Psoralen Ultraviolet A Research Articles

Risks of glaucoma among individuals with psoriasis: apopulation-based cohort study.

Psoriasis is a chronic systemic disorder with ocular involvement. To evaluate the risk of glaucoma among patients with psoriasis. Participants in this cohort study were selected based on Chang Gung Research Database from 1 January 2003 to 31 December 2012. Follow-up ended on 31 December 2017. The participants in the control group were matched with the psoriasis group by sex, age and index date with a 4 : 1 ratio. The hazard ratios of glaucoma were estimated using Cox regression analysis. We also evaluated the relationship between the risk of glaucoma and systemic therapies as well as phototherapy and topical corticosteroid in patients with psoriasis. In total, 6682 patients with psoriasis and 26 728 matched controls were enrolled. The study population was composed mainly of males accounting for 64.2% (21 445/33 410) of the study population. The psoriasis group had higher incidence rates than the control group for glaucoma (adjusted hazard ratio 1.405, 95% confidence interval, 1.051-1.879). Patients with psoriasis receiving psoralen-ultraviolet A (PUVA) therapy for > 200 sessions had an increased risk of glaucoma. Patients with psoriasis had an increased risk of glaucoma. Long-term PUVA therapy raised the risk of glaucoma in people with psoriasis.

Incidence and profile of skin cancers in patients following ultraviolet phototherapy without psoralens: A retrospective cohort study

Psoralen+ultraviolet-A (PUVA) is associated with photocarcinogenesis. However, carcinogenic risk with other ultraviolet phototherapies remains unclear. Evaluate whether phototherapy without psoralens increases skin cancer risk. Retrospective cohort study of patients treated at a teaching-hospital phototherapy center (1977-2018). Skin cancer records were validated against pathology reports. Age-standardized incidence rates (ASIRs) of skin cancer were evaluated for gender, skin phototype, diagnosis, ultraviolet modality, anatomical site; and compared to provincial population incidence rates (2003). In total, 3506 patients treated with broadband-ultraviolet-B, narrowband-UVB and/or combined UVAB were assessed with a mean follow-up of 7.3years. Majority of patients had psoriasis (60.9%) or eczema (26.4%). Median number of treatments was 43 (1-3598). Overall, 170 skin cancers (17 melanoma, 33 squamous cell carcinoma and 120 basal cell carcinoma) occurred in 79 patients. Patient-based and tumor-based ASIR of skin cancer was 149 (95% CI: 112-187)/100,000 and 264 (219-309)/100,000 person-years, respectively. There was no significant difference between tumor-based ASIRs for melanoma, squamous cell carcinoma, and basal cell carcinoma compared to the general population; or in phototherapy patients with-psoriasis or eczema; or immunosuppressants. No cumulative dose-response correlation between UVB and skin cancer was seen. Treatment and follow-up duration. No increased risk of melanoma and keratinocyte cancer was found with phototherapy.

8-Methoxypsoralen Induces Apoptosis by Upregulating p53 and Inhibits Metastasis by Downregulating MMP-2 and MMP-9 in Human Gastric Cancer Cells

Furanocoumarin 8-methoxypsoralen (8-MOP) is the parent compound that naturally occurs in traditional medicinal plants used historically. 8-MOP has been employed as a photochemotherapeutic component of Psoralen + Ultraviolet A (PUVA) therapy for the treatment of vitiligo and psoriasis. Although the role of 8-MOP in PUVA therapy has been studied, little is known about the effects of 8-MOP alone on human gastric cancer cells. In this study, we observed anti-proliferative effect of 8-MOP in several human cancer cell lines. Among these, the human gastric cancer cell line SNU1 is the most sensitive to 8-MOP. 8-MOP treated SNU1 cells showed G1-arrest by upregulating p53 and apoptosis by activating caspase-3 in a dose-dependent manner, which was confirmed by loss-of-function analysis through the knockdown of p53-siRNA and inhibition of apoptosis by Z-VAD-FMK. Moreover, 8-MOPinduced apoptosis is not associated with autophagy or necrosis. The signaling pathway responsible for the effect of 8-MOP on SNU1 cells was confirmed to be related to phosphorylated PI3K, ERK2, and STAT3. In contrast, 8-MOP treatment decreased the expression of the typical metastasis-related proteins MMP-2, MMP-9, and Snail in a p53-independent manner. In accordance with the serendipitous findings, treatment with 8-MOP decreased the wound healing, migration, and invasion ability of cells in a dose-dependent manner. In addition, combination treatment with 8-MOP and gemcitabine was effective at the lowest concentrations. Overall, our findings indicate that oral 8-MOP has the potential to treat early human gastric cancer, with fewer side effects.

Quality of Life among Psoriasis Patients; Correlation with Severity and Response to Psoralen Ultraviolet-A phototherapy

Quality of Life among Psoriasis Patients; Correlation with Severity and Response to Psoralen Ultraviolet-A phototherapy

Suggested Guidelines for the Treatment of Mycosis Fungoides in Countries with Limited Resources.

The treatment options for mycosis fungoides (MF) have been expanding but unfortunately many of the currently used treatment modalities are unavailable in Egypt and other African/Arab countries. In addition, there is a lack of consensus on the treatment of hypopigmented MF (HMF), which is a frequently encountered variant in our population. We aimed to develop regional treatment guidelines based on the international guidelines but modified to encompass the restricted treatment availability and our institutional experience. Special attention was also given to studies conducted on patients with skin phototype (III-IV). Treatment algorithm was formulated at Ain-Shams cutaneous lymphoma clinic through the collaboration of dermatologists, haematologists, and oncologists. Level of evidence is specified for each treatment option. For HMF, phototherapy is recommended as a first line treatment, while low-dose methotrexate is considered a second line. For early classical MF, we recommend Psoralen-ultraviolet A (PUVA), which is a well-tolerated treatment option in dark phenotype. Addition of either retinoic acid receptor (RAR) agonist and/or methotrexate is recommended as a second line. Total skin electron beam (TSEB) is considered a third-line option. For advanced stage, PUVA plus RAR agonist and/or methotrexate is recommended as first line, TSEB or monochemotherapy is considered a second line option. Polychemotherapy is regarded as a final option. All patients with complete response (CR) enter a maintenance and follow-up schedule. We suggest a practical algorithm for the treatment of MF for patients with dark phenotype living in countries with limited resources.

Folliculotropic Mycosis Fungoides: Current Guidance and Experience from Clinical Practice

IntroductionFolliculotropic mycosis fungoides (FMF) is the most frequent variant of mycosis fungoides (MF), with clinical features which differ from the classic form. As for therapeutic options, the latest guidelines on MF agree on a stage-driven strategy, in consideration of clinical presentation, symptom burden and patient’s comorbidities.Materials and MethodsA search on MEDLINE, PubMed, Scopus and Cochrane Library was conducted to gather the latest evidence on FMF clinical management. Manuscripts published in the last five years (January 2017–April 2022) were included. Our single-center experience was also described.ResultsA total of 15 articles were analyzed, with a total of 432 patients (disease stage from IA to IVA2). The most widely-used treatment was psoralen ultra-violet A (PUVA) in monotherapy or in association with other drugs. Oral retinoid-based therapy was also described as a therapeutic option alone or in combination. Other therapy reported were based on Brentuximab Vedotin, Mogamulizumab, Carmustine, topical steroids, tazarotene and excimer laser, interferon, nitrogen mustard, imiquimod, systemic chemotherapy, extracorporeal photopheresis and stem cell transplantation.DiscussionFMF is characterized by specific clinical-pathologic features. Advanced forms assume characteristics more similar to classic MF (infiltrated plaques and nodules), whilst early stages can present in a wide range of clinical forms (acneiform lesions, follicular-like keratoses, erythematous patches). As for therapeutic options, in absence of specific guidelines, a high number of treatments are described in clinical practice, with variable results. Phototherapy in all its forms, especially as PUVA, appears to have the greatest initial therapeutic success. Retinoids, although widely used, appear to be poorly effective in monotherapy, particularly acitretin. Combination treatment with phototherapy seems to be advisable. Ionizing treatments, such as radiotherapy and TSEBT, appear effective, at least in the short term. Overall, an integrated approach is mandatory for the inconstant course of the disease and its multidisciplinary nature.

Theoretical study of new promising conjugated psoralens in psoralen ultraviolet A therapy

AbstractIn our previous report (J. Phys. Org. Chem., 2019), we discussed novel silicon photosensitizers (PSs) in psoralen ultraviolet A (PUVA) therapy. Continuing this quest, we have scrutinized a new brand of PSs, via density functional theory (DFT) and time‐dependent density functional theory (TD‐DFT) methods. These PSs show intense narrow absorption peaks in the therapeutic window with very high molar absorption coefficients ( ). Calculated vertical ionization potential (VIP) and vertical electron affinity (VEA) values indicate that our PSs can produce reactive oxygen species (ROS) through type I mechanism. Also, energies of the first triplet excited states (T1) and spin–orbit coupling (SOC) constants verify the possibility and efficiency of type II mechanism for the generation of the singlet excited state of molecular oxygen (1O2). The results introduce new potential PSs in PDT and PUVA therapy.

In situ monitoring PUVA therapy by using a cell-array chip-based SERS platform

Psoralen ultraviolet A (PUVA) therapy has thrived as a promising treatment for psoriasis. However, overdose of PUVA treatment will cause side-effects, such as melanoma formation. And these side-effects are often ignored during PUVA therapy. Hence, in situ monitoring therapeutic response of PUVA therapy is important to minimize side-effects. Aberrant expression of tyrosinase (TYR) has been proved to be associated with melanoma, indicating that TYR is a potential target for evaluation of PUVA therapy. Herein, we reported a strategy for in situ monitoring TYR activity during PUVA therapy by using a cell-array chip-based SERS platform. The cell-array chip was used to simulate cell survival environment for cell culture. Capture of single cells and living cell analysis were realized in the isolated microchambers. An enzyme-induced core-shell self-assembly substrate was used to evaluate TYR activity in living cells during PUVA therapy. The gold nanoparticle modified with a SERS reporter, 4-mercaptobenzonitrile (4-MBN), was used as the core. In the presence of oxygen and TYR, hydroxylation of l-tyrosine occurred, leading to the reduction of silver ion on the surface of gold cores. The growth of silver shells was accompanied by the increased SERS intensity of the reporter, which is related directly to TYR activity. The detection limit for TYR activity is 0.45 U/mL. Upregulation of TYR activity was successfully monitored after PUVA therapy. Notably, real-time and in situ information of therapeutic response can be obtained through monitoring PUVA therapy by using a cell-array chip-based SERS platform, which has great potential to guide the clinical application of PUVA therapy.

Frequency of phototherapy for treating psoriasis: a systematic review.

Narrow band ultraviolet B (NB-UVB) and psoralen-ultraviolet A (PUVA) remain inexpensive and effective anti-psoriatic therapies adopted worldwide with different frequency protocols. We aimed to systematically assess the evidence on the effects of different frequency protocols of phototherapy in treating psoriasis. We used the following terms, namely "photochemotherapy," "phototherapy," "psoriasis," "UVB," "UVA" and "ultraviolet therapy," to search the Cochrane Controlled Register of Trials, MEDLINE and Embase databases on August 1, 2019. We organized results using a PRISMA diagram and analyzed bias risks with RoB-2 tool. We included five randomized controlled trials (RCTs) on oral PUVA and three RCTs on NB-UVB. The five studies on PUVA included a total of 1452 patients with plaque psoriasis and did not find any significant difference in efficacy comparing two- vs. three- vs. four times weekly protocols. The three studies on NB-UVB included a total of 248 patients with plaque psoriasis. No differences in efficacy were reported in comparing different frequencies in delivering NB-UVB, namely twice vs. thrice weekly, twice vs. four times weekly, and thrice- vs. five times weekly protocols. Although protocols with higher treatments frequency per week achieved clearance faster than lower frequency ones, but they did not differ in terms of efficacy. PUVA and NB-UVB remain effective anti-psoriatic treatments; however further studies are needed to elucidate which protocol may be more effective in different skin phototypes.

Effectiveness of PUVA vs. UVA1 phototherapy in the treatment of morphea patients.

IntroductionMorphea (localized scleroderma) is an inflammatory connective tissue disease, characterized by immune system dysfunction, vasculopathy and skin fibrosing. Phototherapy has been found to be effective in treating localized scleroderma. Psoralen + ultraviolet A (PUVA) and ultraviolet A1 (UVA1) phototherapy significantly enriched therapeutic possibilities.AimTo compare the clinical effect of PUVA photochemotherapy and UVA1 phototherapy and to evaluate the treatment response rates.Material and methodsIt was a retrospective one-centre research and observational study of all morphea patients treated with PUVA and UVA phototherapy. We reviewed phototherapy notes along with electronic and paper case records for all patients with morphea treated with PUVA and UVA1 phototherapy from January 2010 to December 2019.ResultsThe study shows that patients in both groups experienced improvement based on clinical measures, resulting in a reduction in the clinical score in all groups. There is positive short- and long-term efficacy of UVA1 and PUVA phototherapy in patients with morphea. There were no statistical differences between the treatment response rates. Limitations: We had a relatively small study sample and it was a retrospective, observational study.ConclusionsOur data suggest that ultraviolet PUVA and UVA1 should be considered for the treatment of morphea with disseminated lesions or not responding to topical treatment. UVA1 is free of side effects linked to oral psoralens such as nausea, vomiting, photokeratosis, but we showed that there was no statistical advantage in the effectiveness of both. UVA1 phototherapy is, however, a less accessible form of treatment, available in the centres of higher quality.

Safe and effective use of phototherapy and photochemotherapy in the treatment of psoriasis.

Psoriasis is a chronic, multisystem inflammatory disease, predominantly affecting the skin and joints, which is present in 2-3% of the world's population. Narrow band ultraviolet B (NB-UVB) and Psoralen + ultraviolet A (PUVA) are recognised, effective and, in the case of UVB, economical second-line treatments for psoriasis where topical therapies fail to control the disease or are an impracticable option due to the extent of skin involvement. This article examines the history of phototherapy and photochemotherapy and looks at current phototherapy treatments used for psoriasis. It discusses side effects of treatment and regimens that can be followed to increase effectiveness of treatment and minimise risks. The role of the nurse phototherapist is also discussed.

Comparative Study of Safety and Efficacy of Narrow Band Ultraviolet B (NBUVB) and Psoralen Ultraviolet A (PUVA) Therapy in Psoriasis Vulgaris

Comparative Study of Safety and Efficacy of Narrow Band Ultraviolet B (NBUVB) and Psoralen Ultraviolet A (PUVA) Therapy in Psoriasis Vulgaris

Silicon photosensitizers in cancer therapy: Theoretical studies on novel 5‐methoxypsoralens

AbstractThree novel silicon photosensitizers (PSs) are discovered with prospects to be utilized in psoralen ultra‐violet A (PUVA) cancer therapy, at B3LYP/6‐311++G** level of theory. They include 5‐methoxysilolo[3,2‐g]chromen‐2(8H)‐one (1), 5‐methoxybenzo[4,5]silolo[3,2‐g]chromen‐2(10H)‐one (2), and 11‐methoxybenzo[c]silolo[3,2‐g]chromen‐5(8H)‐one (3). Structures 1‐3 exhibit intense narrow absorption peaks in the ultra violet A (UVA) therapeutic window and show T1 energies necessary to activate the ground state triplet molecular oxygen (3O2) to its singlet excited state (1O2).

A clinical and immunological study of phototoxic regimen of ultraviolet A for treatment of alopecia areata: a randomized controlled clinical trial

Background: Various therapeutic agents have been described for alopecia areata but none is satisfactory. The use of ultraviolet A phototherapy in phototoxic regimens has emerged lately with promising results.Objective: To determine the efficacy and safety of phototoxic regimen of psoralen ultraviolet A (PUVA) in comparison to conventional therapy with intralesional corticosteroids in patients with alopecia areata.Methods: In this randomized controlled clinical trial, 40 patients were randomized to either phototoxic regimen of psoralen ultraviolet A group or potent intralesional corticosteroids group for three months. Study ended at six months. The primary outcome was treatment success: sustained regrowth of hair in ≥80% of the affected areas at six months. Tissue cytokines were assessed at zero and three months.Results: At six months, treatment success was achieved by 45% of patients, similarly in both groups. Tissue cytokine expression correlated well with clinical response.Conclusion: Phototoxic regimen of topical PUVA deserves a place among therapeutic tools used in management of alopecia areata especially in more extensive conditions where intralesional corticosteroids would not be suitable.Trial registration: https://clinicaltrials.gov/ct2/show/record/NCT01559584

238 The risk of keratinocyte carcinoma (KC) in psoriasis patients receiving biologic therapy compared to conventional systemic therapy: Results from The British Association of Dermatologists Biologic Interventions Register (BADBIR)

Whether psoriasis patients exposed to biologic therapies have an elevated risk of KC (basal cell carcinoma [BCC] or cutaneous squamous cell carcinoma [cSCC]) remains uncertain. The aim of the present study was to determine whether such patients were at higher risk of developing a KC compared to those on conventional therapy. BADBIR, a pharmacovigilance register of psoriasis patients, explores the long-term safety of systemic therapies. Patients with chronic plaque psoriasis registering to BADBIR on their first biologic or a conventional therapy, who had at least one follow-up completed were included in analyses if they were of white ethnicity, Fitzpatrick skin types 1-4 and reported no previous cancers. Confounding factors included: age; sex; smoking; and previous exposure to acitretin, psoralen ultraviolet-A (PUVA), ciclosporin, and/or PUVA and ciclosporin. Propensity score-weighted Cox-proportional hazard models estimated the hazard ratio (HR) for developing a first KC or separately, first BCC or cSCC. In total, 5672 patients initiating biologic therapy and 3188 patients on conventional therapy who met the entry criteria were identified with 20558 and 7829 person-years of follow-up, respectively. During follow-up, 74 (1.3%) patients initiating a biologic therapy were diagnosed with their first KC (43 BCC; 34 cSCC first) and 22 (0.7%) patients receiving conventional therapy with their first KC (15 BCC; 10 cSCC first). No significant difference in risk was observed for developing a KC (adjusted HR 1.05; 95% CI 0.64, 1.73), BCC (0.84; 95% CI 0.45, 1.54) or cSCC (1.20; 95% CI 0.57, 2.50) on biologic compared to conventional therapy. In conclusion, biologic therapy does not appear to confer a higher risk of developing a first KC as compared to conventional therapy in psoriasis patients. These data will help inform clinical decision making in psoriasis patients at risk of KC in whom biologic or conventional therapy is being considered.

SOAP PUVA.

Psoralen plus ultraviolet A (PUVA) photochemotherapy combines the use of psoralen and long-wave ultraviolet A (UVA) radiation. The phototherapeutic effects of PUVA result from photochemical reactions. PUVA therapy can be administered in various methods such as conventional UV chambers, psoralen with sunlight as source of UV light PUVASOL, bath PUVA, bath suit PUVA, soak PUVA, and turban PUVA. The advantage of using topical psoralen is that it avoids the adverse effects associated with the oral PUVA therapy and is being increasingly used in the treatment of psoriasis. However, it is known to cause increased phototoxicity, and in conditions like vitiligo, the spotty repigmentation is not cosmetically acceptable. Psoralen bath plus UVA therapy is known as bath PUVA therapy. Bath PUVA treatment for psoriasis was first reported by Fischer and Alsins in 1976. Bath PUVA is administered by mixing 37.5 mL of 1% 8-methoxypsoralen in 100 Lof water to obtain a concentration of 3.75 mg/L.[1] In bath suit PUVA, bathing suit of flannel material (stitched to suit the patient) is dipped in this solution for 5 min and worn for 15 min with a raincoat over it to prevent evaporation of the solution, and the patient is then immediately exposed to UVA in a whole-body phototherapy chamber. Bath PUVA needs plenty of water. Bath tub is not easily available and bath suit needs special suit, and treatment is cumbersome. We planned to modify the therapy by mixing psoralen with cleansing lotion and coined it as SOAP PUVA. The choice is due to the solubility factor as 8-MOP being insoluble in water. We reported a novel method of delivering 8-MOP uniformly all over the skin within a short time and on subsequent exposure to UV light. Because8-MOP was not soluble in water, we tried to dissolve it in commercially available moisturizing lotion (cetaphil) and synthetic detergent (cetaphil cleansing lotion). As it dissolved well in cleansing lotion, we decided to use it for our study [Figure 1]. As the method was new, we initially tried to standardize the procedure and determine the minimal pigmentation dose (MPD). The project was done in a single healthy subject with no existing dermatological disease requiring phototherapy. We started by using 1:100 dilution of methoxsalen that was prepared by mixing 0.1 mL of methoxsalen with 9.9 mL of cleansing lotion. The mixture was applied over the back [Figure 2]. The paste was left over for 5 min after which it was wiped with water-soaked gauze. The template cloth was worn along with goggles to protect the eyes. The area was exposed to UVA light (0–3J) with 0.5-J increments. The plan was to observe for MPD after 48 h and delayed pigmentation upto 7 days. No erythema and pigmentation was observed upto 7 days. We increased the concentration to 1:80, and the same procedure was repeated with no erythema or pigmentation. The concentration was increased to 1:60 and the same procedure was repeated. Erythema was observed at 2.5 J after 48 h [Figure 3] and pigmentation was observed after 5 days.Figure 1: Psoralen completely soluble in cleansing lotionFigure 2: Psoralen and cleansing lotion mixture applied over the backFigure 3: Erythema observed after 48 h at 2.5 JOral PUVASOL is effective but is time-consuming because the exposure to UV light occurs after 2 h and the intensity of sunlight varies. It also becomes difficult for children and working women. To overcome these issues bath PUVA was introduced, but it requires consumption of a large quantity of water. Pai and Srinivas introduced bathsuit tPUVA [2] to overcome this but the suit had to be worn for 15 min and was practically difficult. The main purpose of this study was to identify the method and use it with exposure to sunlight. The plan was to increase the concentration of psoralen rather increase the exposure time because we wanted to deliver it in a shorter period and the irradiance of sunlight was much lower than the irradiance of UV light in artificial chambers. The limitation was that it was done on a single subject, and the results might have varied. We plan to conduct further studies on a larger scale to determine the ideal dilution and use it as a viable alternative for delivering PUVA therapy. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Narrow‐band ultraviolet B phototherapy outcomes in atopic dermatitis—A single‐centre retrospective review

Systemic and biological therapies are evolving treatment modalities in the management of atopic dermatitis (AD). Despite these welcome advances in the management of refractory cases, phototherapy remains the recommended1 second-line treatment option for AD when topical treatments fail to control symptoms. According to a recently published survey of UK dermatologists2, 46% of dermatologists still choose phototherapy, either narrow-band ultraviolet B (NB UVB) or psoralen ultraviolet A (PUVA) ahead of systemic therapy which is favoured by 36%. This article is protected by copyright. All rights reserved.

Efficacy of Narrow-Band Ultra Violet B versus Narrow-Band Ultra Violet B with Topical Tacrolimus Ointment (0.1%) in the Treatment of Vitiligo

Introduction: Several treatment options e.g. topical corticosteroids, phototherapy like narrow-band ultra violet B (NB-UVB) and psoralen+ultra violet A (PUVA) etc are available for vitiligo. But none is so effective in single but combined one is more effective and superior.
 Objective: To compare the efficacy of NB-UVB vs NB-UVB with topical Tacrolimus ointment (0.1%) in the treatment of Vitiligo.
 Materials and Methods: This descriptive cross-sectional study was conducted in Combined Military Hospital, Dhaka from October 2015 to April 2016. Total 100 patients with vitiligo were divided into 2 groups of 50 patients. NB-UVB was given for 04 weeks to Group-A. In Group-B patients, topical Tacrolimus ointment (0.1%) twice daily was advised with simultaneous NB-UVB. The patients were followed-up at the baseline of the 4th, 8th and 16th week.
 Results: Majority (46%) of the patients were from 25-34 years of age with a mean age of 27.4±12.6 years. Among all risk factors, Family history of Vitiligo was the most common risk factor and common skin type (Fitzpatrick) was Type IV (40%). At the end of 4th week, maximum cases of Group-B showed good response (score 3) with a mean score of 1.74. Whereas, maximum cases of Group-A showed poor response (score 1) with a mean score of 0.86. End of the 16th week, maximum cases of Group-B improved successfully. In the end, 20% patients of Group-A showed an excellent result; but it was 42% from Group-B.
 Conclusion: It is revealed from this study that patients treated with a combination of NB-UVB with topical Tacrolimus ointment (0.1%) showed better treatment outcome, more effective and becomes a new mode of treatment.
 Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 86-89

Newer Aspects in Phototherapy

The concept of phototherapy has undergone a lot of changes in the past 30 years. It started with the emergence of psoralen ultraviolet A (PUVA) for the treatment of psoriasis. The subsequent evolution of Narrow band UVB therapy, Targeted phototherapy, UVA1 therapy, Home phototherapy and the use of LED lamps have revolutionized the treatment of various skin diseases. This article briefly summarizes the advances made in the last few years in the field of phototherapy.Nepal Journal of Dermatology, Venereology & Leprology, Vol.14(1) 2016, pp.5-8

Dermoscopic Changes of Melanocytic Nevi after Psoralen-Ultraviolet A and Narrow-Band Ultraviolet B Phototherapy.

Background:Phototherapy may alter the morphologic features of melanocytic nevi. Dermoscopy is a non-invasive method for evaluation of skin lesions, specifically melanocytic nevi.Aims and Objectives:This study was designed to evaluate the effects of narrowband ultraviolet B (NB-UVB) and psoralen-ultraviolet A (PUVA) therapy on the dermoscopic features of nevi.Methods:A total of 74 melanocytic nevi were randomly selected from 20 patients. Out of those, 54 nevi received NB-UVB, while 20 received PUVA. 50% of the nevi in each group were exposed to radiation, while the remaining nevi were covered with an opaque tape. All nevi were demoscopically evaluated before and after 30 or 60 sessions of phototherapy.Results:Overall demoscopic changes were observed in 34/37 (91.8%) of the uncovered nevi compared to 16/37 (43.2%) of the covered nevi (P value 0.0001). The most common changes were new dot/globule formation (62.1%), darkening (32.4%), nevus enlargement (27%), and patchy pigmentation (18.8%). Compared to NB-UVB, dermoscopic changes were more frequent in both covered and uncovered nevi of the PUVA group. (P values 0.041 and 0.0172, respectively). New dot/globule formation was observed more frequently in the covered and uncovered nevi of PUVA group.Conclusion:PUVA and NB-UVB induce dermoscopic changes in the majority of the irradiated nevi. However, PUVA is associated with higher frequency of dermoscopic changes in both covered and uncovered nevi.