Phototherapy Regimens Research Articles

A randomized trial of aggressive versus conservative phototherapy for hyperbilirubinemia in infants weighing less than 1500 g: Short- and long-term outcomes

Treatment regimens for hyperbilirubinemia vary for very low birth weight infants. The present study seeks to determine whether the initiation of conservative phototherapy is as effective as aggressive phototherapy in reducing peak bilirubin levels without increasing adverse effects. The present randomized, controlled study included infants with birth weights between 500 g and 1500 g, stratified into two birth weight groups. In one group, aggressive phototherapy was commenced by 12 h of age, while in the other group, conservative phototherapy was commenced if serum bilirubin levels exceeded 150 mumol/L. The primary outcome variables were peak serum bilirubin levels and hours of phototherapy. Secondary outcomes were age at peak bilirubin levels, number of infants with rebound hyperbilirubinemia, and number of adverse short- and long-term outcomes. Of 174 eligible infants, 95 consented to participate -49 in the conservative arm and 46 in the aggressive arm. Ninety-two infants completed the study. There was no significant difference in peak bilirubin levels except in infants who weighed less than 1000 g -171.2+/-26 mumol/L (conservative) versus 139.2+/-46 mumol/L (aggressive); P<0.02. There was no difference in duration of phototherapy or rebound hyperbilirubinemia. There were no differences in short-term adverse outcomes. Of the 87 infants who survived until hospital discharge, 82 (94%) had some follow-up and 75 (86%) attended follow-up until 18 months corrected age. The incidence of cerebral palsy, abnormal mental developmental index at 18 months corrected age, or combined outcome of cerebral palsy and death did not significantly differ between the two groups. In infants weighing less than 1000 g, peak bilirubin levels were significantly higher using conservative phototherapy regimens and there was a tendency for poor neurodevelopmental outcome.

Local narrowband UVB phototherapy vs. local PUVA in the treatment of chronic hand eczema

Hand eczema is a chronic skin disorder characterized by a poor response to conventional therapies. Although local PUVA has been proven to be effective in the treatment of chronic hand eczema, little is known about the efficacy and safety of local narrowband UVB (TL-01) for this condition. The aim of our study was to compare the efficacy and safety of local narrowband UVB phototherapy with paint-PUVA in patients with chronic hand eczema of dry and dyshidrotic types unresponsive to conventional therapies. Fifteen patients (nine men and six women) with chronic hand eczema of dry and dyshidrotic types was included in this prospective, comparative study based on a left to right comparison pattern. The treatments were administered with local narrowband UVB irradiation on one hand and local paint-PUVA using 0.1% 8-methoxypsoralen gel on the other hand three times a week over a 9-week period. The NB-UVB irradiation was administered using a local NB-UVB system equipped with TL-01 lamps. The initial dose was 150 mJ/cm(2) for each patient. An increasing percentile dose schedule based on an increase of 20% was used in every session, until a final dose of 2000 mJ/cm(2) was reached. Evaluation of clinical scores was carried out every 3 weeks during the treatment period. Twelve of the 15 recruited patients completed the study. There was a statistically significant decrease in the mean clinical score at the third, sixth and nineth week in both groups. The difference in clinical response between the two treatment modalities was not statistically significant at the end of the 9-week treatment period. In the narrowband UVB-treated side, the tolerance of all the patients to the treatment was good all patients well-tolerated the treatment with the exception of mild xerosis that responded to topical emollients. Local narrowband UVB phototherapy regimen is as effective as paint-PUVA therapy in patients with chronic hand eczema of dry and dyshidrotic types.

Photoadaptation during Narrowband Ultraviolet-B Therapy Is Independent of Skin Type: A Study of 352 Patients

Understanding how photoadaptation differs between individuals is important when considering susceptibility to the beneficial and harmful effects of sunlight exposure and when determining optimal phototherapy regimens. Most narrowband UVB (NB-UVB) regimens start with 70% of the minimal erythema dose (MED) with 20% increments at each treatment thereafter. We retrospectively studied 352 skin types I-IV psoriatic patients having twice weekly treatment with this regimen. Patients with high skin types tended to have high MEDs (P<0.001). By session 20 the proportion of patients who had developed erythema was approximately 60% regardless of MED. Among patients who developed erythema, the number of treatments before erythema occurred did not differ between skin types (P=0.33). We conclude that patients with high skin types photoadapt approximately equally per physical unit of UVR in comparison to those with low skin types, but they have greater photoadaptation in absolute terms because they are able to tolerate a higher initial dose of radiation. Differences in skin type or MED are not associated with clinically important differences in tendency to erythema during a standard 70/20% NB-UVB twice-weekly regimen. This regimen is suitable for all skin types I-IV patients regardless of skin type or MED.

Effect of Relume broad band ultraviolet B in repigmentation of pregnant abdominal stretch marks: a prelimininary clinical report

目的 观察Relume光子色素再生仪治疗妊娠纹的临床效果.方法用Relume光子色素再生仪的紫外线B波(UVB),治疗腹部妊娠纹20例, 根据皮肤类型选择特定波长,不同能量密度的紫外光子点击腹部妊娠纹,1周治疗1次,共治疗6次.结果除3例病人未完成治疗,随访17例4个月,100 %患者妊娠纹表面出现增色效果, 增色效果非常满意的为29.4 %(5例),增色效果满意的为70.6 %(12例).结论 Relume光子色素再生仪是治疗腹部妊娠纹安全有效的手段。

Whole-body UVB (TL-01) or UVA-1 irradiation does not alter the levels of immunomodulatory cytokines in the serum of human volunteers.

Ultraviolet (UV) exposure of mammalian skin induces local and systemic immunosuppression. In mice it has been proposed that systemic immunosuppression is mediated by an UV-induced cytokine cascade involving systemic interleukin (IL)-4 and IL-10 and a reduction in IL-12 activity. To investigate whether there was a parallel mechanism in humans we examined the effect of whole-body narrowband ultraviolet B (UVB) (311-313 nm; TL-01) and ultraviolet A (UVA)-1 (340-400 nm) on serum cytokine levels. In a first study, five male psoriatic subjects were whole-body irradiated with three sessions of a standard UVB (TL-01) phototherapy regimen previously shown to cause downregulation of natural killer cell activity and T helper 1 (Th1) and Th2 cytokine production by peripheral blood mononuclear cells. Enzyme-linked immunoabsorbent assay (ELISA) of sera taken before and after the third session showed no effect of phototherapy on IL-10 and tumour necrosis factor-alpha (TNF-alpha). In a second study, five healthy subjects received three whole-body exposures of UVB (TL-01) and five other healthy subjects received three exposures of UVA-1 on alternate days (total 22 J/cm(2)). Blood samples were taken before the first irradiation and at 0, 4, 8, 12, 14, 24 and 48 h after the third irradiation. The sera were subsequently analysed for IL-10, IL-12, IL-8, IL-1beta and TNF-alpha, by ELISA. The levels of IL-1beta and TNF-alpha were below detection limits (<5 pg/ml), while no significant change in the levels of IL-10, IL-12 or IL-8 was detected as a result of either TL-01 or UVA-1. It seems unlikely that a modulation in these circulating cytokines assessed in this study accounts for systemic UV-induced immunosuppression in human subjects.

Treatment of patent ductus arteriosus

Patent ductus arteriosus (PDA) continues to be one of the most common problems found in premature infants. The incidence is inversely related to gestation, but may be reduced by use of antenatal steroids, lower volume fluid regimen and judicious use of phototherapy. However, there continues to be controversy as to the appropriate indications for treatment, varying from prophylaxis on the basis of gestation to treatment only when a PDA is demonstrably significant. The situation is further complicated by differing diagnostic criteria for ductal patency or significance. Prophylactic treatment is likely to result in up to 64% of babies being treated unnecessarily. Early treatment of significant or symptomatic PDA depends upon accurate diagnosis. PDA closure can then be achieved using medical means, with surgery reserved for patients in whom this fails or in whom there are contra-indications. However, the optimum timing for intervention remains unknown.

Addition of short-contact anthralin therapy to an ultraviolet B phototherapy regimen: Assessment of efficacy

The purpose of this study was to determine whether the addition of short-contact anthralin therapy to an ultraviolet B phototherapy regimen would result in more rapid resolution of psoriatic plaques. A bilateral paired comparison between an ultraviolet B phototherapy regimen with and without short-contact anthralin was completed in eleven patients. Only two of the patients responded faster on the anthralin-treated side. Our results do not support the routine addition of short-contact anthralin therapy to ultraviolet B phototherapy regimens, but this combination may be more effective in a minority of patients.

Anthralin and Coal Tar Therapy for Psoriasis

Anthralin has been available for many years and has been a useful antipsoriatic agent. It must be used with care, however, by both physician and patient. The introduction of short-contact treatment programs and the combination of anthralin with other therapies may make this compound more usable in the treatment of psoriasis. As for tars, there is significant evidence that they are effective antipsoriatic treatments. When used alone, coal tars are weakly antipsoriatic and do not have the effectiveness of anthralin or potent topical steroids. However, when combined with certain phototherapy regimens, they appear to be useful agents.

Tar gel-phototherapy for psoriasis. Combined therapy with suberythemogenic doses of fluorescent sunlamp ultraviolet radiation

To determine the efficacy of suberythemogenic ultraviolet phototherapy in conjunction with administration of a tar gel (SEUV TG), patients with widespread psoriasis were treated by application of a tar gel preparation followed after 12 hours by suberythemogenic doses of fluorescent sunlamp irradiation. In paired comparison studies, therapeutic effects of the following treatments were evaluated: SEUV-TG, a more conventional erythemogenic tar gel phototherapy regimen (modified Goeckerman), the tar gel alone, and SEUV irradiation following application of gel vehicle. Response to therapy was monitored with a severity score system. In patients with psoriasis responsive to phototherapy, smaller quantities of UV energy administered in combination with a tar gel were at least as effective as larger erythemogenic doses. Production of erythema with fluorescent sunlamp radiation does not appear to be necessary to improve psoriasis. Both UV radiation and tar gel have beneficial effects on psoriasis, but the combination is superior.

Intracellular deoxyribonucleic acid-modifying activity of intermittent phototherapy

Phototherapy is capable of damaging the genetic material of eukaryotic and prokaryotic cells at fluences considerably less than that received by irradiated infants. It has been suggested that intermittent phototherapy, with varying on-off cycles, may offer theoretical advantages since the total light dosage received by the exposed infant is reduced. The present study was undertaken to determine the effect of intermittent phototherapy on the genetic material of human cells in tissue culture. Intermittent illumination produced more DNA damage than a similar light dosage administered continuously. These results suggest that intermittent phototherapy regimens may prove more deleterious to irradiated infants than continuous phototherapy.

Effect of Various Phototherapy Regimens on Bilirubin Decrement

Continuous phototherapy in full-term newborns was found to be more effective than intermittent illumination. Treatment efficacy was also related to age and the initial bilirubin level of the infants. In fact, the reported data indicate an increased therapeutic effect in newborns affected with nonhemolytic hyperbilirubinemia who had an initial bilirubin level greater than 15 mg/dl as compared to neonates with an initial bilirubin level less than 15 mg/dl. The light treatment was also more effective in infants older than 3 days, possibly because of an increased ligandin and conjugating capacity. Shielding the hepatic area during illumination significantly decreases the efficiency of this treatment, suggesting that the liver could also be a phototherapeutic action site.

INTERMITTENT PHOTOTHERAPY: EFFECT ON INTRACELLULAR DNA

Our previous investigations on phototherapy have indicated that this procedure might involve a genetic as well as a carcinogenic hazard by virtue of its ability to modify the intracellular DNA of human cells in tissue culture. Because of this observation techniques for modifying the phototherapy regimen have been advocated. Thus, it has been suggested that intermittent phototherapy might be a safer alternative. Current studies in this laboratory indicate, however, that varying the “on-off” cycle does not prevent DNA damage. On the contrary, the DNA of human cells exposed to an intermittent illumination regimen (30 min off-on cycle) was more damaged than the DNA of cells exposed to the same light dosage administered continuously. It appears that the enhanced DNA degradation is a reflection of the DNA repair process. In this connection it is noteworthy that permanent changes (genetic or carcinogenic) probably are a consequence of such DNA repair (e.g. error-prone repair, misrepair). Thus, intermittent phototherapy may not be a satisfactory alternative in view of its potential effect on DNA repair processes.