PUVA Research Articles

Efficacy and Safety Comparison of Basic Fibroblast Growth Factor-Related Decapeptide 0.1% Solution (bFGFrP) Plus Oral PUVA Combination Therapy with Oral PUVA Monotherapy in the Treatment of Vitiligo.

Phototherapy in its different forms, is mainstay of vitiligo management. Combining treatment modalities like topical calcipotriol (for quicker, more intense repigmentation), Low dose azathioprine with PUVA have proven to be beneficial in management of vitiligo due to different mechanisms of repigmentation and their synergistic effects. Topical bFGF-related decapeptide (bFGFrP) application followed by sun exposure/ UVA phototherapy yields effective repigmentation. bFGFrP has shown to aid the targeted phototherapy in smaller lesions and its combinations with other treatment modalities have been very promising. However, there is paucity of studies on combination treatments; especially oral PUVA along with bFGFrP. This study was aimed at evaluating safety and efficacy of combination of bFGFrP with Oral PUVA in vitiligo (larger body surface area 20% or more). Phase IV, randomized, multicentre study (N = 120) in adult patients with stable vitiligo of 6 months treatment period with monthly follow up visits. Psoralen (Tab. Melanocyl) dosage 0.6 mg/kg orally 2 h before exposure to UVA phototherapy. Oral PUVA therapy, initially, at an irradiation dose 4 J/cm2 (PUVA group), followed by increments 0.5 J/cm2 every four sittings if tolerated for twice weekly. Primary end point was improvement in extent of repigmentation (EOR) in target lesion (at least 2 cm × 2 cm in greatest dimension, without leukotrichia), while secondary endpoints were improvement in patient global assessment (PGA) and safety at end of 6 months of treatment period in bFGFrP + oral PUVA combination group and Oral PUVA monotherapy group. End of 6 months, significantly greater EOR >50%) was achieved in 61.8% (34 patients, n = 55) from combination group while 30.2% (16 patients, n = 53) from the oral PUVA monotherapy group (n = 53). Regarding Grade of repigmentation (GOR), complete repigmentation was observed 5.5% (3 patients, n = 55) in combination group whereas no patient showed complete repigmentation in monotherapy group (p ≤ 0.05), PGA showed significant overall improvement in combination group (p ≤ 0.05); 6 patients (10.9%) from combination group Vs one (1.9%) showed complete improvement. During treatment period, there were no reported adverse events. Addition of bFGFrP to oral PUVA therapy resulted in intense and faster induction of repigmentation than oral PUVA monotherapy with favorable safety profile.

Evaluation of the Additional Effect of Vitix® Gel on Vitiligo Lesions in Patients Treated with Narrow-Band Ultraviolet-B Phototherapy

Vitiligo is a polygenic acquired skin disorder resulting from the destruction of melanocytes in epidermal cells. Conventional therapeutic options include covering agents, topical corticosteroids, topical immunomodulators, phototherapy with psolaren ultraviolet A (PUVA) and narrowband ultraviolet B (NBUVB). However, successful repigmentation with these modalities is expected only in half of the patients. This study aimed to compare the efficiency of topical Vitix® gel combined with NB-UVB versus NB-UVB alone in the treatment of vitiligo lesions. Thirty patients with vitiligo were enrolled in this study. All patients had relatively symmetrical lesions and received topical Vitix® gel in combination with NB-UVB on one side and NB-UVB alone on the other side. Data were analyzed using Wilcoxon and Mann-Whitney tests. Twenty-five patients completed the course of study (68% female, age: 32.3 ± 13.5 years). Five patients were excluded due to noncompliance to follow-up. The highest treatment response rate was observed in the upper limb’s lesions. However, no statistical difference was observed in patients treated with Vitix® gel combined with NB-UVB versus NB-UVB alone after adjusting for age, sex and lesions’ site (p > 0.05). Significant additional clinical repigmentation was not observed by adding Vitix® gel to NBUVB therapy in treatment of vitiligo lesions.

Effect of phototherapy on psychoemotional state in psoriasis: assessment of depression, anxiety and quality of life

BACKGROUND: Psoriasis is a widespread chronic genetically determined inflammatory dermatosis that affects approximately 125 million people worldwide. In the vast majority of cases, the first rashes appear in people younger than 35 years old who are just starting to build a career and start a family. Localization of psoriatic rashes on visible areas of the skin and stigmatization in society, regular exacerbations and multiple courses of expensive and insufficiently effective treatment negatively affect the quality of life and emotional state of patients up to the development of depressive and anxiety disorders, and even suicide attempts. An imbalance of mental status leads to the progression of psoriasis, which further aggravates the course of the skin process. This necessitates a personalized approach to the choice of a therapy method, taking into account high efficiency and maximum comfort for patients, which will improve their psychoemotional state.
 AIM: to study the effect of phototherapy (PUVA and UVB-311 nm) on the mental status of psoriasis patients
 MATERIALS AND METHODS: A prospective study was conducted on the basis of FGKU Central Polyclinic and V.A. Rakhmanovs clinic of skin and venereal diseases of Sechenov University with the participation of 228 patients with moderate-to-severe psoriasis who received UVB-311 nm (n=116) and PUVA therapy (n=112), including psoriasis vulgaris (n=193), guttate psoriasis (n=14), exudative psoriasis (n=21). Before and after treatment, patients were assessed for the severity of psoriasis (PASI), quality of life (DQLI), as well as the presence of depression and anxiety disorders (panic disorder, social phobia) using PHQ-9 and GAD-7 questionnaire tests. The initial radiation dose was 1 J/cm2 at PUVA and 0.10.2 J/cm2 at UVB-311 nm with a gradual increase in the dose every 12 sessions by 0.5 J/cm2 and 0.1 J/cm2, respectively. As photosensitizers ammifurin and oxoralen were used. The treatment was carried out according to the method of four-time irradiation per week using the UV-7001K cabin (Waldmann, Germany).
 RESULTS: Among 228 patients there were 108 women and 120 men aged 438.2 years. The UVB-311 nm group included 102 patients with moderate psoriasis vulgaris and 14 guttate psoriasis, the second group (PUVA) included patients with severe recalcitrant psoriasis vulgaris (n=91) and exudative psoriasis (n=21). In the first group, the course of therapy consisted of 282 procedures of UVB-311 nm. Before treatment, minimal depression was observed in 19 (16%) patients, mild depression in 87 (75%), moderate depression in 10 (9%). A high level of anxiety was observed in 94 (81%), the average level in 22 (19%) patients. At the end of the course of UVB, PASI 90 was achieved in 94% (n=109) of patients, PASI 100 in 88% (n=102); at the same time, on average, anxiety decreased by 80%, depressive symptoms decreased by 73%, quality of life increased by 92%. In the second group, the PUVA course consisted of 253 irradiation sessions. Before starting therapy, minimal depression was observed in 12 (11%) cases, mild depression in 73 (65%), moderate depression in 27 (24%). A high level of anxiety was characteristic of 100% of patients. As a result of therapy, PASI 90 was achieved in 95.5% (n=107) of cases, PASI 100 in 90% (n=101). The average severity of anxiety, depression, and quality of life improved by 88%, 83%, and 96% respectively.
 CONCLUSION: PUVA and UVB-311 nm have demonstrated high efficacy and safety in moderate-to -severe psoriasis, contributing to the rapid cleansing of the skin from rashes and improving the psycho-emotional state, which not only significantly improves the quality, but also increases the life expectancy of patients.
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Hereditary keratoderma. Clinical case: Unna–Toast keratoderma and Buschke–Fischer–Brauer keratoderma

Palmoplantar keratoderma is a heterogeneous group of diseases, both hereditary and acquired, affecting, as a rule, the skin of the palms and soles in the form of focal or diffuse hyperkeratotic layers. Hereditary forms are characterized by a defect in the genes encoding certain structural components of keratinocytes, which leads to the corresponding clinical manifestations. The actual method of genomic sequencing has made it possible to identify the localization of defects in certain genes for specific types of hereditary palmoplantar keratoderma, however, despite the big step in diagnosis, therapy still remains complex and can only reduce the manifestations of the disease and improve the quality of life, and not cure it completely.
 The authors demonstrate a clinical case of UnnaToast keratoderma in a young patient with a long history of treatment of the disease, who showed a pronounced positive dynamics from the skin process against the background of the use of local agents, as well as the use of such a physiotherapeutic method as local PUVA therapy. In addition, the article provides a clinical case of hereditary keratoderma BuschkeFischerBrauer as an example of an accidentally diagnosed disease at a dermatologists appointment.

534 NB-UVB therapy response of different body regions in vitiligo

Narrow-Band Ultraviolet B (NB-UVB) in combination with topical therapy is a widely used treatment for non-segmental vitiligo (NSV). The location of the vitiligo lesions is of influence on the potential repigmentation response after therapy. To date however, these differences in therapeutic response between specific anatomical areas of the body have not been fully characterized. This study aimed to evaluate the clinical response NB-UVB therapy in 19 different body regions. A multicentre study of NSV patients starting with NB-UVB therapy was performed in hospitals in Egypt, Singapore and the Netherlands.

Efficacy and safety of PUVA and UVB-311 nm in psoriasis: single-center retrospective study

BACKGROUND:Psoriasis is a widespread, genetically determined immunemediated dermatosis of a multifactorial nature, characterized by a recurrent course with frequent associative damage to other organs and systems, which significantly reduces the quality of patients lives. For many years, phototherapy (PUVA and UVB-311 nm) has had one of the leading places in the treatment of moderate and severe psoriasis according to the world dermatological communities. However, with the advent of genetically engineered biological drugs, the frequency of its administration has significantly decreased.
 AIM:to evaluate the efficacy and safety of PUVA and UVB-311 nm in the treatment of moderate and severe psoriasis.
 MATERIALS AND METHODS:A retrospective study was conducted on the basis of the Federal State Institution Central polyclinic with the participation of 920 patients with moderate and severe psoriasis who received phototherapy (PUVA and UVB-311 nm) in the period from 2005 to 2021. The initial radiation dose was 0.51 J/cm2at PUVA and 0.10.2 J/cm2at UVB-311 nm with a gradual increase in the dose every 12 sessions by 0.5 J/cm2and 0.1 J/cm2, respectively. The treatment was carried out according to the method of four-time irradiation per week using the UV-7001K cabin (Waldmann, Germany).
 RESULTS:Among 920 patients there were 478 (52%) men and 442 (48%) women (aged 21 to 68 years). The average age of psoriasis onset is 345.2 years. The duration of the disease averaged 10.58.2 years. Vulgar psoriasis was observed in 756 (82%) patients, teardrop-shaped ― in 36 (4%), exudative ― in 73 (8%), inverse ― in 55 (6%). 249 (27%) were diagnosed with psoriatic arthritis. On average, the first phototherapy sessions were prescribed 2.11.6 years after the onset of the disease. The choice of phototherapy method depended on the severity of the process. Thus, with moderate psoriasis, patients were prescribed UVB-311 nm (n=473). The course consisted of 2535 sessions of radiation with a cumulative dose of 35.35.9 J/cm2. Clinical remission was observed in 93% of patients, significant improvement ― in 7%. The achieved clinical remission was maintained for 361194 days. In total, during the studied period, 149 people received 27 courses of UVB-therapy, 132 ― 24 courses, 53 ― 19 courses, 69 ― 15 courses, 58 ― 11 courses, 12 ― 7 courses. Multiple infiltrated plaques and refractory course of severe psoriasis was an indication for PUVA therapy (n=447). The course consisted of 2030 irradiation sessions with a cumulative dose of 81.514.3 J/cm2. Clinical remission was observed in 98% of patients, a significant improvement in 2%. 14 people received 23 courses, 21 ― 20 courses, 12 ― 19 courses, 227 ― 15 courses, 104 ― 13 courses, 33 ― 10 courses, 27 ― 4 courses, 9 ― 2 courses of PUVA. The achieved clinical remission was maintained for 420275 days. 12 (1.3%) patients cancelled PUVA prematurely due to the inability to take a photosensitizer. In other cases, the observed side effects were minor and did not cause discontinuation of therapy.
 CONCLUSION:PUVA and UVB-311 nm have demonstrated high efficacy and safety in the treatment of moderate and severe psoriasis. At the same time, it is necessary to conduct further research to improve the methods of phototherapy for faster achievement of long-lasting clinical remission, which will allow phototherapy to regain its leading position in the treatment of psoriasis, increasing the doctors trust and patients compliance.

A review on PUVA pricks-A debilitating adverse event.

PUVA phototherapy is indicated for various dermatological conditions. Adverse events due to PUVA phototherapy are seen in a sizable number of patients and can result in therapy cessation. This review will focus on PUVA pricks, an adverse event first reported by Tegner in 1979. Articles were retrieved from PubMed starting from January 1979 until February 2021 yielding 1228 unique articles. Articles were included when they described individual patient characteristics, and patients were treated with PUVA therapy. After screening, 33 patients were extracted from 9 articles, published between 1979 and 2005. PUVA pricks are paroxysmal episodes of burning or prickling pain, akin to peripheral neuropathy of the unmyelinated C-fibers. Increased excitability of TRPV1 and TRPA1 channels while under PUVA therapy might be a contributing factor. Effective topical treatment options for PUVA pricks are capsaicin 8% cream, urea 4%, or petrolatum emollients. Antiepileptics such as phenytoin, clonazepam, and gabapentin are acceptable oral treatment options. A possible role of N-acetylcysteine in the prevention of PUVA pricks is discussed, though further research is required.

"Fundamental principles of photodynamic, laser and PUVA therapy": a session of the Russian Photobiology Society 9th Congress (Shepsi, Krasnodar region, Russia; September, 12-19, 2021).

At the section "Fundamentals of photodynamic, laser and PUVA therapy," 32 reports were presented in full-time and on-line format. Representatives of various scientific schools reported on the results of fundamental and applied research on the processes occurring at the cellular and organismal levels upon irradiation with low-intensity red light and upon the introduction of photosensitizers of various nature, followed by laser irradiation. Scientific reports proposed new photosensitizers, as well as their conjugates with biologically active molecules for fluorescent diagnostics and photodynamic therapy of oncological diseases. Plenary reports were presented by Professor Mikhail Grin "Natural chlorins as a promising platform for creating drugs with photoinduced antitumor and antimicrobial activity," Professor Alexander Krasnovsky "Laser activation of dissolved oxygen in natural conditions," and Professor Elena Filonenko "Photodynamic therapy in the treatment of demodicosis of the facial skin with topical application of a gel based on 5-ALA." At the poster section, young scientists presented 18 posters, which describe in detail the research voiced in the section reports.

522 Skin microbiome in cutaneous T-cell lymphoma is associated with phototherapy treatment response

The cutaneous T cell lymphoma(CTCL) microbiome is poorly understood despite evidence that CTCL patients have an increased risk of skin infections with disease progression. Narrowband UVB therapy(UV) has response rates of 54-90% in early-stage disease. Here, we examined skin microbial changes of 25 UV-treated CTCL patients (20 mycosis fungoides, 2 Sézary syndrome, 3 unspecified CTCL; 14 responders [R], 11 non-responders [NR]) using 16S gene sequencing. For lesional skin(LS), microbial richness was unchanged in R pre- and post-UV, but decreased after UV in NR (Simpson, p=0.046).

A novel mouse model of cutaneous T-cell lymphoma revealed the combined effect of mogamulizumab with psoralen and ultraviolet a therapy.

Mycosis fungoides (MF) is a subtype of cutaneous T-cell lymphoma (CTCL). Topical or systemic treatment with psoralen, such as 8-methoxypsoralen (8-MOP), followed by ultraviolet A (UVA) irradiation (PUVA therapy) is an effective phototherapy for early-stage MF. However, the efficacy of PUVA therapy for advanced-stage MF is not satisfactory, and the ideal combination partner for PUVA therapy has not yet been found. In this study, we developed a new mouse model of CTCL in which efficacy of PUVA was detected and further evaluated the efficacy of combination treatment of PUVA and mogamulizumab, an anti-CCR4 monoclonal antibody. Cytotoxicity of PUVA therapy against HH cells, a CTCL cell line, was observed in vitro. The cytotoxicity was dependent on both 8-MOP and UVA. Using HH cells, we developed a mouse model in which HH cells were subcutaneously inoculated in the ear. In this model, PUVA therapy suppressed tumour growth with statistical significance, while 8-MOP or UVA alone did not. Combination therapy of PUVA and mogamulizumab showed greater antitumor activity than either monotherapy with statistical significance. In the histological analysis of the tumour tissue, PUVA accelerated tumour necrosis and then induced the infiltration inflammatory cells in the necrotic area, suggesting that these cells served as effector cells for mogamulizumab. This combination therapy is expected to be a beneficial option for CTCL therapy.

Alteration of gut microbiota during narrowband ultraviolet B therapy in psoriasis: A preliminary study.

Gut microbiome dysbiosis is associated with psoriasis development. A relationship between gut microbiota and psoriasis treatment response has been reported. No study has reported the effect of narrowband ultraviolet B (NBUVB) therapy, a standard treatment of psoriasis, on gut microbiota. This study aimed to evaluate gut microbiota change during NBUVB therapy. Stool samples from 22 participants, including 13 patients with chronic plaque psoriasis and nine healthy controls, were recruited. Faecal microbiota composition was analysed using 16S rRNA sequencing before and after NBUVB therapy. Serum 25-OH vitamin D of patients with psoriasis was evaluated simultaneously. The most abundant phyla of gut microbiota in patients with psoriasis were Firmicutes, Bacteroidetes, Proteobacteria and Actinobacteria in all participants. Bilophila, Paraprevotella, Alistipes, Sutterella, Romboutsia, Clostridium sensu stricto and Agathobacter are significantly more enriched in healthy controls. Lactobacillales and Ruminococus torques appeared more enriched after NBUVB treatment in responders but not non-responders. Serum vitamin D levels significantly increased after NBUVB treatment. The present study revealed that gut microbiota altered after NBUVB treatment. The change might be treatment-specific and influence the treatment response.

PUVA therapy in persistent cutaneous histiocytosis: Case report and literature review.

Cutaneous and mucocutaneous histiocytosis (group C) comprise a wide variety of entities affecting skin and/or mucosae. Although they are considered as reactive proliferations, their exact pathophysiology remains unknown and, therefore, they lack a specific treatment. The aim of this study is to review the evidence on cases of histiocytosis treated with UVB and/or UVA and to report a new case of relapsing group C histiocytosis that has been successfully treated with PUVA therapy. We have conducted a review of the literature published over the last 40 years on the treatment of histiocytosis with phototherapy in the online PubMed database. We also describe a new case of successful treatment of histiocytosis with PUVA therapy. Our patient was a 27-year-old man with persistent outbreaks of cutaneous histiocytosis over the previous 8 years. He responded successfully to PUVA therapy, and no relapse has been detected after one year of follow-up. Self-involution is usual in group C histiocytosis, so conservative management is usually the first approach. Relapsing cases pose a therapeutic challenge. Reported treatment options for these patients include isotretinoin, cryotherapy, immunosuppressants, low-dose chemotherapy, CO2 laser, radiotherapy, and surgery. Phototherapy and photochemotherapy have been used in a small number of patients with considerable success. The main limitation to provide firm recommendations on histiocytosis therapy is the absence of solid evidence, as the articles published are mainly case reports with a short follow-up. In our patient, despite the short follow-up we have considered photochemotherapy to be effective since no spontaneous remission had been achieved in the previous 8 years. PUVA therapy could be a safe and effective option to treat persistent cutaneous manifestations in patients with histiocytosis, although more evidence is required to support this statement.

Scleroderma-like form of lipoid necrobiosis in a patient with idiopathic thrombocytopenic purpura

A 33-year-old female patient with idiopathic thrombocytopenic purpura complained of rashes on the skin of the lower extremities, accompanied by moderate itching and a feeling of skin tightness, as well as a histologically verified diagnosis of lipoid necrobiosis. A combined treatment was carried out with the glucocorticosteroid Methylprednisolone at a dose of 32 mg per day in combination with PUVA therapy with 0.3% solution of ammi majus fructuum furocumarines, with a positive effect in the form of a decrease in the color intensity and induction of rashes, under the control of platelet levels. When using the method of PUVA-therapy with 0.3% solution of ammi majus fructuum furocumarines, there was an improvement in the 8th phototherapy procedure, however, due to a decrease in the level of platelets in the blood, the course of phototherapy was suspended.
 The method of PUVA therapy with 0.3% solution of ammi majus fructuum furocumarines turned out to be clinically effective in the treatment of lipoid necrobiosis, however, the presence of concomitant pathology in the patient requires an interdisciplinary approach to the choice of treatment tactics.

Chronicles of A.I. Pospelov Moscow Society of Dermatovenerologists and Cosmetologists (MSDC was founded on October 4, 1891). Bulletin of the MSDC № 1142

On March 16, 2021, the 1142nd meeting of the Moscow Society of Dermatovenereologists and Cosmetologists named after A.I. Pospelov took place.
 Two people have been accepted as members of the MODV: the list of new members was approved unanimously.
 The agenda includes a discussion of two clinical cases. The interest in the first demonstration ― mushroom mycosis lies in the relative rarity of T-cell lymphomas in the skin clinic, as well as the effectiveness of PUVA therapy in the plaque stage of the disease. Another observation is a case of acquired epidermolysis bullosa, a rare sporadic autoimmune disease with increased skin injury, the formation of subepidermal blisters, the presence of antibodies against type 7 collagen, the prognosis for which is usually favorable and even with a possible spontaneous recovery.
 A number of scientific reports were made at the meeting. The first of them is on the problems of vulgar acne. The patient-oriented approach for vulgar acne implies individual, personalized treatment of the patient. Among the strategic directions in the development of therapeutic approaches to patients with vulgar acne, special attention, in addition to external remedies, systemic therapy, physiotherapy and cosmetic care, should be paid to the adherence of patients to treatment. Among the various technologies for determining the severity of vulgar acne, an interactive electronic DIA calculator developed at the Department of Skin Diseases of Sechenov University, combined with medicinal recommendations in accordance with a certain severity of the disease of a particular patient, deserves attention.
 The report on modern and classical methods of diagnosis of human and animal mycoses represents the most pressing issues of medical mycology in general and dermatomycology in particular due to their extreme prevalence. To date, all laboratory methods for the diagnosis of mycoses can be divided into classical and modern high-tech, while in most laboratories on the ground, almost only confocal microscopy has been introduced.
 The last report was devoted to dermatoses that developed at the site of tattoos and tattooing. Since the composition of the coloring pigment includes iron oxide, titanium dioxide, isopropyl alcohol, natural organic and inorganic pigments, dermatoses such as benign lymphoplasia (lymphocytoma), sarcoidosis, psoriasis, discoid lupus, vitiligo, vasculitis, lichen planus, annular granuloma, lipoid necrobiosis, melanoma may develop in places of skin damage, basal cell carcinoma, gangrenous pyoderma, mycosis, syphilis, tuberculosis. It is noted that the treatment of lymphocytoma and sarcoidosis is a difficult task.

Utility of phototherapy in patients with systemic sclerosis: Systematic review.

Phototherapy is a recommended treatment regimen for different scleroderma spectrum disorders, but so far it has been included neither by European nor by worldwide experts committee in recommendations for the treatment of systemic sclerosis (SSc). The aim of the study was to revisit the utility of dermatological phototherapy in patients with SSc. PubMed using medical subject headings was searched to identify studies evaluating response to dermatological phototherapy in SSc patients. Both UVA1 (340-400 nm) and PUVA (psoralen plus UVA) treatments were found to reduce skin thickening and increase skin elasticity, therefore allowing for the improvement of joint tension mobility, especially in hands. At least several papers showed efficacy of phototherapy in patients who remained non-responsive to previous immunosuppressive therapies. The most probable mechanisms of action of phototherapy in SSc include inhibition of T-cells and prevention from dermal fibrosis. Although most data on the efficacy of phototherapy come from small experimental studies and case reports, phototherapy based on UVA of wavelength manifests relatively mild spectrum of side effects and this should be considered as a treatment option for SSc with dominant cutaneous involvement.

Influence of narrow-band ultraviolet B therapy on sirtuin 1 expression in lesional skin of patients with chronic plaque psoriasis: Relation to clinical improvement and interferon-γ expression.

Reduced sirtuin 1 (Sirt1) expression in psoriasis was previously reported, and its activation was associated with disease improvement. Narrow-band ultraviolet B (NB-UVB) downregulates several pro-inflammatory cytokines such as interferon-γ (IFN-γ) and influences keratinocyte differentiation in psoriasis. The aim of this study was to study the in vivo influence NB-UVB treatment on Sirt1 expression in psoriatic skin in relation to disease improvement and IFN-γ expression. Twenty-six patients with chronic plaque psoriasis were evaluated, and psoriasis area severity index (PASI) was calculated. Skin biopsies were taken from lesional skin of the patients before and after 3 months of treatment with NB-UVB and from 26 controls, where the distribution and immunohistochemistry (IHC) scores of Sirt1 and IFN-γ were determined. After 3 months of treatment, Sirt1 distribution and epidermal IHC score were significantly higher, whereas Sirt1 dermal IHC score and IFN-γ distribution, epidermal and dermal IHC scores were significantly lower than the pre-treatment values. Before and after 3 months of NB-UVB therapy, PASI showed a significant negative correlation with Sirt1 distribution and epidermal IHC score; and a significant positive correlation with interferon-γ distribution and epidermal IHC score. Moreover, Sirt1 distributions were negatively correlated with the corresponding interferon-γ distributions. Conclusions The detected upregulation of epidermal Sirt1 following NB-UVB therapy possibly represents another mechanism by which NB-UVB can act in psoriasis and also highlights the role of Sirt1 upregulation in psoriasis treatment.

Comparison of Efficacy of Combination of Acitretin and Narrow Band Ultraviolet B versus Narrow Band Ultraviolet B Alone in the Treatment of Chronic Plaque Psoriasis

Objective: To compare the efficacy of combination of narrow band ultraviolet B (NBUVB) and Acitretin (ReUVB) versus NBUVB alone in the treatment of moderate to severe plaque psoriasis. Method: This randomized clinical trial was conducted at the Department of Dermatology Services Hospital, Lahore from October 2020 to April 2021. After getting approval from Ethical Review Committee, 100 patients of moderate to severe plaque psoriasis were enrolled. They were divided into two groups of fifty patients each. Group A patients received both acitretin and NBUVB therapy while group B received NBUVB therapy alone for 8 weeks. PASI 50 was set as the efficacy end point. PASI scores and photographs taken before and after treatment were analysed. Results: Mean age of patients was 34.99 ± 9.28 years. In group A, 46 (92%) patients achieved PASI 50 while in group B, 19 (38%) patients achieved PASI 50. Therefore, the efficacy of combination of acitretin and NBUVB was significantly higher compared to NBUVB alone. Statistically significant effect of age, gender, body mass index and duration of disease was found on efficacy. Conclusion: Narrow band Ultraviolet-B therapy is a useful treatment modality in moderate to severe psoriasis. However, combining it with acitretin can significantly enhance its efficacy. How to cite: Qadeer F, Tariq H, Aman S.. Comparison of Efficacy of Combination of Acitretin and Narrow Band Ultraviolet B versus Narrow Band Ultraviolet B Alone in the Treatment of Chronic Plaque Psoriasis. Esculapio - JSIMS 2022;18(01):6-10.

Cardiovascular diseases in patients with psoriasis in clinical practice: case report. Eurasian heart journal

Psoriasis is a genetically determined multifactorial disease that affects about 2% of the population. According to modern concepts of this disease, the level of comorbid diseases, especially those associated with damage to the cardiovascular system, is high. This article presents a clinical case of severe disseminated psoriasis vulgaris, progressive stage, mixed form in a patient with a very high cardiovascular risk. The uniqueness of this clinical case lies in the combined course of psoriasis and such comorbid diseases as: severe hypertension, obesity, dyslipidemia, type 2 diabetes mellitus (DM), hyperuricemia. The main clinical manifestations were the presence of widespread lesions on the patient’s skin, episodes of discomfort behind the sternum during physical activity, as well as destabilization of blood pressure numbers (maximum rise to 180/100 mm Hg). As part of the hospitalization in the skin clinic, the patient underwent topical ointment therapy with the use of glucocorticoid ointments, ointments containing salicylic acid, PUVA therapy, as a result of which the skin process showed positive dynamics with regression of lesions by 90-100% with an outcome in residual hyperpigmentation, no new lesions were noted. During hospitalization to a therapy department, the optimal antihypertensive, lipid-lowering, uricosuric, hypoglycemic therapy was selected, as a result of which it was possible to achieve an improvement in the patient’s condition, stabilization of blood pressure at the level of 130-140/70 mm Hg. So patients with psoriasis require careful assessment of cardiovascular risk in clinical practice. A multidisciplinary approach will not only improve the quality of life of patients, reduce the likelihood of major cardiovascular events, but also increase life expectancy and reduce mortality.

Effect of PUVA and NB-UVB Therapy on the Skin Cytokine Profile in Patients with Mycosis Fungoides.

Background Mycosis fungoides (MF) is the most common subtype of cutaneous T-cell lymphoma. The aim of the present study was to produce up-to-date information on different phototherapy approaches on skin cytokines in patients with MF. Methods A total of 27 patients with mycosis fungoides were treated with phototherapy: NB-UVB (narrow‐band ultraviolet B therapy) (10 patients) and PUVA (long-wavelength ultraviolet radiation of spectrum A with the use of skin-photosensitizing furocoumarins) therapy (17 patients). Evaluation of the effectiveness of treatment was carried out using BSA (body surface area) and the modified assessment of the severity of the skin lesions scale (mSWAT) used to quantify tumor mass in cutaneous T-cell lymphomas. Average numbers of procedures were 30.2 and 27.8 in the NB-UVB and PUVA groups, respectively. The median total dose of NB-UVB irradiation was 19.9 J/cm2 and PUVA therapy was 104.0 J/cm2. The overall response to therapy including complete and partial remission was 74.9% in the total group; 70% in the NB-UVB group, and 77.7% in the PUVA therapy group. In the obtained biopsies from lesions, surrounding tissue before treatment and skin samples of four healthy volunteers, the concentration of the IL-1β, IL-4, IL-6, IL-10, IL-17A, IL-17F, IL-21, IL-22, IL-23, IL-25, IL-31, IL-33, IFN-γ, sCD40L, and TNF-α cytokines was studied. An increase in IL-4 and TNF-α levels was shown in the lesional skin of patients compared to the skin of healthy controls. After the treatment, positive correlations of mSWAT with the levels of IL22, IL33, and TNF-α in the tumor tissue were found. The levels of IL10 and IFN-γ after PUVA treatment were increased in comparison to baseline. There was no difference in cytokine levels before/after NB-UVB therapy.

Low Dose Oral Alitretinoin With Narrowband Ultraviolet B Therapy for Chronic Hand Dermatitis.

BackgroundChronic hand dermatitis (CHD) is difficult to treat and has high individual and societal burdens. Phototherapy and oral alitretinoin are safe monotherapies for CHD, but their combination has not been assessed.ObjectiveTo assess the effectiveness and safety of low dose oral alitretinoin combined with phototherapy versus high dose oral alitretinoin for CHD refractory to topical corticosteroids.MethodsThis retrospective study of adult patients with CHD refractory to topical corticosteroid therapy compared low dose oral alitretinoin (10 mg three times weekly) combined with narrowband ultraviolet B therapy (three times weekly; LDA-UVB) to high dose oral alitretinoin (30 mg daily; HDA) for 16 weeks. Outcomes were improvement in disease severity measured by the Physician’s Global Assessment and quality of life measured with the Dermatology Life Quality Index.ResultsThe mean age of the study population (n = 64) was 41.25 years and 57.8% were male. Both cohorts experienced improvements in disease severity and quality of life after 16 weeks, however, significantly more participants who received LDA-UVB (n = 21/33, 63.6%) achieved “clear” or “almost clear” assessments compared to those who received HDA (n = 12/31, 38.7%; P < .05). Adverse effects were significantly more prevalent in the HDA group (P < .0001) and included headache, elevated cholesterol, and dry lips.ConclusionsThe combination of low dose oral alitretinoin with narrowband-UVB therapy was more effective and had fewer adverse effects compared to high dose oral alitretinoin for participants with CHD refractory to topical corticosteroid therapy.