PUVA Research Articles

Sensitivity of wild and domesticated Rhododendron chrysanthum to different light regime (UVA, UVB, and PAR)

Effects of UV radiation on photosynthetic capacity of wild and domesticated Rhododendron chrysanthum were compared by applying PAR (P), P + UVA (PA), and P + UVA + UVB (PAB) radiation for 3 d, respectively. Results showed that photosynthetic activity of two R. chrysanthum types was not affected by UVA but inhibited by UVB, and the inhibitory effects of UVB were dose-dependent. Changes in nonphotochemical quenching suggest that the range of photosynthetic capacity is ranked as follows: 24-48 h of UVB dose < wild type < 72 h of UVB dose < domesticated type, indicating that the wild type initiated photoprotective function in response to UVB stress due to its lower photosynthetic capacity, while domesticated type did not due to its higher photosynthetic capacity. Taken all the given data together, the wild type was more sensitive to UV stress, but it showed more effective mechanisms of counteracting it.

Evaluation of serum folate level before and after bath PUVA therapy in patients referred to Razi Hospital, Rasht, Iran

Ultraviolet (UV) radiation could disintegrate folate molecule, so phototherapy may reduce folate levels in the patients. The effect of phototherapy on serum folate in human body is questionable. We investigated the effect of bath PUVA therapy on serum folate level. This study was designed as a before-after study. Thirty-two patients completed study during 2 years. Our variables were demographic data, folate levels before and 8 weeks after treatment and cumulative dosage of UVA during 8 weeks of treatment. Serum folate was evaluated with chemiluminescence immunoassay technique. All data were analyzed using SPSS 18 software. Folate level changes were statistically significant before and after bath PUVA therapy. There was no significant difference in folate levels in psoriasis patients compared with nonpsoriasis patients. In psoriasis patients, folate levels had no significant correlation with psoriasis activity index before treatment. Decrease in folate levels was more significant in fair-skinned patients. There was no association between folate status and cumulative dosage of UVA. Bath PUVA therapy reduced serum folate level in our patients although none of them were folate deficient. Folate deficiency should be evaluated and corrected especially in fair-skinned cases, as it may be aggravated by phototherapy.

PUVA AND INTERFERON α2b COMBINED THERAPY FOR PATIENTS WITH MYCOSIS FUNGOIDES: A SEVEN‐YEAR RETROSPECTIVE STUDY IN RUSSIA

Introduction: Cutaneous T-Cell Lymphomas (CTCLs) are characterized by proliferation and accumulation of malignant monoclonal T lymphocytes or Natural Killer cells in the skin, which may also sequentially involve lymph nodes, internal organs and bone marrow. There are still only a limited number of controlled studies to support treatment decisions for MF patients with therapy being frequently determined by institutional experience and availability. The aim of our survey was to investigate the efficacy and tolerability of combined PUVA and IFN-α2b therapy in patients with different stages of MF, refractory to first line treatment with PUVA. Methods: We observed 31 patients with MF. The diagnoses were verified with histological, immunohictochemical methods and molecular analysis. The following combined IFN-α2b - PUVA treatment protocol was used: IFN-α2b was administered at a dose of 3 MU three times weekly. The dose was increased according to patient's tolerance up to 6 MU three times weekly. For PUVA therapy, 0.8 mg/kg oral 8-methoxypsoralen was given 1.5 hours before UVA radiation, three times a week with gradually increasing dose of 0.5-1.0 J/cm2 in every 2 sessions starting from a dose of 0.5-2 J/cm2 depending on skin phototype. Treatment toxicity was graded according to World Health Organization (WHO) criteria. Results: In terms of the stage of the disease, patients were distributed as follows: IB – 3 (10%), IIA – 7 (23%), IIB – 6 (19%), IIIA – 4 (12%), IIIB – 3 (10%), IVA – 3 (10%), IVB – 5 (16%). The mean total IFN-α2b dose was 275 MU (range 171-576 MU). Conversely, the median PUVA sessions for the entire group of patients was 81 with the median joules/ cm2 being 177.13 (range 127-204 joules/ cm2) and the median combination treatment period being 189 days (range 133–254 days). The overall response rate was 93%, including complete response (CR) (73%) and partial response (PR) (20%). CR was found in 100% stage IIB-IIIA group respect 0% in stage IIIB-IV, P<0.05; the CR rate was in line with the mean CR percentage reported in previous studies (76.5%). Patients with early stage disease had a 2-year progression free survival of 100% vs. 82% for the advanced stage group (P<0.001). In our study, combined treatment showed a 2- and 5-year progression free survival (PFS) of 90% and 43%, respectively; obviously, patients with early stage disease had a superior 2-year PFS respect to the advanced stage group (100% vs 82%) (P < 0.001). Сonclusion: IFN-α2b + PUVA combined treatment seemed to be an efficacious therapy option for MF patients refractory to PUVA ± topical corticosteroids, presenting also a convenient tolerability profile, especially in patients with IB-IIB stage. This combined therapy protocol showed to be effective in both early and advanced MF disease stage, even if significantly better outcomes were observed for early stage disease. Keywords: interferon (INF); mycosis fungoides (MF); phototherapy.

Sneddon — Wilkinson disease: Review of the modern literature

The article provides a current overview of the correlation between a rare dermatosis — subcorneal pustulosis (Sneddon — Wilkinson disease) — and various diseases of internal organs; features of immunological changes; the role of desmocollin 1, chemoatractants, interleukin-1β, interleukin-6, interleukin-8, interleukin-10, leukotriene B4, tumour necrosis factor-alpha and K5a complement fraction in the pathogenesis of the disease. In this work, the authors describe the features of the clinical picture of the disease, as well as diagnostic criteria, including the use of serum protein electrophoresis. Histological features of the disease are discussed in detail. In addition, modern methods for treating this disease, including the use of dapsone, acitretin, infliximab, PUVA therapy are presented.

Experiencia en el uso de fototerapia en pacientes pediátricos y comparación de esta técnica frente a pacientes adultos

IntroductionPhototherapy involves the use of UV radiation to treat different dermatologic diseases. Its efficacy and safety have been thoroughly established in adults and some publications indicate that it is also an effective and safe treatment in pediatric patients with refractory skin diseases. Material and methodsRetrospective study that included all patients under 17 years of age and 122 randomly selected adults who received phototherapy in our department between 2002 and 2017. ResultsNinety-eight pediatric patients (61% girls and 39% boys) with a mean age of 10.5 years received phototherapy. The 3 most frequently treated diseases were psoriasis (48% of patients), vitiligo (17%), and atopic dermatitis (16%). Eighty-six percent of the patients received phototherapy with narrowband UV-B, whereas 7% received phototherapy with psoralen and UV-A (PUVA). No statistically significant differences were found in terms of dosage, duration, or number of sessions compared to the adult population treated with narrowband UV-B therapy or PUVA. A complete response was achieved in 35% of the pediatric patients and no differences were found with respect to the adults. Only 16% of the children showed adverse effects, mostly in the form of mild erythema. We found greater adherence to treatment in the pediatric patients than in the adult patients (P<.05). ConclusionsNarrowband UV-B therapy and PUVA appear to be safe and effective in children and can be administered using the same treatment protocols as those used in adults. Adherence to treatment is greater in children than in adult patients.

Outcomes of various types of therapy in patients with treatment-resistant acrodermatitis continua of Hallopeau.

Background: Chronic acrodermatitis continua of Hallopeau (ACH) is a rare form of pustular psoriasis predominantly affecting the distal phalanges of the fingers and toes. The disease manifests by pustular rash with marked infiltration, fissures, and often results into severe dystrophy of nail plates. ACH is refractory to most of psoriasis standard of care (SOC) therapies.Objective: The objective of this study is to assess the prospects of secukinumab therapy of ACH based on current clinical observation.Methods: We observed a female patient with ACH. Number of SOC treatments were applied in that case including local PUVA therapy, systemic retinoids, methotrexate, and biologic agents.Result: Secukinumab, a IL-17 inhibitor, demonstrated pronounced clinical effect in the case of ACH refractory to other SOC therapies.Conclusion: IL-17 inhibition provided by secukinumab was linked to clinically meaningful improvement in the heavily pretreated ACH. Further exploration and clinical studies may be important to provide more data on secukinumab effects in ACH.

Incidence of non-melanoma skin cancer in patients treated with psoralen and ultraviolet A therapy

IntroductionStudies reporting incidences of non-melanoma skin cancer (NMSC) are heterogeneous, depend on the geographic area of the studied population and are often short-term. The aim of this study is to determine the incidence of NMSC in patients treated with oral PUVA therapy in the Mediterranean area. Material and methodsA retrospective, observational study was carried out with a sample of 234 patients treated with systemic PUVA between 1982 and 1996, carrying out a historical follow-up until May 2017. The incidence density rate of CCNM (crude and adjusted) was calculated by direct standardisation. The incidence of CCNM was compared with that reported in the general population in a similar geographical area. Results50 neoplasms were diagnosed in 22 patients. The prevalence of CCNM in patients treated with phototherapy was 10.3%. The mean follow-up time was 21 years. The crude-adjusted incidence density rate of CCNM was 554.4–183.9 cases/100,000 treated patients per year. The crude-adjusted incidence density rate of basal cell carcinoma was 352.3–111.2 cases/100.000 patients and of squamous cell carcinoma was 229–77.7 cases/100,000 patients. ConclusionPUVA therapy is associated with an increased risk of CCNM in the Mediterranean population.

The efficacy and safety of targeted narrowband UVB therapy: a retrospective cohort study

Background/aim Phototherapy is a safe and effective treatment modality for numerous dermatological conditions. Recently, targeted phototherapy modalities have gained importance due to their advantages over conventional phototherapy. This retrospective study aimed to evaluate the safety and efficacy of targeted narrowband UVB phototherapy in patients with dermatological disorders.Materials and methods This single-center study included 173 patients who were treated with targeted narrowband UVB phototherapy. Demographic features, phototherapy parameters, and adverse effects were evaluated in all patients, and the treatment response was assessed in patients who attended at least one follow-up visit. Results A total of 173 patients (102 females; 71 males) with vitiligo, alopecia areata, lichen simplex chronicus, palmoplantar psoriasis, and psoriasis vulgaris were included in the study. Among 73 patients, with whom the treatment was finalized by physician, an excellent response was obtained in 10%, 52.9%, 53.8%, 28.6%, and 40% of patients with vitiligo, alopecia areata, lichen simplex chronicus, palmoplantar psoriasis, and psoriasis, respectively. The treatment was generally well tolerated and was discontinued in only two patients due to adverse effects.Conclusion This study demonstrates that targeted narrowband UVB therapy is a safe and effective treatment alternative, particularly for alopecia areata, lichen simplex chronicus, and palmoplantar and plaque-type psoriasis.

Chronic eczema. The search for treatment of severe forms

Objective:to study the clinical efficacy of re-PUVA therapy in patients with torpid forms of chronic true hand eczema.Materials and methods:the study involved 78 patients (47 women, 31 men) with severe and moderate forms of chronic true hand eczema. Clinical indices were used before and after treatment: HECSI, DLQI. The patients were randomly divided into 3 groups: 1 group (25 people) received standard therapy (antihistamines, external glucocorticosteroid drugs, emollients); 2 group (27 people) received the indicated standard therapy against the background of PUVA; Group 3 (26 people) -standard therapy on the background of re-PUVA (combination of PUVA with retinoids (isotretinoin)). The duration of therapy was about 3 months.Results:in group I, before treatment, the average value of the HECSI index was 76.0 ± 37.9, and after the treatment, 63.6 ± 30.2; in group II, before treatment, the average value of the HECSI index was 78.3 ± 34.2, and after treatment it decreased to 51.5 ± 24.0, in group III, respectively, before treatment, the average HECSI was 77.2 ± 35.3, and after course of therapy 28.7 ± 14.0. The duration of remission in the first group after a course of standard therapy was 2.52 ± 1.1 weeks, in the second group 15.7 ± 7.5 weeks, in the third group 61.7 ± 32.4 weeks.Conclusions:The re-PUVA method is most effective in the treatment of chronic eczema of the hands in comparison with the PUVA and standard therapy.

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

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

The Decline of PUVA Therapy in Vietnam: Effective Treatment of Narrow Band UVB in Vietnamese Vitiligo Patients.

AIM:To examine the efficacy and safety of Narrowband ultraviolet B (NB-UVB) in Vietnamese vitiligo patients.METHODS:We recruited thirty-one patients (14 males, 17 females), aged from 7 to 67 years, with both segmental vitiligo (SV) and non-segmental vitiligo (NSV), treated three times weekly with NB-UVB. The starting dose for adults from 15 years old and children less than 15 years old was 200 mJ/cm2 and 150 mJ/cm2, respectively, with 50 mJ/cm2 and 20 mJ/cm2 dose increments at each subsequent visit, respectively, until mild erythema lasting less than 24 hrs reported by patient, given for a period of 6 months. Response to therapy was assessed based on VASI score changes.RESULTS:Based upon our results, 38.7% (12/31) of patients achieved a very good response of more than 50% VASI changes, 41.9% (13/31) obtained a good response (VASI changed from 25 to 50%). Total good and very good response to therapy significantly increased with prolonged treatment, increasing from 19.4% to 64.5% and 80.6% after 2, 4 and 6 months, respectively. Localised NSV patients obtained good and very good response significantly more frequently than generalised NSV (55.6% versus 18.2%). Adverse effects were minimal, of which one case developed herpes simplex, and 4 cases reported mild photo burn reaction which completely disappeared after adjusting the dose.CONCLUSION:NB-UVB therapy is an effective and safe tool in the management of Vietnamese vitiligo patients.

Benign T cells drive clinical skin inflammation in cutaneous T cell lymphoma.

Psoralen plus UVA (PUVA) is an effective therapy for mycosis fungoides (MF), the skin-limited variant of cutaneous T cell lymphoma (CTCL). In low-burden patients, PUVA reduced or eradicated malignant T cells and induced clonal expansion of CD8+ T cells associated with malignant T cell depletion. High-burden patients appeared to clinically improve but large numbers of malignant T cells persisted in skin. Clinical improvement was linked to turnover of benign T cell clones but not to malignant T cell reduction. Benign T cells were associated with the Th2-recruiting chemokine CCL18 before therapy and with the Th1-recruiting chemokines CXCL9, CXCL10, and CXCL11 after therapy, suggesting a switch from Th2 to Th1. Inflammation was correlated with OX40L and CD40L gene expression; immunostaining localized these receptors to CCL18-expressing c-Kit+ dendritic cells that clustered together with CD40+OX40+ benign and CD40+CD40L+ malignant T cells, creating a proinflammatory synapse in skin. Our data suggest that visible inflammation in CTCL results from the recruitment and activation of benign T cells by c-Kit+OX40L+CD40L+ dendritic cells and that this activation may provide tumorigenic signals. Targeting c-Kit, OX40, and CD40 signaling may be novel therapeutic avenues for the treatment of MF.

Evaluation of Neopterin Level and Disease Severity in Patients with Psoriasis Vulgaris Treated with Narrowband UVB.

Background:Neopterin is a biochemical marker of cellular immunity. It has been reported that serum and urine neopterin levels increase in psoriasis and decrease with treatment. Nevertheless, assessment of a direct link between narrowband ultraviolet B (UVB) therapy and neopterin level in association with Psoriasis Area and Severity Index (PASI) scores has not been performed yet. We aimed to evaluate the serum neopterin level in patients with psoriasis treated with narrowband UVB therapy in association with disease severity.Materials and Methods:The study included 35 patients with chronic plaque-type psoriasis who had PASI scores of >10 or below 10 but resistant to topical therapies and 30 healthy individuals. The narrowband UVB therapy was administered to the patient group (n = 35). Serum neopterin analysis was performed with an enzyme-linked immunosorbent assay method before and after treatment.Results:There was statistically significant correlation between neopterin level and PASI score in the patient group (P = 0.011). The serum neopterin level was significantly increased in patients with higher PASI score. Moreover, the serum neopterin level was found to be statistically higher in severe psoriasis group (PASI score ≥10, n = 14) than the mild-moderate group (PASI score <10, n = 21) (P = 0.001). Furthermore, a significant decrease was observed according to serum neopterin level after the narrowband UVB therapy in the remaining 20 patients who were able to comply with the scheduled therapy and follow-up procedure (P = 0.026).Conclusion:Serum neopterin levels were found to be an useful marker for evaluating disease severity and efficacy of narrowband UVB treatment. Thus, our findings may provide a new approach with the management of disease and follow-up strategies in patients with psoriasis.

Treatment Response to Phototherapy in Patients with Mycosis Fungoides and Parapsoriasis

Background: Early stage mycosis fungoides (MF) and parapsoriasis are treated by phototherapy techniques. In this study, we aimed to assess treatment responses to narrow-band ultraviolet B (NB-UVB) and psoralen plus ultraviolet A (PUVA) therapies in patients with MF and parapsoriasis in a comparative manner. Materials and Methods: We retrospectively reviewed patients with early-stage MF and parapsoriasis who underwent phototherapy in Phototherapy Unit of our clinic between 2008 and 2018. In all groups, data regarding phototherapy were recorded and evaluated statistically. Results: In this study, 127 patients including 46 patients with early-stage MF, 48 patients with small plaque psoriasis and 33 patients with large plaque psoriasis received phototherapy. PUVA therapy session rate was significantly higher in patients with MF while NB-UVB therapy rate was significantly higher in patients with SPP. Number and duration of sessions to achieve complete remission were significantly higher in patients with MF when compared to those with SPP while no significant correlation was found between MF and LPP. In addition, the number and duration of sessions to achieve complete remission were significantly higher in patients with LPP than those with SPP. When patients groups were assessed according to phototherapy type given, it was seen that the complete remission rate was significantly higher in MF patients received PUVA therapy than patients received NB-UVB therapy (p

A Case of Scleredema Diabeticorum: Could Pentoxifylline Be a Therapeutic Option?

Background: Scleredema diabeticorum is a dermatosis characterized by hardening of skin over the upper back. It is commonly seen in poor-controlled diabetic patients. Therapeutic options are limited. Psoralen and ultraviolet A therapy (PUVA), methotrexate, and topical steroids have been used with some success. Pentoxifylline is a xanthine derivative used mainly in peripheral vascular diseases. It also has antifibrotic effects due to its collagen synthesis inhibition action. Case Presentation: In this paper, a trial of intralesional pentoxifylline treatment and magnetic resonance images of a male patient with scleredema diabeticorum are presented. Some subjective symptoms of the patient improved after this treatment, but, the thickness of the lesion did not change. Conclusion: Pentoxifylline, probably via the oral route, could still be thought in such patients unresponsive to conventional approaches due to its antifibrotic activity and high safety profile.

109 - Effect of oral psoralen plus UV-A (PUVA) photochemotherapy on quality of life, anxiety and depression in patients with early-stage mycosis fungoides

109 - Effect of oral psoralen plus UV-A (PUVA) photochemotherapy on quality of life, anxiety and depression in patients with early-stage mycosis fungoides

Transient Acantholytic Dermatosis (Grover's Disease) in a Bulgarian Patient Associated With Idiopathic Low-Grade Thrombocytopenia: First Description in the Medical Literature!

Grover’s disease is a transient acantholytic dermatosis that usually disappears within a few weeks, but it can also be presented as a persistent variant with a duration of more than 3 years. The etiology of this disease is not entirely clear and possible causes include viral infections, drug reactions (BRAF inhibitors and allogeneic haematopoietic stem cell transplantation). In terms of treatment, topical and systemic steroids, oral vitamin A and PUVA therapy are described. We present a 79-year-old man with a 1-month complaint for a recurring, highly itchy, blistering rash on the skin of the upper limbs, back and chest. During the clinical examination, there was an erythemo-papulo-vesicular polymorphic rash , in places with xerosis areas, engaging the upper part of the trunk, as the initial data and subsequent histopathological verification data spoke undoubtly in direction of acantholytic dermatosis or Grover’s disease .During hospitalization, systemic antihistamine and topical steroid therapy was performed. Subsequently, ambulatory therapy with Acitretin 20 mg /daily per os and Methylprednisolone aceponate 0.1% x 2 / daily topically was given with a good therapeutic response. We believe that this case seems to be the first officially documented case of Morbus Grover associated with idiopathic low-grade thrombocytopenia. Key words: Morbus Grover; Idiopathic thrombocytopenia; Acitretin; Prednisolone; PSA

ПСОРИАЗ: ЗНАЧЕНИЕ ФИЗИОТЕРАПЕВТИЧЕСКИХ ФАКТОРОВ В КОМПЛЕКСНОЙ ТЕРАПИИ ХРОНИЧЕСКОГО ДЕРМАТОЗА

The analysis of the literature data conducted incorporating modern views on psoriasis and the effectiveness of its complex therapy with the use of existing methods of physiotherapeutic treatment. The questions of the urgency of the problem of psoriasis, its etiology, and pathogenesis, the clinical picture of the disease, drug treatment are reflected. The review of physiotherapeutic methods in the complex treatment of psoriasis is presented. The modern scientific view of psoriasis is described as a systemic disease that manifests as a form of immune-dependence dermatosis. The question of application of physical factors considered in the complex therapy of psoriasis, the mechanism of their action, and describes the methods of physiotherapy due to the therapeutic treatment of psoriasis, in particular, ultraviolet radiation Keywords: psoriasis, physiotherapy, treatment, PUVA therapy, ultraviolet radiation, prophylactic physiotherapy.

Analysis of Physical Therapy in Psoriasis

Introduction: Psoriasis is one of the most common skin diseases. It is a chronic and recurrent disorder that constitutes both a clinical and a social problem. Psoriasis can be effectively treated with comprehensive balneophysiotherapy (sulphide/hydrogen sulphide baths, PUVA therapy, cryotherapy). Aim: To analyse physical therapy in patients with psoriasis treated at a thermal resort. Material and Methods: The study was conducted at the “Jasna” thermal resort in Solec-Zdrój. The patients underwent balneophysiotherapy in the form of sulphide/hydrogen sulphide baths, PUVA therapy, and cryotherapy. The study group consisted of 40 subjects (28 females and 12 males) with psoriasis. The mean age was 43 years (range: 21 to 65 years). Subjective (a 21-item questionnaire) and objective assessment of the patients’ status was performed both before and after a series of physical therapy procedures. Results: After 3 weeks of treatment, the patients’ physical status was remarkably improved; skin lesions, pain, and burning resolved. The mental status of the subjects was improved as well. The results confirm that physical therapy is highly effective in psoriatic patients. Conclusions: The procedures performed at the thermal resort had a beneficial influence on the subjects’ health. Remarkable improvements were found using both subjective and objective methods of assessment. Thermal hospital treatment is an optimal form of management in psoriatic patients.

Sporadic Case of dyschromatosis universalis hereditaria showing moderate response to narrow-band ultraviolet-B

Dyschromatosis universalis hereditaria (DUH) is a rare genodermatosis where the affected manifests mottled pigmentation with intermingled hyper- and hypo-pigmented macules. On most occasions, the lesions begin on limbs and then extend to trunk. Most of the cases reported in literature are from Japan. It is rarer in Indians. In this report, we describe a 12-year-old male child with DUH, who showed response to narrow-band ultraviolet-B therapy.