in comparison to narrowband UVB alone

The potential of psoralen-narrowband ultraviolet B (NBUVB) photochemotherapy has been investigated in vitiligo. The present study aims to evaluate the efficacy of psoralen-NBUVB (P-NBUVB) vs. NBUVB in vitiligo. In a randomized study, 45 Indian patients (age above 13 years) with vitiligo involving more than 5% body surface area were randomly allocated to receive either NBUVB or P-NBUVB treatment. Both groups received NBUVB exposure thrice weekly, with a total of 60 sessions. The extent of repigmentation achieved was calculated on the basis of Vitiligo Area Severity Index (VASI) scoring. Forty patients were available for analysis at the end of the study. The extent of repigmentation in the P-NBUVB group was statistically significantly greater in face and neck (P = 0.006, t-test) and hands (P = 0.007, t-test) in comparison with the NBUVB group (t-test). Percentage reduction in VASI scores was statistically significantly greater in the P-NBUVB group (29.2% vs. 21.7%, P = 0.043, t-test). The response to P-NBUVB therapy started earlier than the response to NBUVB. After excluding sunlight as a confounding factor, treatment response was also significantly better in the P-NBUVB group (P = 0.005). Addition of psoralen increased the extent of repigmentation due to NBUVB therapy in vitiligo. Further studies are required to determine the long-term efficacy and safety of P-NBUVB.

Effect of narrowband ultraviolet B phototherapy on melanocytic naevi

Melanocytic naevi have been observed to undergo morphological changes following exposure to narrowband ultraviolet (NB-UV)B radiation. To analyse changes in naevi exposed to NB-UVB in a large cohort of patients. Subjects referred for phototherapy had macroscopic and dermoscopic images taken of prominent melanocytic naevi at the following time points: immediately prior to NB-UVB treatment, after 10 exposures, after 30 exposures or at the end of treatment if earlier, and 3 months after discontinuing treatment. Four dermatologists, by consensus, examined each naevus for specific clinical and dermoscopic features at each time point. The size (area) of each naevus was determined by plenimetry. Complete sets of images were taken for 36 out of 51 patients. The most common global dermoscopic patterns in the 440 naevi examined were reticular (50%) and globular (32%). Following NB-UVB exposure, blurring or merging of lines was observed in 45% of reticular naevi. An increase in colour intensity and in the number of dots or globules was observed in 63% of globular naevi, and 167 naevi (40%) underwent a change in size. Of these, 91/167 (54%) decreased in size, with a median area reduction of 8% (0·9-42%); while 76/167 (46%) increased in size, with a median area increase of 9% (1-76%). Around half of naevi exposed to a course of NB-UVB treatment undergo size or morphological changes. Naevi that enlarged tended to revert to pretreatment size 3 months after discontinuation of phototherapy.

Catechol-O-methyltransferase activity is higher in psoriasis patients and is down-regulated by narrowband ultraviolet B treatment

Narrowband ultraviolet B (nbUVB) phototherapy is widely used in psoriasis treatment. UVB irradiation decreases catechol-O-methyltransferase (COMT) activity in human keratinocytes and melanoma cells. COMT activity is higher in psoriatic lesions than in normal skin but the effect of nbUVB on COMT activity in psoriasis patients is unknown. To evaluate COMT activity in patients with psoriasis and determine whether nbUVB modifies this activity. An open observational study was conducted with 20 psoriasis patients and 15 healthy volunteers. Patients were treated with nbUVB thrice weekly during six weeks and evaluated at baseline, three and six weeks after phototherapy and four weeks after stopping. In each evaluation body mass index (BMI), Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) were calculated and blood samples for erythrocytes soluble (S-) COMT activity assessment were taken. Before phototherapy (baseline), using a single concentration of substrate adreneline (1,000 μM), S-COMT activity levels (pmol/mg protein/h) were significantly higher in psoriasis patients than in controls. After nbUVB treatment, S-COMT activity significantly decreased. This decrease correlated positively with baseline activity. Four weeks after stopping phototherapy, S-COMT activity returned to baseline levels. After phototherapy, PASI score improved significantly but no correlation to baseline S-COMT values or decrease in S-COMT activity was found. This study shows that baseline S-COMT activity is higher in psoriasis patients than in controls and that this activity is significantly decreased by nbUVB treatment for psoriasis. This decrease is more evident in patients with higher baseline S-COMT activity.

No Evidence for Increased Skin Cancer Risk in Koreans with Skin Phototypes III-V Treated with Narrowband UVB Phototherapy.

Narrowband ultraviolet B (nbUVB) phototherapy is used around the world for the treatment of various skin diseases. However, the carcinogenic risk associated with nbUVB treatment in patients with skin phototypes III-V has not been studied. This retrospective study compared the incidence of skin cancer in Korean patients with skin phototypes III-V treated with nbUVB with that in a control Korean population. A total of 445 nbUVB-treated patients were followed for 1,274 person-years (mean follow-up period 34.4 months). No melanoma cases were detected during the follow-up period. How-ever, one patient developed basal cell carcinoma four months after the start of nbUVB phototherapy. For non-melanoma skin cancer, the expected number of cases was 0.059 and the standardized incidence ratio 17.0 (95% confidence interval 0.4-94.8). There were no statistically significant differences between the nbUVB and control groups. Thus, nbUVB phototherapy using TL-01 lamps seems to be a safe therapeutic modality for patients with skin phototypes III-V.

Psoriasis Therapy and Cardiovascular Risk Factors

Psoriatic patients present with an increased frequency of cardiovascular events. To study the impact of psoriasis duration and therapy on traditional and new cardiovascular risk factors. A longitudinal study performed between 2005 and the first trimester of 2008. Each patient was followed up for 12 weeks, and was observed before and 3, 6, and 12 weeks after starting therapy. Patients attending the Dermatology Service, University Hospital of Coimbra, Coimbra, Portugal were enrolled. Thirty-four patients with psoriasis vulgaris and 37 healthy volunteers as controls. Psoriasis Area and Severity Index (PASI); lipid profile, oxidized low-density lipoprotein (oxLDL), oxLDL/low-density lipoprotein (LDL), total antioxidant status, lipid peroxidation, C-reactive protein (CRP), and circulating levels of adiponectin. Ten patients started therapy with topical treatment, 11 with narrow-band UVB radiation (NB-UVB), and 13 with psolaren plus UVA (PUVA). Before starting therapy, psoriatic patients presented with several risk changes in their lipid profiles, and significantly higher CRP, oxLDL, and oxLDL/LDL, and lower adiponectin levels (vs control subjects), which may further contribute to inflammation and atherogenesis. After treatment of the patients, although no significant differences were observed in the lipid profile compared with baseline, some changes suggested that the treatment could somehow alter lipid metabolism, as the reduction in high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A and the increase in the atherogenic index cholesterol/HDL-C maintained an even higher significance (as shown by p-values) when compared with the control group. After topical therapy, there was a significant reduction in thiobarbituric acid reactivity only, suggesting that the reduction in the hyperproliferative process within the lesions is important for lipid peroxidation. After NB-UVB therapy, oxLDL/LDL, cholesterol/HDL-C, lipoprotein (a) [Lp(a)], and CRP remained higher than in the control subjects, reflecting persistent inflammation and atherogenic risk. After PUVA treatment, there was a significant reduction in Lp(a), associated with an almost significant increase in apolipoprotein-B (p = 0.054); these changes were not observed after NB-UVB treatment. However, after PUVA and NB-UVB treatment, CRP and, in the NB-UVB group, oxLDL/LDL were persistently higher than controls. Our data show that psoriatic patients present with several lipid profile changes that seem to be related to the severity of the disease and/or the treatment used. Mild psoriasis patients receiving topical treatment presented before starting therapy with a lipid profile similar to controls, whereas those undergoing NB-UVB and PUVA, who had higher PASI scores, presented with several risk factors. Moreover, PUVA therapy seems to interact in a different way with lipids that might result from an interaction of psoralen with plasma lipids, namely Lp(a). Inflammation, a hallmark of psoriasis, also seems to be related to psoriasis severity. Both NB-UVB and PUVA were effective, as shown by the reduction in PASI score, as well as in the oxidative and inflammatory stress markers. However, after NB-UVB and PUVA, a low-grade inflammatory process still persisted, which might be related to the duration of remission of the disease.

The Effect of Narrowband UV-B Treatment for Psoriasis on Vitamin D Status During Wintertime in Ireland

To determine whether narrowband UV-B (NB-UV-B) may mediate its beneficial effect on psoriasis by increasing vitamin D levels, and to assess the effect of NB-UV-B on vitamin D status in patients with psoriasis in wintertime. A prospective controlled study from October 2008 to February 2009. A dermatology outpatient department at a university teaching hospital. Thirty consecutive patients with psoriasis treated with NB-UV-B and 30 control patients with psoriasis were recruited. Control patients were recruited within 1 week of treated patients to control for seasonal variation of serum 25-hydroxyvitamin D [25(OH)D] levels. One patient with photo aggravated psoriasis was withdrawn from the study. Narrowband UV-B was administered 3 times per week. Serum 25(OH)D was measured at baseline, after 4 weeks and at completion of treatment. Levels of serum 25(OH)D increased significantly(P< .001) from a median (range) of 23 (9-46)ng/mL at baseline to 51 [rather than 59, as given in the originally published article] (32-112) ng/mL at the end of NB–UV-B treatment compared with no change in the control group [corrected]. The change in serum 25(OH)D level correlated with the number of exposures of NB-UV-B (r = 0.61; P < .001) and cumulative UV-B dose (r = 0.47; P = .01) but not with treatment response. At the end of the study, all patients in the treatment group were vitamin D sufficient, but 75% of the control group had vitamin D insufficiency [serum 25(OH)D level <20 ng/mL]. In a multiple regression model, prior phototherapy was the sole predictor of baseline serum 25(OH)D level (r(2) = 0.13; P = .006), whereas the number of exposures of NB-UV-B predicted change in serum 25(OH)D level (r(2) = 0.38; P = .001). Narrowband UV-B effectively increases serum 25(OH)D level while clearing psoriasis. Up to 75% of Irish patients with psoriasis were shown to be vitamin D insufficient during wintertime.

Narrowband UVB (311 nm, TL01) phototherapy for pityriasis lichenoides

Narrowband (NB) UVB (NB-UVB) phototherapy has recently demonstrated high levels of efficacy and tolerability in a variety of skin diseases. The purpose of the present study was to assess the efficacy of NB-UVB phototherapy in the management of pityriasis lichenoides (PL). The therapeutic response in 31 PL patients (23 pityriasis lichenoides et varioliformis acuta; PLEVA, eight pityriasis lichenoides chronica; PLC) treated with NB-UVB phototherapy between 2000 and 2007 was assessed. NB-UVB treatment led to a complete response (CR) in 15 out of 23 PLEVA patients (65.2%) with a mean cumulative dose of 23 J/cm(2) after a mean number of 43.4 exposures and a partial response (PR) in eight patients (34.8%) with a cumulative dose of 15.6 J/cm(2) after a mean number of 32.3 exposures. NB-UVB treatment led to CR in seven out of eight PLC patients (87.5%) with a mean cumulative dose of 18.4 J/cm(2) after a mean number of 45.8 exposures and PR in one patient (12.5%) with a cumulative dose of 9.1 J/cm(2) after a mean number of 19 exposures. Relapses occurred in four PL patients within a mean time period of 6 months. NB-UVB therapy is an effective, safe and practical alternative treatment modality for the management of PLEVA and PLC.

Antioxidants and narrow band-UVB in the treatment of vitiligo: a double-blind placebo controlled trial

Vitiligo is an acquired depigmenting disease with uncertain aetiopathogenesis, possibly associated with oxidative stress. Narrowband ultraviolet B phototherapy (NB-UVB) is the most widely used and effective treatment. To evaluate the clinical effectiveness of NB-UVB and the repairing of oxidative stress-induced damage, using oral supplementation with an antioxidant pool (AP). Patients (n = 35) with nonsegmental vitiligo were enrolled in a randomized, double-blind, placebo-controlled multicentre trial. The treatment group received, for 2 months before and for 6 months during the NB-UVB treatment, a balanced AP containing alpha-lipoic acid, vitamins C and E, and polyunsaturated fatty acids. The area and number of lesions, as well as some parameters of the oxidation-reduction (redox) status of the peripheral blood mononuclear cells (PBMCs) were estimated at the beginning, after 2 months, and at the end of the trial. In total, 28 patients completed the study. After 2 months of AP supplementation, the catalase activity and the production of reactive oxygen species (ROS) were 121% and 57% of the basal values (P < 0.05 and P < 0.02 vs. placebo, respectively). The AP increased the therapeutic success of NB-UVB, with 47% of the patients obtaining > 75% repigmentation vs. 18% in the placebo group (P < 0.05). An increase in catalase activity to 114% (P < 0.05 vs. placebo) and decrease in ROS level of up to 60% (P < 0.02 vs. placebo) of the basal value was observed in PBMCs. Finally, the AP intake maintained the membrane lipid ratio (saturated : unsaturated fatty acids 1.8 : 3.1; P < 0.05), counteracting phototherapy-induced saturation. Oral supplementation with AP containing alpha-lipoic acid before and during NB-UVB significantly improves the clinical effectiveness of NB-UVB, reducing vitiligo-associated oxidative stress.