Sessions Of Phototherapy Research Articles

Assessment of Topical PUVA in Acral Vitiligo

Abstract Acral vitiligo is a resistant subtype of vitiligo that does not respond easily to any treatment modalities. Topical psoralen plus ultraviolet A (topical PUVA) therapy is an option in case of localized dermatosis such as acral vitiligo. Ultraviolet A therapy can penetrate the dermis of the skin. This study objective was to evaluate the effect of topical PUVA in acral vitiligo. Methods Patients in this prospective randomized-controlled comparative clinical trial were divided in to two groups, first group received narrow band ultraviolet B (NB-UVB) and topical PUVA at the same time, second group were already on NB-UVB and topical PUVA were added. Patients received 36 sessions of phototherapy over a period of 16 weeks. Every patient was evaluated monthly using point counting. Results No statistically significant difference was found between both groups regarding response. Conclusion Topical PUVA is of limited use in acral vitiligo.

Probiotics' effects on gut microbiota in jaundiced neonates: a randomized controlled trial protocol.

Recent evidence suggests that blue-light phototherapy impacts gut microbiota composition in jaundiced newborns, leading to disturbances closely related to the therapy's side effects. As a result, gut microbiota may serve as a potential intervention target to mitigate these side effects. In this study, we aim to examine the effects of AB-GG (Lactobacillus rhamnosus LGG), Bb-12 (Bifidobacterium animalis Bb-12) and M-16V (Bifidobacterium breve M-16V) and their combination on the intestinal microbiota, metabolomics and phototherapy-related side effects in neonates with jaundice. A total of 100 jaundiced newborns aged two weeks or younger will be included in this randomized, single-blind (the parents knew, but the neonatologists did not know), single-center controlled trial to receive either 109 colony-forming units of AB-GG, Bb-12, M-16V, a combination of the three probiotics with blue-light phototherapy, or blue-light phototherapy alone. The experimental group will be treated with oral probiotics once daily for 30 days, while the control group will receive only blue-light phototherapy. The follow-up duration will last 30 days. The primary outcomes include changes in gut microbiota, metabolomics, and the incidence of phototherapy side effects, assessed after each phototherapy session, as well as on days 10, 20, and 30. The study protocol has been approved by the Ethics Committee of our institution. The findings of this trial will be submitted to a peer-reviewed pediatric journal. Its abstracts will be submitted to relevant national and international conferences. http://www.chictr.org.cn/index.aspx, identifer (ChiCTR2000036013).

The effect of phototherapy on Demodex density: acase-control study.

Human Demodex mites, Demodex folliculorum and Demodex brevis, are microorganisms that reside in the pilosebaceous units, usually without causing symptoms. Phototherapy has been linked to demodicosis in previous studies. We aimed to determine whether there was an increase in the frequency of demodicosis and Demodex density after 20 phototherapy sessions. A case-control study was conducted with 32 participants who received narrowband ultraviolet B or ultraviolet A-1 therapy for various dermatological indications. Standardized skin surface biopsies were performed before and after phototherapy to assess Demodex density. The presence of Demodex-related skin conditions was assessed before phototherapy. A statistical analysis was performed to compare the Demodex densities and prevalence of demodicosis between the baseline and 20th session of phototherapy. No significant change was observed in Demodex density after 20 sessions of phototherapy. The average Demodex density before treatment was 2.75 ± 4.48 (/cm2 ), and after treatment, it was 2.85 ± 4.81 (/cm2 ), indicating no significant difference (P = 0.879). The percentage of patients with demodicosis in at least one region of the face was 28.1% (9/32) before treatment, and after treatment, it was 31.3% (10/32), with no significant difference (P = 1.00). Our findings contradict previous studies that suggested an increased Demodex density and demodicosis prevalence after phototherapy. The data from previous studies are open to debate due to their selected samples, designs, and interpretations regarding the phototherapy-immunosuppression-Demodex relationship. Larger-scale longitudinal studies conducted on a homogeneous sample are warranted to better understand the relationship between phototherapy and demodicosis.

Estimation of serum and tissue level of interleukin-15 (IL-15) and IL-15 receptor alpha (IL-15Rα) in mycosis fungoides before and after phototherapy: An interventional cohort study.

Mycosis fungoides (MF) is a chronic, highly recurrent cutaneous T-cell lymphoma, whose pathogenesis has not yet been fully elucidated. Interleukin-15 was previously highlighted as a viability factor for cutaneous T-cell lymphoma with previous studies shedding light on its role in pathogenesis of MF and its plausibility as a potential therapeutic target. This study was conducted to evaluate serum and tissue expression of IL-15 and IL-15Rα in early cases of MF (IA, IB, IIA) at baseline and following phototherapy. Fourteen early MF cases were recruited. Samples were withdrawn prior to starting phototherapy treatment and following near complete clearance of the biopsied lesion or after a maximum of 36 sessions of phototherapy. Samples were assessed for change in expression of IL-15 and IL-15 Rα levels following treatment, whose levels were compared to healthy controls. Serum and tissue levels of IL-15 and IL-15Rα in early MF cases were significantly higher at baseline than their levels following phototherapy treatment and higher than healthy controls. However, they dropped significantly following treatment with no statistical difference between treated cases and controls, apart from serum IL-15Rα that remained significantly elevated than controls. Interleukin-15 and its receptor alpha appear to contribute to the pathogenesis of MF, being significantly elevated than healthy controls, which were normalized following phototherapy treatment, apart from serum IL-15Rα, which remained elevated. Controlling IL-15/IL-15Rα expression is a newly proposed mechanism of action of phototherapy in MF.

Implementation of neonatal phototherapy with the BiliCocoon Bag® device in the maternity ward and impact on mother–infant separation

BackgroundFree bilirubin jaundice is a frequent pathology in the neonatal period. The major complication is neurological toxicity, the most severe form of which is kernicterus. Overall, 5%–10% of jaundiced neonates require treatment. The first-line treatment is phototherapy, with intensive phototherapy being the gold standard. Other equipment is also available, including the BiliCocoon Bag®. It is a safe and controlled therapy that can be performed in the mother's room in the maternity ward, thereby avoiding separation and allowing for breast- or bottle-feeding during treatment. It is easy to install and does not require protective glasses, thus no scope or hospitalization. In our maternity ward, all neonates requiring intensive phototherapy are hospitalized in the neonatology ward. ObjectiveThe objective of our study was to evaluate the number of avoided hospitalizations in neonatology for free bilirubin jaundice since the introduction, according to a strict protocol, of the BiliCocoon Bag® device. Material and MethodThis was a single-center retrospective cohort study using data of newborns usually collected as part of standard care. Children born in our maternity ward during an 18-month period (August 1, 2020 to January 31, 2022) were included. Causes of jaundice, age at the beginning and mode of treatment, number of sessions for each device, and length of stay were compared. Results are presented as number and percentage with median (25th–75th) or mean (extremes) values for categorical and continuous variables, respectively. A t-test was used to compare the means of the independent groups. ResultsA total of 316 newborns were included. Physiological jaundice was the main cause of jaundice. The median age for the first phototherapy treatment was 54.5 h (30–68). The 316 neonates needed 438 phototherapy sessions: 235 (74%) neonates required only one phototherapy session, 85 (36%) of them were treated with the BiliCocoon Bag®. For the 81 children who needed two or more phototherapy sessions, 19 children (23.5%) were treated by tunnel phototherapy and then the BiliCocoon Bag®, and eight children (10%) by BiliCocoon Bag® alone. The BiliCocoon Bag® enabled a relative reduction in the hospitalization rate of 38% and avoided hospitalization for approximately one third of the newborns treated. The BiliCocoon Bag® failure rate was 3.6% and the average length of stay was comparable between the two types of treatment. ConclusionFollowing a strict protocol of use, the BiliCocoon Bag® is a reliable method and a good alternative to intensive phototherapy for newborns in the maternity ward, as it avoids hospitalization and mother–infant separation.

Characteristics and decreased Vitiligo Area Scoring Index of vitiligo patients with narrowband-UVB phototherapy in Yogyakarta, Indonesia.

Narrowband ultraviolet-B (NB-UVB) phototherapy is the mainstay of vitiligo therapy. The response can be evaluated using the vitiligo area scoring index (VASI) and repigmentation grade. However, few studies used VASI to evaluate phototherapy response and there are no definitive data on the reduction of VASI. This retrospective descriptive study aimed to determine the characteristics and decrease of VASI in patients with vitiligo after 36 and 48 sessions of NB-UVB phototherapy, conducted at Dr. Sardjito General Hospital, Yogyakarta, from December 2021-June 2022. The most common predilection was on the face (71.43%) and acral (61.90%). The most common responses after 36 and 48 phototherapy sessions were minimally improved (decrease in VASI<10%) and improved (reduction in VASI 10-25%). The mean decrease in VASI was 18% and 22% after 36 and 48 phototherapy sessions, respectively. 9.52% and 6.67% of patients experienced a reduction in VASI >50% after 36 and 48 phototherapy sessions, respectively. VASI assessment can be used to evaluate the response to phototherapy in vitiligo. However, VASI cannot show a reduction in vitiligo with slight repigmentation in slow-response patients.

The impact of the COVID-19 surge on phototherapy in Taiwan: Focusing on the patient profile, adherence, and attitude before and after the surge.

Coronavirus disease 2019 (COVID-19) pandemic has caused changes in the medical practice. However, it is unclear whether the patients receiving phototherapy for their dermatoses have been affected. This study aimed to identify the impact of the COVID-19 pandemic on phototherapy, focusing on the patient profile, adherence, and attitude before and after the surge. The study encompassed the time 5 months prior to and after the surge of the COVID-19 pandemic (from May to July, 2021), resulting in the temporary closure of our phototherapeutic unit. Nine hundred eighty-one patients received phototherapy during this period. Vitiligo, psoriasis (Ps), and atopic dermatitis (AD) represented the groups with the highest patient numbers. For vitiligo, Ps and AD, 39.6%, 41.9%, and 28.4% of the patients resumed phototherapy after the pandemic-related shutdown (PRS). No significant difference was noted in age, gender, and number of weekly sessions between those who resumed or stopped phototherapy after PRS among three groups. Patients who resumed phototherapy after PRS tended to receive more weekly sessions of phototherapy than those who initiated after PRS. Additionally, patients who resumed phototherapy showed no significant difference in the number of weekly sessions before and after PRS. This study reveals a significant impact of the COVID-19 pandemic on patients undergoing phototherapy. Although the patient number remained similar before and after PRS, a significant portion of patients discontinued phototherapy after PRS. New strategies and continued education are needed to improve patient management in times of pandemic.

Narrowband Ultraviolet B (NB-UVB) Phototherapy in Psoriasis: A Retrospective Study

Background: Psoriasis with higher Psoriasis Area and Severity Index (PASI) scores correlate with impaired quality of life. Assessing narrowband ultraviolet B (NB-UVB) phototherapy as a new therapy option in Indonesia is necessary to find the most effective treatment for psoriasis patients. Purpose: To determine the usage of NB-UVB phototherapy and the therapy response in psoriasis patients. Methods: This retrospective descriptive observational study was conducted at Dr. Soetomo General Academic Hospital Surabaya in March 2019-November 2020. The variables were collected through medical records. Result: A total of 28 patients were obtained at this study. Psoriasis type plaque/vulgaris were found in 92.9% of the patients. The patients mostly started with PASI score &gt;10 with the initial dose of NB-UVB phototherapy is 260 mJ/cm2. The most common initial phototherapy frequency is 3 times per week (53.6%). The latest dose and frequency distribution was varied in each subject. The mean total number of sessions was 31.54 ± 20.549. Patients were also administered various combination therapy. The majority of patients had missed NB-UVB phototherapy sessions and the phototherapy dose needed to be reduced (57.1%). The achievement of PASI-75 (treatment success) was mostly achieved by subjects that went through 40-60 sessions of phototherapy and subjects with psoriasis type plaque/vulgaris. Conclusion: The achievement of PASI-75 was found to be low (17.5%), influenced by multiple factors such as the total number of NB-UVB phototherapy sessions, combination therapy, dose of NB-UVB phototherapy, frequency of NB-UVB phototherapy, and the level of patient compliance to therapy.

Clinical and laboratory characterization of patients with localized scleroderma and response to UVA-1 phototherapy: In vivo and in vitro skin models.

Localized scleroderma (LS) is a rare disease leading to progressive hardening and induration of the skin and subcutaneous tissues. LS is responsive to UVA-1 phototherapy, though its exact mechanism of action dermal fibrosis is yet to be fully elucidated. We aimed to investigate the molecular changes induced by UVA-1 rays in human primary fibroblasts cultures. A total of 16 LS patients were treated with medium-dose UVA-1 phototherapy. At baseline, during and after therapy, Localized Scleroderma Assessment Tool, Dermatology Life Quality Index and lesions' staging and mapping were performed along with high-frequency ultrasound (HFUS) examination for dermal thickness assessment. Gene expression analysis for 23 mRNA transcripts, in vitro UVA-1 irradiation and viability tests were realized on lesional fibroblasts' primary cultures, before and 3 months after therapy. The dermal thickness, the LoSCAT and the DLQI progressively decreased starting from the last phototherapy session up to the 6 and 9 month follow-ups (-57% and -60%, respectively). Molecular gene analysis (rt-PCR) revealed that UVA-1 phototherapy exerts multiple effects: the activation of specific anti-fibrotic pathways (e.g., overexpression of CTHRC1 and metalloproteases 1, 2, 7, 8, 9, 12, suppression of TIMP-1), the downregulation of peculiar pro-fibrotic pathways (e.g., downregulation of TGF-ß, TGF-ßrII, Grb2, SMAD 2/3, TNRSF12A, CTGF) through a significant overexpression of IL-1ß; the stabilization of collagen synthesis acting on genes COL1A1, COL3A1, COL8A1, COL10A1, COL12A1. UVA-1 phototherapy adds significant benefits in local tissue remodeling, rebalancing the alteration between pro-fibrotic and anti-fibrotic pathways; these changes can be well monitored by HFUS.

Combination effect of methotrexate with Narrowband Ultraviolet B (NB-UVB) phototherapy in psoriasis vulgaris patients in dermatology and venereology outpatient clinic Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

Background: Psoriasis is a chronic, recurrent, inflammatory skin disease that alters the quality of life. Systemic therapy and biologic agents are prescribed for severe and widespread psoriasis, but these drugs may have systemic side effects and immune suppression. Narrowband Ultraviolet B (NB-UVB) phototherapy remains one of the most effective and safe treatments for psoriasis.Methods: This study was an observational retrospective cohort with one group pretest and post-test design. A retrospective analysis was done on 16 medical records of patients who met the inclusion criteria. The efficacy of the therapy was identified and analyzed using the SPSS version 17 for Windows.Results: This study found that 16 psoriasis patients received NB-UVB phototherapy, 11 (68.75%) in men and 5 (31.25%) in women. The mean age was 47.31 years. There was a statistically significant difference in the reduction in PASI score before and after receiving combination methotrexate with 24 sessions of NB-UVB phototherapy (p=0.000); the delta PASI score was 45,02%. A statistical analysis based on the number of phototherapy sessions per week showed enhanced results when patients attended 3 phototherapy sessions per week (p = 0.001).Conclusion: There was a statistically significant reduction in PASI score in psoriasis vulgaris patients before and after receiving combination methotrexate with 24 sessions of NB-UVB phototherapy.

Hypocalcemia in Jaundiced Term Neonates Undergoing Phototherapy

Objective: frequency of hypocalcemia in jaundiced term neonates undergoing phototherapy. Methodology: A total of 150 term neonates of either gender who develop jaundice requiring phototherapy are included in this study presenting within first week of life whereas those term jaundiced neonates who are at known risk of developing hypocalcemia, infant of diabetic mother, neonates having history of birth asphyxix, septic neonates, those requiring exchange transfusion and those with hemolytic anemias were excluded from study. The patients were examined thoroughly (complete history and physical examination).Informed consent was obtained to include the data in study. Jaundiced neonate is applied phototherapy and after 48 hrs of phototherapy session, 5ml blood sample is drawn and sent to hospital laboratory for estimation of total serum calcium level. Hypocalcemia (i.e. Calcium level &lt; 8 mg/dl after 48 hours application of phototherapy for jaundice neonatorum) was recorded and managed as per hospital protocol. Results: Out of 150 cases, 46%(n=69) were in range of 1-3 days while 54%(n=81) were between the range of 4-7 days of life. The common age was 3.59+1.60 days. There were 53.33%(n=80) male while 46.67%(n=70) were female participants. Hypocalcemia was recorded in 20.67%(n=31). Conclusion: We concluded that the frequency of phototherapy associated hypocalcemia is not very high, however, calcium levels should be monitored as it is a potential but very less studied complication in our clinical settings. Keywords: Term neonates, jaundice, phototherapy, hypocalcemia

Stellate Ganglion Phototherapy Using Low-Level Laser

This study investigates the effect of stellate ganglion (SG) phototherapy in healthy participants and assesses its efficacy in suppressing electrical storm (ES) refractory to antiarrhythmic drugs and catheter ablation.Modulation of the autonomic nervous system has been shown to be an effective adjunctive therapy for ES.Ten-minute SG phototherapy was performed twice weekly for 4 weeks in 20 healthy volunteers. To evaluate the acute and chronic effects of SG phototherapy, heart rate variability and serum concentrations of adrenaline, noradrenaline, and dopamine were obtained before phototherapy, immediately after the first phototherapy session, after 8 sessions of phototherapy, and 3 months after the first phototherapy session. In addition, the efficacy of SG phototherapy was evaluated in 11 patients with ES refractory to medication, sedation, and catheter ablation.In healthy participants, serum adrenaline concentration significantly decreased after phototherapy, whereas low-frequency power/high-frequency power significantly decreased during phototherapy. Moreover, the effect on heart rate variability did not last beyond 3 months. In the clinical pilot study, 7 patients had a suppression of ES after SG phototherapy; however, without maintenance therapy, 2 patients had a recurrence of ventricular arrhythmias. Furthermore, it did not control ES in 4 patients.SG phototherapy reduced sympathetic activity and may be a safe and effective adjunctive therapy to control ES in some patients, but its long-term efficacy remains unknown. Chronic phototherapy might help reduce ES recurrence.

Erythema Increase Predicts Psoriasis Improvement after Phototherapy.

Psoriasis is a major global health problem. There is a need to develop techniques to help physicians select the most appropriate cost-effective therapy for each patient. The main objectives of this study are (1) to evaluate changes in epidermal barrier function and skin homeostasis after phototherapy and (2) to explore potentially predictive values in epidermal barrier function and skin homeostasis to assess clinical improvement after fifteen sessions of phototherapy. A total of 76 subjects, 38 patients with plaque-type psoriasis and 38 gender- and age-matched healthy volunteers, were included in the study. Erythema, transepidermal water loss (TEWL), temperature, stratum corneum hydration (SCH), pH, sebum, and antioxidant capacity were measured before and after the first and fifteenth phototherapy session. Erythema (401.09 vs. 291.12 vs. 284.52 AU, p < 0.001) and TEWL (18.23 vs. 11.44 vs. 11.41 g·m−2·h−1, p < 0.001) were significantly higher at psoriatic plaques than in uninvolved psoriatic skin and healthy volunteers, respectively, while SCH was lower (9.71 vs. 44.64 vs. 40.00 AU, p < 0.001). After fifteen phototherapy sessions, TEWL (–5.19 g·m−2·h−1, p = 0.016) decreased while SCH (+7.01 AU, p = 0.013) and erythema (+30.82 AU, p = 0.083) increased at psoriatic plaques. An erythema increase exceeding 53.23 AU after the first phototherapy session, with a sensitivity of 71.4% and specificity of 84.2%, indicates that a patient may improve Psoriasis Area and Severity Index (PASI) by ≥3 points after fifteen phototherapy sessions. In conclusion, phototherapy improves epidermal barrier function in psoriatic patients and the erythema increase after one phototherapy session could help doctors select psoriasis patients who are more likely to respond to phototherapy.

Diabetic Foot Wounds Treated With Human Amniotic Membrane and Low-level Laser Therapy: A Pilot Clinical Study

Low-level laser therapy (LLLT) and human amniotic membrane (HAM) application have been shown to be viable options for use in wound healing. This study sought to compare LLLT and HAM to a control treatment (hydrogel, saline, and gauze) in persons with diabetes mellitus (DM) and foot ulcers. Using a prospective pilot clinical study design, patients receiving care at a health center that specializes in the treatment of diabetic foot wounds between November 2016 and August 2017 were recruited. Eligible patients had to be 30 to 59 years of age; diagnosed with type 2 DM (postprandial capillary glucose levels between 140 and 350 mg/dL); and have uninfected, granulating stage 2 or 3 foot ulcers measuring less than 7 cm by 3 cm. Immunosuppressed and malnourished patients or those with neoplasms or in critical condition were not eligible to participate. Patients received the control treatment (2 mg hydrogel, saline, and gauze), HAM (patches of thawed HAM, applied with overlapping edges), or LLLT (phototherapy session, 2 mg hydrogel, saline, and gauze) for 28 days. Variables, wound area measurements, Pressure Ulcer Scale for Healing (PUSH) scores, and Visual Analog Scale (VAS) scores were used to assess wound improvement progress and pain on days 7, 14, 21, and 28. Descriptive statistics were used to analyze the participant anthropometric and clinical profiles. The Kolmogorov-Smirnov test was used to analyze the sample distribution. The Kruskal-Wallis test with Dunn's post-test was used to evaluate differences in PUSH and VAS scores and wound size for intergroup analysis, and the Mann-Whitney U test was used for the same outcomes in intragroup analysis. The level of significance was 5% (P < .05). Twenty-seven (27) patients participated (mean age, 51.4 years; mean body mass index, 26.5 kg/m2), with 9 patients in each treatment group. No statistically significant differences were noted in clinical or anthropometric variables among the groups, but mean baseline wound areas were different (2.6 cm² for the control, 1.9 cm² for the LLLT, and 5.5 cm² for the HAM groups). Intragroup comparisons showed a significant reduction in PUSH score in the LLT group between days 0 and 21 (8.2 vs 4.9; P < .01) and days 21 to 28 (4.9 vs 3.2; P < .001). In all treatment groups the percent reduction was significantly different between days 7 and 28. No outcomes were significantly different between groups. Diabetic foot ulcer wound area as well as PUSH and VAS scores showed more improvement for patients with DM receiving LLLT or HAM than for the control group, but the differences were not significant. Larger studies are needed to compare these treatment modalities.

Evaluation of serum folate level before and after oral PUVA therapy in psoriatic patients

Psoriasis is a chronic, recurrent, and immune-mediated inflammatory disease that affects 2–3% of the world population. The present study aimed to evaluate serum folate level before and after oral PUVA therapy in psoriatic patients. Patient and methods: A total of 40 psoriatic patients without any other morbidities (age ranged from 19 to 63 years, including 20 males and 20 females), All the patients recieved oral 8-methoxypsoralen at a dose of 0.6 mg/kg, followed 2 hours later by ultraviolet A exposure (oral PUVA therapy), For each patient the therapy will be twice weekly for eight weeks. Patients in the PUVA group were treated twice times weekly with a starting dose of 2 J/cm2, increasing by 20% each session, to a maximum of 15 J/cm2 per dose. Patients underwent up to 16 sessions. The dosage was adjusted if patients developed erythema. We have measured serum folate levels at baseline and after oral PUVA exposure. Also we use PASI score as objective method to visualize the relationship between improvement of psoriasis and changes in folate serum levels at baseline and after 16 exposures to PUVA for 8 weeks along with subjective methods which were done by photography and adverse effects were also reported. Results: There is statistically significant decrease of folic acid level after 16 sessions of phototherapy by average 20%. According to PASI score, Our results shows that there is statistically significant improvement in PASI score after phototherapy by average 60% .Conclusion: Folate deficiency should be evaluated and corrected in the patients, as it may be aggravated by UV therapy.

Epidermal barrier changes in patients with psoriasis: The role of phototherapy.

Some skin diseases may modify epidermal barrier function. Psoriasis is a chronic multi-systemic inflammatory disease that affects the epidermal barrier. Phototherapy is an option for treating psoriasis, but little is known about how epidermal barrier function is modified by phototherapy in psoriatic patients. (a) To compare skin homeostasis between involved and uninvolved skin in psoriatic patients with healthy controls (b) To evaluate changes in the epidermal barrier function in psoriatic patients treated with phototherapy. Sixty patients with plaque-type psoriasis and sixty gender and age-matched healthy controls were enrolled. Temperature, transepidermal water loss (TEWL), stratum corneum hydration (SCH), pH, elasticity, erythema and melanin index were measured using non-invasive tools in the healthy control and involved and uninvolved psoriatic skin before and after phototherapy. Healthy controls had lower TEWL and erythema index and higher SCH than psoriatic patients, both at uninvolved psoriatic skin and psoriasis plaques. TEWL was higher at psoriasis plaques than at uninvolved skin (19.20 vs 11.57g/h/m2 ; P<.001). Following phototherapy, a decreasing trend was observed for TEWL, of 1.03 (SD 0.75) and 0.97 (SD 0.81)g/h/m2 for uninvolved and involved skin respectively. SCH was significantly lower at psoriatic plaques than at uninvolved skin (7.32 vs 36.62Arbitrary Units [AU]; P<.001). SCH increased by 1.15AU (SD 0.26) on psoriatic plaques after the phototherapy session (P<.001). Psoriatic plaques showed epidermal barrier dysfunction compared to uninvolved skin and healthy controls. Phototherapy may improve epidermal barrier function in psoriatic patients. SCH increased after a phototherapy session on the psoriatic plaques.

Total skin electron beam therapy in mycosis fungoides

Background: Mycosis fungoides (MF) is a rare type of non-Hodgkin’s lymphoma of T cells that primarily affects the skin. Radiation therapy is a cornerstone of therapy for all stages. Case Presentation: A 76-year-old man diagnosed in 2010 with MF in the patch/plaque phase (stage IB T2 N0 M0 B0) was treated with topical corticosteroids and successive sessions of photochemotherapy (psoralen and ultraviolet A) and phototherapy (narrowband ultraviolet B) with relative control of the lesional condition for 9 years. Due to the absence of clinical response and progression of the lesions, it was proposed for the treatment with radiotherapy. The patient underwent total skin electron beam therapy (TSEBT) (6 MeV electron/30/1 Gy per day/4 days per week). The patient showed marked improvement of the lesional condition with minimal toxicity. Remains in follow-up, with good control of the disease to date. Conclusion: MF is a challenging disorder from all perspectives. TSEBT in patients with extensive patches or plaques has an excellent response rate and rapid palliation.

12983 The effectiveness of high-dose ultraviolet A-1 phototherapy on acute exacerbated atopic dermatitis

Atopic dermatitis (AD) is a chronic inflammatory skin disease, characterized by pruritus, a chronic course of exacerbations and remissions. High-dose ultraviolet A-1 (UVA-1) phototherapy has been shown to be effective in the treatment of acute exacerbated AD, however, there was no previous case study in Asia. We present a retrospective review of our experiences with high-dose UVA-1 phototherapy. This study was conducted on 16 patients with acute exacerbation of AD. High-dose (100 J/cm2) regimens of UVA-1 therapy were employed. The therapeutic effectiveness was assessed according to the clinical examination and SCORAD index before and after the 5th and 10th sessions of treatment. In addition, side effects and recurrence during follow-up were retrospectively evaluated. The patients were between 7 and 50 years of age with average age of 25.8 years. The SCORAD index of 16 patients were between 41 and 89.5 with average score of 64.9. Among the 16 patients, two patients discontinued the treatement because of side effects such as erythema and pruritus. Of 14 patients who completed the 10 sessions of high-dose UVA-1 phototherapy, nine patients (64.3%) showed complete remission and five patients (35.7%) showed partial remission. The average SCORAD index was reduced from 64.2 (before treatment) to 23.3 (after 10th session of treatment). This is the first case study of high-dose UVA-1 phototherapy on Asian acute exacerbated AD patients, suggesting that high dose UVA-1 phototherapy can be a well tolerated and effective treatment for acute exacerbated AD. Afterwards, large-scale prospective studies are needed.

Cutan T-sejtes lymphomák bőrre irányuló kezelése (skin directed treatment) egy eset kapcsán

Cutaneous T-cell lymphomas are rare diseases with significant differences in their clinical course and prognosis. The choice of treatment basically depends on the stage, in the early stages of the disease only skin directed treatment is recommended. With most of the treatment modalities, complete cure is not possible, only long-term remission can be achieved. The authors report the case of a 52-year-old female patient who developed extensive annular, erythematous, infiltrated plaques in the spring of 2019. Histological examination confirmed mycosis fungoides, imaging did not show lymph node or other organ involvement. Given the disease (stage IB), PUVA treatment was initiated. After a total of 21 sessions of phototherapy from September 2019, the patient underwent complete remission. The authors provide a detailed review of skin directed treatment options for mycosis fungoides based on current international recommendations.

Epidermal carotenoid levels in vivo of patients with plaque psoriasis: Effects of narrow-band UVB phototherapy.

Psoriasis is a systemic inflammatory disease characterized by hindered antioxidant defense and increased formation of free radicals. There are limited data on the skin carotenoids in psoriatic skin as well as their modulation during narrow-band UVB (NB-UVB) phototherapy of the disease. The aim of this prospective study is to reveal the skin carotenoids levels during NB-UVB phototherapy of psoriasis in humans. Twenty Caucasian subjects with mild-to-moderate plaque psoriasis (15m; 5f) were enrolled in the study, and nine gender- and age-matched healthy volunteers were recruited for controls of oxidative stress measurements. All psoriasis patients underwent 10 sessions of NB-UVB phototherapy. Measurements were taken at baseline and after 10 sessions of NB-UVB phototherapy. The assessment of carotenoid levels in the skin in vivo was performed by a non-invasive, reflectance spectroscopy-based device. Psoriasis severity was assessed by psoriasis area and severity index (PASI). The dermatology life quality index (DLQI) was evaluated in psoriatic patients. Baseline carotenoid levels were significantly lower in psoriasis patients in comparison to healthy controls. NB-UVB phototherapy insignificantly diminished carotenoid levels in the skin of psoriasis patients, while clinical improvement both in PASI score and DLQI was observed. We showed the levels of skin carotenoids in psoriatic patients are lower than in healthy subjects. NB-UVB did not change significantly skin carotenoid levels. Further studies should elucidate the potential effect of antioxidants supplementation during NB-UVB of psoriasis.