Phototherapy Regimens Research Articles

Phototesting for a variety of skin conditions before narrowband (TL-01) Ultraviolet-B

Background: For the majority of photo responsive skin disorders, narrowband ultraviolet-B (NBUV-B) phototherapy is currently regarded as the preferred option. The initial dosage of NBUV-B phototherapy is determined as a percentage of the minimal erythema dose (MED) at the majority of dermatology centers that offer phototherapy. This will shorten the time of therapy and lower the chance of burning while optimizing the therapeutic effect. Three times a week is the usual dosage for NBUV-B phototherapy treatment, which takes 18 to 30 sessions on average to clear the condition. For these types of treatment plans, a precise evaluation of the MED is necessary before starting treatment in order to prevent NBUV-B overdoses or underdoses. Aim: The objective of this study is to investigate the MED of 311nm NBUV-B phototherapy in a group of Libyan patients. Methods: For this prospective study, 150 patients with a range of skin conditions who saw the phototherapy unit at Bir Usta Melad Hospital of Dermatology and Venereology in Tripoli, Libya over an 8-month period were enrolled. Skin conditions include vitiligo, atopic dermatitis, and psoriasis are among those being researched. Using Fitzpatrick's questionnaire, skin types were assigned to each patient. Using a MED tester instrument (Dermalight® 80), 311 nm NBUV-B was applied to the right forearm. The test findings were recorded 24 hours later. Results: Of the patients studied, 82 (54.7%) were female and 68 (45.3%) were male. Their ages ranged from 10 to 60 years, with 30% of the sample falling between the ages of 31 and 40. The patients were clinically diagnosed with the following conditions: vitiligo 65(43.3%), psoriasis 61(40.7%), eczema 8(5.3%), pruritus 6(4%), and alopecia areata and lichen planus 5(3.3%) each. According to Fitzpatrick's categorization, the skin prototypes in the included series were 15(10%) patients of skin type III, 118(78.7%) patients of skin type IV, and 17(11.3%) patients of skin type V. Among the enrolled participants, the minimum necessary dose to elicit an erythema for NBUV-B ranged between 300 mJ/cm2 and 750 mJ/cm2, with the mean dosage was 484.7 ± 82.2 mJ/cm2. Conclusions: The average MED to 311nm NBUV-B in Libyan patients was around 500 mJ/cm2, which can be utilized to determine the initial dose and treatment regimen of phototherapy for various skin conditions.

Efficiency of phototherapy in patients with mycosis fungoides: preliminary results of a comparative non-randomized study

Clinical reasoning. There is a need to optimize the use of UV-B-311 nm and PUVA-therapy in patients with mycosis fungoides to determine the duration of the treatment regimen, the number of sessions per week, and ultraviolet irradiation regimen.
 Goal of research. Evaluation of the effect of the type and duration phototherapy on efficacy in patients with mycosis fungoides.
 Principle. A comparative, non-randomized study of the effectiveness of phototherapy in patients with mycosis fungoides in the early stages. Evaluation of the effectiveness of UV-B-311 nm and PUVA therapy was performed using the BSA index (area of skin lesions) and Modified Severity-Weighted Assessment Tool (mSWAT), as well as according to the criteria proposed by the International Society for Skin Lymphomas (ISCL), the European Organization for the Study and Cancer Treatment (EORTC) and United States Cutaneous Lymphoma Consortium (USCLC).
 Results. The study included 14 patients with mycosis fungoides, 5 of whom received treatment with UV-B-311 nm, 9 PUVA therapy. A strong correlation was found between the duration of UV-B-311 nm therapy with mSWAT delta (R = 0.90; p = 0.038) and BSA delta (R = 0.90; p = 0.038), while similar correlation was not found in the PUVA-therapy group (mSWAT (R = 0.24; p = 0.527); BSA (R = 0.09; p = 0.823)). When comparing the effectiveness of therapy between the treatment group UV-B-311 nm and PUVA therapy, delta mSWAT and BSA at the 20th procedure, delta mSWAT and BSA after the end of therapy did not have a statistically significant difference between the UVB-311 nm and PUVA groups.
 Conclusion. Statistically significant correlation was found between the number of procedures and the effectiveness of therapy In the UV-B-311 nm group. An increase in the number of PUVA therapy procedures (after 20) does not lead to a statistically significant increase in the effectiveness of treatment. Additional research is needed to increase the level of evidence of the results and develop optimal phototherapy regimens.

Efficiency of phototherapy in patients with mycosis fungoides: preliminary results of a comparative non-randomized study

Clinical reasoning. There is a need to optimize the use of UV-B-311 nm and PUVA-therapy in patients with mycosis fungoides to determine the duration of the treatment regimen, the number of sessions per week, and ultraviolet irradiation regimen.
 Goal of research. Evaluation of the effect of the type and duration phototherapy on efficacy in patients with mycosis fungoides.
 Principle. A comparative, non-randomized study of the effectiveness of phototherapy in patients with mycosis fungoides in the early stages. Evaluation of the effectiveness of UV-B-311 nm and PUVA therapy was performed using the BSA index (area of skin lesions) and Modified Severity-Weighted Assessment Tool (mSWAT), as well as according to the criteria proposed by the International Society for Skin Lymphomas (ISCL), the European Organization for the Study and Cancer Treatment (EORTC) and United States Cutaneous Lymphoma Consortium (USCLC).
 Results. The study included 14 patients with mycosis fungoides, 5 of whom received treatment with UV-B-311 nm, 9 PUVA therapy. A strong correlation was found between the duration of UV-B-311 nm therapy with mSWAT delta (R = 0.90; p = 0.038) and BSA delta (R = 0.90; p = 0.038), while similar correlation was not found in the PUVA-therapy group (mSWAT (R = 0.24; p = 0.527); BSA (R = 0.09; p = 0.823)). When comparing the effectiveness of therapy between the treatment group UV-B-311 nm and PUVA therapy, delta mSWAT and BSA at the 20th procedure, delta mSWAT and BSA after the end of therapy did not have a statistically significant difference between the UVB-311 nm and PUVA groups.
 Conclusion. Statistically significant correlation was found between the number of procedures and the effectiveness of therapy In the UV-B-311 nm group. An increase in the number of PUVA therapy procedures (after 20) does not lead to a statistically significant increase in the effectiveness of treatment. Additional research is needed to increase the level of evidence of the results and develop optimal phototherapy regimens.

Cycled Phototherapy Dose-Finding Study for Extremely Low-Birth-Weight Infants

Cycled (intermittent) phototherapy (PT) might adequately control peak total serum bilirubin (TSB) level and avoid mortality associated with usual care (continuous PT) among extremely low-birth-weight (ELBW) infants (401-1000 g). To identify a cycled PT regimen that substantially reduces PT exposure, with an increase in mean peak TSB level lower than 1.5 mg/dL in ELBW infants. This dose-finding randomized clinical trial of cycled PT vs continuous PT among 305 ELBW infants in 6 US newborn intensive care units was conducted from March 12, 2014, to November 14, 2018. Two cycled PT regimens (≥15 min/h and ≥30 min/h) were provided using a simple, commercially available timer to titrate PT minutes per hour against TSB level. The comparator arm was usual care (continuous PT). Mean peak TSB level and total PT hours through day 14 in all 6 centers and predischarge brainstem auditory-evoked response wave V latency in 1 center. Mortality and major morbidities were secondary outcomes despite limited power. Consent was requested for 452 eligible infants and obtained for 305 (all enrolled) (mean [SD] birth weight, 749 [152] g; gestational age, 25.7 [1.9] weeks; 81 infants [27%] were multiple births; 137 infants [45%] were male; 112 [37%] were black infants; and 107 [35%] were Hispanic infants). Clinical and demographic characteristics of the groups were similar at baseline. After a preplanned interim analysis of 100 infants, the regimen of 30 min/h or more was discontinued, and the study proceeded with 2 arms. Comparing 128 infants receiving PT of 15 min/h or more with 128 infants receiving continuous PT among those surviving to 14 days, mean peak TSB levels were 7.1 vs 6.4 mg/dL (adjusted difference, 0.7; 95% CI, 0.4-1.1 mg/dL) and mean total PT hours were 34 vs 72 (adjusted difference, -39; 95% CI, -45 to -32). Wave V latency adjusted for postmenstrual age was similar in 37 infants receiving 15 min/h or more of PT and 33 infants receiving continuous PT: 7.42 vs 7.32 milliseconds (difference, 0.10; 95% CI, -0.11 to 0.30 millisecond). The relative risk for death was 0.79 (95% CI, 0.40-1.54), with a risk difference of -4.5% (95% CI, -10.9 to 2.0). Morbidities did not differ between groups. Cycled PT can substantially reduce total PT with little increase in peak TSB level. A large, randomized trial is needed to assess whether cycled PT would increase survival and survival without impairment in small, preterm infants. ClinicalTrials.gov Identifier: NCT01944696.

A new phototherapy regimen during winter as an add-on therapy, coupled with oral vitamin D supplementation, for the long-term control of atopic dermatitis: study protocol for a multicentre, randomized, crossover, pragmatic trial \u2013 the PRADA trial

BackgroundAtopic dermatitis is a highly prevalent, chronic, relapsing disease in both adults and children. On the severity spectrum, lower-end patients benefit from small amounts of topical anti-inflammatory treatments (TAT), whereas higher-end patients need systemic immunosuppressants; in-between patients are treated with TAT and phototherapy. The major therapeutic challenge in this population is the long-term control of disease activity, and the current TAT-based pro-active strategy does not meet all their needs. Immunosuppressants are used as long-term control add-on treatments, but they are restricted to the most severely affected patients because of safety concerns. In addition, neither immunosuppressants nor other strategies have been properly evaluated in the long term despite long-term control having been acknowledged as one of the most important core outcome domains to be targeted in atopic dermatitis trials. Safe add-on therapies, rigorously evaluated for long-term control of the disease, are therefore needed. Phototherapy and vitamin D supplementation are both good candidates.MethodsThis is a multicenter, national, randomized, superiority, crossover trial testing add-on phototherapy (one winter under spaced sessions of phototherapy and one winter under observation) among subjects receiving standard care (i.e., TAT). On the same population, we will test the long-term control provided by oral supplementation of vitamin D versus placebo in a randomized, superiority, double-blind, parallel-group trial. The primary outcomes are (1) repeat measures of the PO-SCORAD severity score over 1 year and (2) cumulate consumption of TAT (number of tubes) during the winter. They will be tested following a hierarchical testing procedure. The secondary outcomes will be measures repeated over 2 years of investigator-based severity scores, patient-reported severity and quality of life scores, serum vitamin D levels, weeks during which the disease is well-controlled, inter-visit cumulate consumption of TAT, and synthetic patient-reported satisfaction at the end of each winter.DiscussionThis study includes two separate 2-year pragmatic trials designed to evaluate the efficacy of vitamin D supplementation and pro-active phototherapy for primary care atopic dermatitis patients receiving TAT on long-term control of disease activity. The experimental design enables the study of both interventions and exploration of the interaction between vitamin D and phototherapy. A pragmatic trial is particularly suited to the assessment of long-term control. This study explores the possibility of new and safe therapeutic strategies for the control of long-term atopic dermatitis, and is an example of efficacy research that is unlikely to be sponsored by industrialists. A potentially effective low-cost therapeutic strategy for long-term control is essential for patients and public health.Trial registrationClinicalTrials.gov Identifier: NCT02537509, first received: 1 September 2015.

The role of phototherapy in the surgical treatment of vitiligo: a systematic review.

Vitiligo is frequently treated with the combination of phototherapy and melanocyte transplantation. However, the additional benefit of phototherapy is unclear. Moreover, the optimal type and regimen of phototherapy are unknown. The objective of this systematic review was to identify whether phototherapy improves the outcome of melanocyte transplantation in vitiligo. We searched and screened for eligible studies in the databases of MEDLINE, EMBASE and CENTRAL. We included all clinical studies investigating melanocyte transplantation combined with phototherapy. After screening and selection of abstracts and full-texts, we found 39 eligible clinical studies with 1624 patients. The eligible studies investigated several phototherapy modalities, such as NBUVB (n=9), PUVA (n=19), UVA (n=1), MEL (n=4) and active sunlight exposure (n=9). Four studies directly compared phototherapy versus no phototherapy and two studies confirmed the benefit of phototherapy for melanocyte transplantation. We found no significant differences in repigmentation in studies directly comparing phototherapy modalities. The overall quality of the studies was moderate to poor and high heterogeneity between studies was found. We found limited evidence that phototherapy improves the outcome of melanocyte transplantation in vitiligo. There is insufficient evidence to recommend a specific type or regimen of phototherapy. More studies should be performed investigating the additional benefit of different phototherapies and the preferred moment of phototherapy.

Narrow-band ultraviolet B phototherapy regimens for the treatment of chronic actinic dermatitis and analysis of factors influencing treatment compliance

Objective To investigate the optimal regimen of narrow-band ultraviolet B (NB-UVB) phototherapy in the treatment of chronic actinic dermatitis (CAD) , and to analyze factors influencing treatment compliance. Methods Demographic data, results of photobiological tests, treatment parameters and clinical responses were collected from CAD patients who received NB-UVB phototherapy in Huashan Hospital affiliated to Fudan University from January 2008 to June 2015, and were reviewed retrospectively. Statistical analysis was done by using two independent samples t-test and chi-square test with SAS9.3 software to compare the clinical data between patients who completed and did not complete the NB-UVB phototherapy. Results A total of 79 CAD patients with Fitzpatrick skin type Ⅳ received NB-UVB phototherapy. Of these patients, 61 (77%) completed the whole treatment, while 18 (23%) dropped out because of intolerance to the NB-UVB radiation. Among the 61 patients who completed the treatment, the average initial, final and cumulative radiation doses of NB-UVB were (0.08 ± 0.01) J/cm2, (0.32 ± 0.08) J/cm2 and (5.9 ± 2.5) J respectively, and patients received (28 ± 8) times of treatment in average. When the radiation dose went up to 0.30 J/cm2, most skin lesions were cleared in 52 (85%) patients. A total of 19 patients received phototesting again after the end of phototherapy. Among 16 patients sensitive to ultraviolet A (UVA) before the treatment, 6 had normal minimal erythema dose to UVA (UVA-MED) , and another 6 had improved UVA-MED after the treatment. Among 16 patients sensitive to UVB before the treatment, 11 got normal UVB-MED and another 3 had improved UVB-MED after the treatment. Univariate analysis showed no significant differences in gender, age, duration of the disease, sensitivity to UVA and UVB radiation, results of photopatch test and patch test between the patients who completed and did not complete the treatment (all P > 0.05) . Conclusions The appropriate NB-UVB phototherapy for CAD patients should start at an initial radiation dose of 0.08 J/cm2 in spring and end at a final radiation dose of 0.30 J/cm2 for about 28 sessions, which can effectively reduce the photosensitivity to both UVA and UVB in CAD patients. Additionally, NB-UVB phototherapy can be applied in CAD patients of different gender, age, disease duration and photosensitive condition. Key words: Dermatitis, photoallergic; Ultraviolet therapy; Narrow-band ultraviolet ray; Phototest; Photopatch test

Circulation Enrichment of Functional Endothelial Progenitor Cells by Infantile Phototherapy.

Phototherapy is the most common therapy used for severe jaundice. There is increasing evidence that phototherapy can directly affect the expression and function of cell surface receptors including adhesion molecules, cytokines, and growth factor receptors. In this study, the effect of two infantile phototherapy regimens, including single and intensive phototherapy was investigated on biological features of circulation endothelial progenitor cells (cEPCs), as well as on serum secretion of two important chemotactic cytokines, SDF-1 and VEGF. Sixty infants diagnosed with severe hyperbilirubinemia and exposed to phototherapy were enrolled in this study. cEPCs were isolated before and after phototherapy and then migratory, proliferative, tubulogenic, and functional properties of these cells were analyzed. Our results revealed that intensive phototherapy markedly increased the release of EPCs into the circulation, and augmented the serum concentrations of both SDF-1 and VEGF cytokines. Cell proliferation, tubulogenic, and migratory properties of cEPCs isolated and expanded from infants with intensive phototherapy were significantly improved. cEPCs from infants with intensive phototherapy also showed greater levels of acetylated low-density lipoprotein and lectin binding. Overall, our results showed that the intensive phototherapy regimen can mobilize functional EPCs into the circulation through up-regulation of serum levels of VEGF and SDF-1, indicating phototherapy as an effective modality for improvement of stem cell mobilization in the therapeutic regenerative medicine. J. Cell. Biochem. 118: 330-340, 2017. © 2016 Wiley Periodicals, Inc.

Compliance and phototherapy

When beginning a phototherapy regimen for a patient, consideration of compliance rates is important. Compliance to phototherapy can be affected by several factors, including the grade of discomfort and side effects from therapy, failure of previous therapies, accessibility and convenience to reach the phototherapy center, grade of improvement during phototherapy, patient relief due to light therapy, and rapport with staff. Understanding how these factors can affect patient adherence can allow for phototherapy regimens to be tailored in a manner that optimizes health outcomes and allows for proper patient selection.

Finding the optimal dose for psoriasis ultraviolet radiation therapy through multi-objective evolutionary optimization on a skin model

Ultraviolet radiation (UVR) is proven to be an effective treatment for psoriasis yet it needs to be carefully controlled since it is a widely known carcinogen. Due to the time-consuming, expensive and hazardous nature of clinical tests on actual patients, the range of possible values for the optimal regimen set has not yet been thoroughly explored. An agent-based model was constructed in order to study the complex role of UVR in psoriasis phototherapy, including possible contribution to the formation of skin cancers. The treatment progression of the simulated psoriasis undergoing UVR phototherapy was monitored weekly and compared with the corresponding clinical data. For model calibration, a single-objective optimization via genetic algorithm was employed that aimed to minimize the discrepancy between the model output and the expected clinical result. After fitting and validation, the model was then subjected to multi-objective evolutionary optimization using Non-dominated Sorting Genetic Algorithm-II (NSGA-II) in order to suggest sets of optimal UVR phototherapy regimen for psoriasis taking into account the safety, clearance time as well as aggressiveness of the therapy. Results show a good model fit against clinical data and gave some plausible sets of dosimetry for UVR phototherapy that maximize its therapeutic efficacy while minimizing the associated skin cancer risk.

Ultraviolet-A1 phototherapy in the treatment of primary diffuse cutaneous amyloidosis: an additional phototherapy regimen for cutaneous amyloidosis with review of treatment options

Ultraviolet-A1 phototherapy in the treatment of primary diffuse cutaneous amyloidosis: an additional phototherapy regimen for cutaneous amyloidosis with review of treatment options

Ultraviolet A1 for the treatment of cutaneous diseases

Since ultraviolet A1 (UVA1) can penetrate into deep layers of the skin,induce the apoptosis of T cells,down-regulate multiple cytokines,activate endothelial cells and promote neovascularization,it has been used to treat many dermatoses over the last three decades.There have been evidences from randomized control and cohort studies for the application of UVA1 phototherapy in atopic dermatitis,localized scleroderma and systemic lupus erythematosus.Other indications of UVA1 phototherapy are cutaneous T cell lymphoma,systemic scleroderma,pretibial myxedema,prurigo nodularis,etc.Compared with the other phototherapy regimens,UVA1 phototherapy shows less short-term side effects.However,little is known about long-term side effects of UVA1 phototherapy,and long-term follow-up studies are required. Key words: Dermatitis, atopic ; Scleroderma, systemic ; Dermatology ; Ultraviolet rays

A Reduction in Dosage of Acitretin to 17.5 mg/day Maintains Efficacy While Improving Tolerability

Background Oral acitretin 25 mg/day combined with a phototherapy regimen is a standard treatment for severe plaque-type psoriasis. Retinoid-related adverse events include alopecia, dry mucus membranes, pruritus, photosensitivity, elevation of liver enzymes, elevation of serum triglycerides and cholesterol and decrease of HDL, arthralgias, myalgias, eye irritation, blepharitis, photophobia, conjunctivitis, headaches, nausea, and anemia. Objective This single-center open label study evaluated the efficacy and tolerability of a reduced acitretin dose in patients with severe plaque-type psoriasis undergoing phototherapy treatment who were experiencing at least one retinoid-related adverse event. Results Of patients treated with 17.5 mg/day of acitretin, 89% demonstrated improved or comparable psoriasis area-and-severity index scores at week 12; 79% showed improvement in adverse events reported at baseline through week 12. Conclusion There is a role for a lower dose of acitretin in patients who are experiencing retinoid-related side effects and who are stabilized on a phototherapy regimen.

Psoriasis treatment: faster and long‐standing results after bathing in geothermal seawater. A randomized trial of three UVB phototherapy regimens

The combination of seawater baths and narrowband ultraviolet B (NB-UVB) is a known treatment for psoriasis. This study evaluates two treatment regimens that combine bathing in geothermal seawater and NB-UVB therapy in comparison with NB-UVB monotherapy. Sixty-eight psoriasis patients were randomly assigned to outpatient bathing in geothermal seawater combined with NB-UVB therapy three times a week, intensive daily treatment involving bathing in geothermal seawater combined with NB-UVB therapy, or NB-UVB therapy alone three times a week; treatment period was 6 weeks. Disease severity [Psoriasis Area Severity Index (PASI) and Lattice System Physician's Global Assessment scores], quality of life (Dermatology Life Quality Index) and histological changes were evaluated before, during and after treatment. The primary end point was the proportion of patients who achieved PASI 75 at 6 weeks. At 6 weeks, the percentage of patients who achieved PASI 75 and PASI 90 was significantly greater for both regimens, bathing in geothermal seawater three times a week (68.1% and 18.2%, respectively) and intensive treatment with geothermal seawater (73.1% and 42.3%, respectively) than for NB-UVB monotherapy (16.7% and 0%, respectively) (P < 0.05 in all comparisons). Clinical improvement was paralleled by improvement in quality of life and histological score and a reduction in NB-UVB doses. Bathing in geothermal seawater combined with NB-UVB therapy in psoriasis induces faster clinical and histological improvement, produces longer remission time and permits lower NB-UVB doses than UVB therapy alone.

A review of protocols for 308-nm excimer laser phototherapy in psoriasis

308 nm excimer laser phototherapy is efficacious in the treatment of localized psoriasis. Different approaches regarding dose fluency, number of treatments, and maintenance have been utilized, and there is yet to be a consensus on standard protocol.To characterize treatment parameters for 308 nm excimer laser phototherapy.We performed a PubMed search for studies describing excimer laser treatment protocol with particular attention to dosage determination, dose adjustment, dose fluency, number of treatments, and maintenance.Seven prospective studies were found describing the excimer efficacy for psoriasis. All studies determined the initial treatment dose using either the minimal erythema dose (MED) or induration. Fluency ranged from 0.5 MED (low) to 16 MED (high); one study demonstrated that medium to high fluencies yielded better improvement in fewer number of treatments. Fluency adjustments during the course of treatment were important to minimize phototherapy-associated side effects. The use of higher fluencies was reported to result in higher occurrences of blistering. One study implemented a maintenance tapering of dose-frequency phase to better manage psoriasis flare-ups.The 308 nm excimer laser is an effective therapy for psoriasis regardless of the method used to determine initial dosage, dose fluency, or number of treatments. As its usage as a targeted monotherapy increases, future trials should consider evaluating and modifying these parameters to determine the most optimal management of localized psoriasis. Based on our reviewed studies, there is no consensus for a single excimer laser therapy protocol and as a result, patient preferences should continue to be an important consideration for phototherapy regimen planning.

A comparative study on efficacy of UVA1 vs. narrow‐band UVB phototherapy in the treatment of vitiligo

Narrow-band ultraviolet B (NB-UVB) is considered the most effective and safe initial treatment for moderate-to-severe vitiligo but phototoxicity and possible carcinogenicity are the reported side effects. Ultraviolet A1 (UVA1) phototherapy has overlapping biological effects to NB-UVB and is relatively free of side effects associated with other phototherapy regimens. Forty patients with vitiligo were included in this prospective, randomized controlled comparative clinical trial. Twenty patients received NB-UVB and 20 received UVA1 three times weekly for 12 weeks. The UVA1 group was divided into two subgroups. Ten patients received moderate and 10 received low dose of UVA1. Serum samples were collected before and after 36 sessions to assess soluble interleukin 2 receptor level. Patients were clinically evaluated before therapy then monthly according to Vitiligo Area Scoring Index (VASI) and Vitiligo European Task Force (VETF) scores. In addition, extent of response was determined by a blinded dermatologist comparing before and after therapy photographs. Pattern of response and side effects were recorded. NB-UVB was superior to UVA1 with a significant difference in blinded dermatological assessment (P<0.001), percentage change in VASI score (P<0.001) and percentage change in VETF area score (P=0.001). No significant difference in side effects was observed between both groups. Comparing UVA1 subgroups, better response in moderate-dose group was found as regard to percentage change in VASI (P<0.001) and percentage change in VETF area score (P=0.001), while no significant difference was found in blinded dermatological assessment (P=0.121). NB-UVB phototherapy remains to be an effective and safe therapeutic option in vitiligo. Response to UVA1 in vitiligo seems to be dose dependent and seems to be of limited value in treatment of vitiligo as a monotherapy. Further studies combining it with other lines of therapy such as systemic steroids may prove beneficial.

Brief morning light treatment for sleep/wake disturbances in older memory-impaired individuals and their caregivers

Scheduled exposure to bright light (phototherapy) has been used, with varying degrees of success, to treat sleep disruption in older individuals. Most of these studies have been done in institutional settings and have used several hours of daily light exposure. Such a regimen in the home setting may be untenable, especially when the individual with the sleep disruption has memory impairment and is being cared for by a family member. As such, we examined the effectiveness of a "user-friendly" phototherapy protocol that would be readily usable in the home environment. We exposed a group of 54 older caregiver/care recipient dyads, in which the care recipient had memory impairment, to two weeks of morning bright light phototherapy. Dyads were exposed to either bright white (∼4200 lux) or dim red (∼90 lux) light for 30 min every day, starting within 30 min of rising. All subjects also received sleep hygiene therapy. Objective (actigraphy) and subjective measures of sleep and mood were obtained at baseline and at the end of the two weeks of phototherapy. In care recipients, actigraphy- and log-determined time in bed and total sleep time declined in the active condition (p<0.05, ANOVA); there was no corresponding change in subjective insomnia symptoms (p's>0.37, ANOVA). The decrease in the time in bed was associated with an earlier out of bed time in the morning (p<0.001, Pearson correlation). The decrease in the total sleep time was associated with a decrease in sleep efficiency (p<0.001, Pearson correlation) and an increase in wake after sleep onset (p<0.001, Pearson correlation). In caregivers, there were no differential changes in actigraphic measures of sleep (p's>0.05, ANOVA). Actigraphy-measured wake after sleep onset and sleep efficiency did, however, improve in both conditions, as did sleepiness, insomnia symptoms, and depressive symptomatology (p's<0.05, ANOVA). Exposure to this regimen of phototherapy diminished sleep in older individuals with memory impairments. Their caregivers, however, experienced an improvement in sleep and mood that appeared independent of the phototherapy and likely due to participation in this protocol or the sleep hygiene therapy.

Chronic Actinic Dermatitis: Two Patients with Successful Management using Narrowband Ultraviolet B Phototherapy with Systemic Steroids

BackgroundChronic actinic dermatitis (CAD) is a debilitating photodermatosis with characteristic clinical, histological and photobiological features (reduced minimal erythema dose: MED). Its management involves various therapeutic approaches, among them there is phototherapy. Efficacy of psoralen ultraviolet therapy (PUVA therapy) was previously demonstrated but there are no current data on the use of narrowband ultra violet B (UVB) therapy (NB-UVB) in CAD. NB-UVB has already been proven to be effective and safe in several other photodermatoses. Case reportsWe report here two dark-skinned patients (skin type IV and V) with CAD, successfully treated with an incremental regimen of NB-UVB phototherapy coupled to a 3 month-course of systemic steroids (1mg/Kg/day). ConclusionOur protocol of NB-UVB with steroids seems to be effective for the management of CAD with a good short term safety profile.

UVA1 phototherapy: a review of mechanism and therapeutic application

Ultraviolet radiation (UVR) phototherapy has been associated with both deleterious and beneficial effects to patients with both localized and systemic skin disorders. Phototherapy is advantageous in diseases of the epidermis and dermis, as it provides the most direct approach minimizing systemic side effects. Most recently, ultraviolet A1 (UVA1) phototherapy has emerged as a specific UVR phototherapeutic mechanism. It has shown to be therapeutic in a number of sclerosing skin conditions and other dermatitides, in many cases proving to be more effective than other phototherapy modalities. Treatment advantages of UVA1 phototherapy include the ability to penetrate into the deep layers of the skin to affect changes on disease-causing T cells, as well as activation of endothelial cells to promote neovascularization. UVA1 therapy also has been shown to be relatively free of side effects associated with other phototherapy regimens, including erythema and cellular transformation. These properties make UVA1 phototherapy an important treatment option for many debilitating skin conditions.

A review of home phototherapy for psoriasis

Phototherapy is a mainstay in the treatment of psoriasis and other photoresponsive dermatoses and home phototherapy has broadened therapeutic options. To describe the history of home phototherapy, the technological advances in the safety and efficacy of the equipment available, and the associated issues of cost, convenience, adherence, and quality of life. We conducted a literature review of home phototherapy, broad-band UVB, narrow-band UVB, and PUVA phototherapy using PUBMED. A Google search of home phototherapy equipment and technology was also undertaken. Technological advances in home phototherapy equipment have allowed for more treatment options and improvements in safety and efficacy. One randomized, controlled trial found results comparable to office-based phototherapy. Home phototherapy is convenient, cost-effective, and associated with better quality of life compared to outpatient phototherapy treatment. One trial found that adherence to home phototherapy regimens was better than to oral retinoids. Home phototherapy is a well-tolerated, efficacious, economical and patient friendly therapeutic option. Advantages of home phototherapy include improved quality of life, greater convenience, lower cost, and less time lost from work and social activities. Dermatologists should strongly consider home phototherapy as a first-line treatment option for appropriately selected psoriasis patients.