Total UVA Research Articles

Effects of thermal hydrolysis process-generated melanoidins on partial nitritation/anammox in full-scale installations treating waste activated sludge

Thermal hydrolysis process (THP) is a well-established anaerobic digestion (AD) pre-treatment technology. Despite the THP benefits the pre-treatment increases the concentrations of nutrients and melanoidins in the digestate reject water after dewatering. The increased concentrations of nutrients and melanoidins formed during THP-AD can impact downstream processes, such as struvite precipitation and partial nitritation/anammox (PN/A). In our present work, six full-scale PN/A influents and effluents were sampled in The Netherlands (4 with THP and 2 without THP). Full-scale samples were characterised and the stoichiometric O2 consumption and melanoidins chelated to trace elements were analysed. The results showed that THP increased the concentration of total ammoniacal nitrogen (TAN), chemical oxygen demand (COD), total organic carbon (TOC), UVA 254 and colour, which are indicators of melanoidins occurrence. THP furthermore decreased the stoichiometric NO3−-N production from the PN/A reaction in effluents. The disparity between stoichiometric and measured NO3− -N in the THP-using plants was explained by the proliferation of denitrifiers. Moreover, denitrification improved the N removal efficiency due to the consumption of the stoichiometrically-produced NO3− -N. Also, the stoichiometric O2 consumption increased in the plants using THP, reaching up to 56% of the O2 used for partial oxidation of TAN. Trace elements analysis revealed that the plants with elevated concentrations of melanoidins in the effluent showed a high percentage of chelated multivalent cations, particularly transition metals such as Fe. Kendall correlation coefficient analysis showed that the chelation of multivalent cations was correlated mainly with colour occurrence in the reject waters. Overall, the results indicated that in PN/A systems using THP-AD increased O2 consumption and trace elements availability should be considered during the process design.

Role of Topical Calcipotriol to Potentiate the Effect of Photochemotherapy (PUVA) in Treatment of Vitiligo

Introduction: Vitiligo is a specific, common, often heritable acquired disorder characterized by well-circumscribed milky white cutaneous macules and patches devoid of identifiable melanocyte. Treatment of vitiligo, though quite frustrating, includes repigmentation therapies like Topical glucocorticoids, Topical calcipotrieinene, Topical PUVA (Psoralen + Ultraviolet Light A). The combination of calcipotriol and PUVA proves quite effective for management of this condition. Objectives: To compare the effectiveness of PUVA and the combination of topical calcipotriol and PUVA in treatment of vitiligo. Materials and Methods: This quasi experimental study was undertaken at Combined Military Hospital, Dhaka Cantonment, Dhaka from March to October 2015. A total of 32 patients suffering from vitiligo diagnosed clinically and confirmed by Wood’s lamp examination were selected as study population. Systemic PUVA, thrice weekly was given but Topical calcipotriol applied twice daily at one side of the body and other side used nothing Topically. Response was assessed clinically every 4 weeks along with photographic record and compared between two sides of the body. Results: During the course of the treatment, the calcipotriol plus PUVA treated side showed considerably better improvement than only PUVA treated side. The response was Excellent; 37.8% (12/32), Good; 31.3% (10/32), Fair; 18.8% (6/32), Poor; 12.5% (4/32) in calcipotriol plus PUVA treated side whereas Excellent; 12.5% (4/32), Good; 25% (8/32), Fair; 43.8% (14/32) and Poor; 18.8% (6/32) in only PUVA treated side. Conclusion: This study shown that concurrent topical calcipotriol potentiates the efficacy of PUVA in the treatment of vitiligo along with the fact that this combination achieves earlier pigmentation with a lower total UVA dosage in comparison to only PUVA therapy. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 23-25

Comparison between three different high fluence UVA levels in corneal collagen cross-linking for treatment of experimentally induced fungal keratitis in rabbits.

The aim of this study was to compare the efficacy of Photo-Activated Chromophore for Keratitis - Corneal Collagen Cross-linking (PACK-CXL) of three different total UVA fluence levels and topical voriconazole in treatment of fungal keratitis experimentally induced in rabbits. This is an interventional experimental study including both eyes of 16 rabbits (32 eyes). Fungal keratitis was induced by intrastromal injection of Fusarium Solani into the cornea. The rabbits were then divided into four groups (8 eyes for each) from which group A received Voriconazole eye drops and considered as control group. Group B, C, D received single PACK-CXL session with total fluence levels of 7.2, 10.0 and 15.0 J/cm2 for each respectively. Daily clinical examination was recorded and all corneas were removed for microbiology and histopathology on day ten. The mean clinical signs score eyes treated with high fluence PACK-CXL showed evident clinical improvement from fourth to tenth day of treatment. This improvement was equivalent to that of Voriconazole treatment. The results showed better improvement with increasing the UVA total fluence levels but this difference was not statistically significant (P < 0.05). Similarly, the median CFU/ml declined on increasing UVA fluence but with no statistically significant values. Histopathological examination revealed better improvement of inflammatory signs on higher fluence levels compared to lower ones. High intensity PACK-CXL (30 mW/cm2) was as effective as Voriconazole in the treatment of fungal keratitis in rabbits. Increasing the fluence of UVA was associated with slightly better clinical outcomes with no added risks. More clinical studies are needed to confirm these results.

Evaluation of the Long-term Cumulative UVA Facial Exposure of Queensland School Teachers derived for an Extended Period from the OMI Satellite Irradiance.

This research presents a novel methodology for deriving the total daily broadband solar UVA (320-400nm) received by school teachers during their working day from Ozone Monitoring Instrument (OMI) satellite solar noon UVA irradiance measurements for a Queensland subtropical site (27.5°S, 152°E). Daily UVA exposures are weighted to the anatomical human cheek (anterior infra-orbital region) for teachers wearing and not wearing broad-brimmed hats. The method utilizes the OMI UVA irradiance data collected daily at high temporal resolution over 2005 to 2016 to derive the total daily UVA exposure to a horizontal plane. These horizontal plane exposures are scaled by factors to take into account the timing of outdoor activity. The relationship between exposures to a horizontal plane and those to a vertical plane and the protection provided by a broad-brimmed hat was assessed to evaluate the total daily UVA exposures to the cheek for classroom and physical education teaching staff expected to be outside at different periods of the day. The developed method enables the total daily UVA exposure to specific anatomical sites to be evaluated from the satellite solar noon irradiance at locations that do not have access to surface-based instrumentation capable of recording in the solar UVA waveband.

Seasonal Variation In Sunlight Exposure, Nitric Oxide Metabolites, And Blood Pressure

A reduced exposure to ultraviolet (UV) radiation in winter can decrease 25-hydroxyvitamin D (25(OH)D) levels, increase cardiovascular risk factors, and inhibit athletic performance. Exposing skin to UV-A light in the laboratory has also been shown to release nitric oxide (NO) metabolites into the circulation; molecules known to regulate multiple cardiovascular and metabolic processes. However, it is presently unclear whether NO availability is influenced by the seasonal variation in UV exposure. PURPOSE: To compare UV exposure, serum 25(OH)D, plasma nitrate and nitrite, and blood pressure between the summer and winter months. METHODS: Thirty-four healthy adults (21 males) residing in Scotland (~55.8o N, 4.1o W) were monitored for 7 days in the summer (June - August) and winter (December - February) in a randomised order. Participants wore a personal UV monitor on the wrist throughout each monitoring phase before visiting the laboratory to provide a venous blood sample and to have blood pressure measured. Serum levels of 25(OH)D were measured using an enzyme-linked immunosorbent assay and plasma nitrate and nitrite analysed using gas-phase chemiluminescence. RESULTS: Total UV-A exposure was higher in summer (17 ± 21 J.cm2) compared to winter (2.5 ± 3.0 J.cm2, P<0.001). Plasma nitrate did not differ between seasons (P=0.57) but nitrite (137 ± 31 nM) and serum 25(OH)D (22 ± 8 ng/ml) were lower (both P<0.001) in the winter compared to summer (200 ± 56 nM and 35 ± 13 ng/ml, respectively). Blood pressure was higher in winter (systolic 126 ± 13 mmHg; diastolic 76 ± 9 mmHg) than in summer (systolic 119 ± 11 mmHg; diastolic 67 ± 8 mmHg; both P<0.001). UV-A exposure was positively associated with plasma nitrite (R=0.41, P<0.01) and 25(OH)D (R=0.43, P<0.01). Plasma nitrite was negatively associated with systolic (R=−0.5, P<0.01) and diastolic blood pressure (R=−0.4, P<0.01). CONCLUSIONS: In a similar fashion to 25(OH)D, circulating levels of plasma nitrite, a marker of NO bioavailability, appear to be influenced by seasonal variations in UV exposure. The negative association between nitrite and blood pressure suggest that a reduced level of NO may increase cardiovascular risk factors in the winter months.

Influence of clouds on OMI satellite total daily UVA exposure over a 12-year period at a southern hemisphere site

ABSTRACT This research investigated and evaluated the influence of clouds on the total daily UVA (320–400 nm) exposures calculated from the three Ozone Monitoring Instrument (OMI) UV spectral irradiances at solar noon. These evaluated satellite total daily UVA exposure data were compared to the total daily UVA exposures of a ground-based instrument over the period of October 2004 to December 2014 at a sub-tropical Australian site (27.5°S, 151.9°E) under all cloud cover conditions including sun obscured and not obscured conditions. The aim was to evaluate the influence of clouds on the total daily UVA. When the sun was not obscured by clouds, there was good agreement between satellite and ground-based daily UVA exposure measurements with coefficient of determination (R 2) between 0.80 and 0.84, for the cloud conditions 0 to 2, >2 to 4, >4 to 6 and >6 to 8 oktas. For sun obscured by clouds, the R 2 was 0.71, 0.64 and 0.75, respectively, for >2 to 4, >4 to 6 and >6 to 8 oktas. The method was validated using total daily UVA exposures from ground measurements taken in 2015 and 2016 giving a mean absolute error of 84.2 kJ m−2 (10%) and 138.8 kJ m−2 (30%) respectively, for the cases of sun not obscured cloudy days and sun obscured by cloud cover. Total daily UVA exposures were able to be calculated from the OMI satellite spectral irradiance for all cloud conditions, including cases where the sun was obscured, demonstrating the potential application of the technique to be applied in locations that do not record surface UVA measurements directly.

Critical role of the light spectrum on the simulation of solar photocatalytic reactors

This work describes the critical role of the matching between the spectral distribution of the incident light and the absorption spectra of the semiconductor material on the accuracy of the simulation of solar photocatalytic reactors. In silico results have been generated by a multiphysics model including the rigorous description of the hydrodynamics, radiation transfer, mass transport and chemical reaction rate, with the particular feature of using a spectral band discretization approach for the resolution of the radiation balance and the estimation of the spectral local volumetric rate of photon absorption. Model predictions with a mechanistic kinetic model have been experimentally validated using a solar reactor based on a tubular reactor coupled to a compound parabolic collector (CPC) under illumination with a solar simulator (xenon lamp) and natural sunlight. Small differences in the spectral distribution of both light sources led to significantly different predictions for the reaction rate, explaining the higher efficiency experimentally achieved with natural sunlight in comparison with the solar simulator for equivalent total UV-A irradiances. The developed model is able to explain the discrepancies between experimental results in solar simulators and under natural sunlight, usually reported in the literature, offering a novel numerical approach for rigorous modelling of photoreactors using light sources with any spectral distribution.

Staphylococcus aureus resists UVA at low irradiance but succumbs in the presence of TiO2 photocatalytic coatings

The aim of this study was to evaluate the bactericidal effect of reactive oxygen species (ROS) generated upon irradiation of photocatalytic TiO2 surface coatings using low levels of UVA and the consequent killing of Staphylococcus aureus. The role of intracellular enzymes catalase and superoxide dismutase in protecting the bacteria was investigated using mutant strains. Differences were observed in the intracellular oxidative stress response and viability of S. aureus upon exposure to UVA; these were found to be dependent on the level of irradiance and not the total UVA dose. The wild type bacteria were able to survive almost indefinitely in the absence of the coatings at low UVA irradiance (LI, 1 mW/cm2), whereas in the presence of TiO2 coatings, no viable bacteria were measurable after 24 h of exposure. At LI, the lethality of the photocatalytic effect due to the TiO2 surface coatings was correlated with high intracellular oxidative stress levels. The wild type strain was found to be more resistant to UVA at HI compared with an identical dose at LI in the presence of the TiO2 coatings. The UVA-irradiated titania operates by a “stealth” mechanism at low UVA irradiance, generating low levels of extracellular lethal ROS against which the bacteria are defenceless because the low light level fails to induce the oxidative stress defence mechanism of the bacteria. These results are encouraging for the deployment of antibacterial titania surface coatings wherever it is desirable to reduce the environmental bacterial burden under typical indoor lighting conditions.

Correlates of unprotected sex with male clients among female sex workers in 13 Mexican cities

ABSTRACTThis study examined correlates of unprotected vaginal and anal sex (UVA) with male clients among female sex workers (FSWs). Baseline data were gathered from 1089 FSWs recruited from 13 cities across Mexico enrolled in an evidence-based sexual risk reduction intervention. We used generalised estimating equations (GEE) to predict total UVA while controlling for the nested structure of the data. Total UVA with clients in the past month was examined in relation to selected sociodemographic, substance-use, and micro- and macro-environmental factors. A greater number of UVA acts was associated with three micro-level environmental factors (i.e. never getting condoms for free, unaffordability of condoms, greater number of clients per month), and three macro-level environmental factors (i.e. lower health and higher education indices, greater population size of city). These findings suggest the development of social and structural approaches to HIV prevention for FSWs in Mexico, including modification of venue-based policies that pressure FSWs to maximise client volume, changes to the work environment that promote availability and affordability of condoms, and improved population health. Moreover, our findings call for the development of context-specific HIV interventions that take into account variations in the sexual risk behaviours and HIV risk environments of FSWs throughout Mexico.

Scleral Cross-linking Using Riboflavin and Ultraviolet-A Radiation for Prevention of Axial Myopia in a Rabbit Model.

Myopic individuals, especially those with severe myopia, are at higher-than-normal risk of cataract, glaucoma, retinal detachment and chorioretinal abnormalities. In addition, pathological myopia is a common irreversible cause of visual impairment and blindness. Our study demonstrates the effect of scleral crosslinking using riboflavin and ultraviolet-A radiation on the development of axial myopia in a rabbit model. The axial length of the eyeball was measured by A-scan ultrasound in New Zealand white rabbits aged 13 days (male and female). The eye then underwent 360° conjunctival peritomy with scleral crosslinking, followed by tarsorrhaphy. Axial elongation was induced in 13 day-old New Zealand rabbits by suturing their right eye eyelids (tarsorrhaphy). The eyes were divided into quadrants, and every quadrant had two scleral irradiation zones, each with an area of 0.2 cm² and a radius of 4 mm. Crosslinking was performed by dropping 0.1% dextran-free riboflavin-5-phosphate onto the irradiation zones 20 sec before ultraviolet-A irradiation and every 20 sec during the 200 sec irradiation time. UVA radiation (370 nm) was applied perpendicular to the sclera at 57 mW/cm² (total UVA light dose, 57 J/cm²). Tarsorrhaphies were removed on day 55, followed by repeated axial length measurements. This study demonstrates that scleral crosslinking with riboflavin and ultraviolet-A radiation effectively prevents occlusion-induced axial elongation in a rabbit model.

Efficacy and safety of topical PUVA treatment for refractory lesions of mycosis fungoides

To evaluate the efficacy and safety of topical PUVA treatment of refractory lesions of mycosis fungoides. From January 2008 to 2014, a total of 10 patients (4 males and 6 females) with mycosis fungoides were treated with topical PUVA in Peking Union Medical College Hospital, including 7 cases in plaque stage and 3 cases in tumor stage. The average number of lesions were 1.9±0.9. The median age of these patients was (46.0±9.4) years. The average course of disease was (12.4±7.7) years. Psoralen was applied topically on treatment area 30 min before total body UVA irradiation treatment, 3 times a week. And the efficiency and safety of the therapy were evaluated. All the patients were treated with topical PUVA with a median total dose of (161.60±135.96) J/cm2 in an average of (18.10±14.61) fractions. Total dose of UVA was (1 953.25±829.73) J/cm2, and total number of treatment was (261.90±116.79) fractions. The total treatment time was (45.80±26.64) months. Complete clinical response (CR) rate was 60.0%, partial response (PR) rate was 30.0%, and the overall response rate (CR+PR) was 90.0%. One patient showed no response. No severe acute or chronic side effects were observed. Topical PUVA therapy is effective in the treatment of refractory lesions of mycosis fungoides with little severe side effects.

Risk of Cutaneous Malignancy in Mycosis Fungoides Patients Treated with PUVA: A Retrospective Study

Istanbul Universitesi Istanbul Tip Fakultesi, Dermatoloji Anabilim Dali, Istanbul, Turkiye @Telif Hakki 2015 Turk Dermatoloji Dernegi Makale metnine www. turkdermatolojidergisi.com web sayfasindan ulasilabilir. @Copyright 2015 by Turkish Society of Dermatology Available on-line at www.turkdermatolojidergisi.com Melike Umarova Aslan, Istanbul Universitesi Istanbul Tip Fakultesi, Dermatoloji Anabilim Dali, Istanbul, Turkiye E-posta: melikeumarova@hotmail.com Gelis Tarihi/Submitted: 27.08.2014 Kabul Tarihi/Accepted: 02.12.2014 Yazisma Adresi/ Correspondence: Objective: PUVA therapy is mostly used longer than other diseases in mycosis fungoides (MF) patients. We aimed to investigate the chronic side effects of PUVA therapy, including skin cancer to disclose the actual risk in Turkish population. Methods: We screened all MF patients treated with PUVA at the Department of Dermatology and Venereology of Istanbul Medical Faculty and included patients in whom PUVA has first initiated between 1994 and 2006 and administered in one or several courses and who were followed up more than five years with last visit in 2012. Results: Fifty patients with MF had a mean follow-up duration of 10.2±2.8 years. Six patients (12%) had PUVA lentigines. Two of them (4%) developed skin cancer (basal cell carcinoma, Bowen’s disease) during their follow-up. The mean sessions (295.5±7.8 sessions) and total UVA doses (1452 J/cm2) in these patients with skin cancer were higher than those who did not develop skin cancer (128.7±73 sessions and 515±31 J/ cm2, respectively). There was a significant relationship between the PUVA lentigines and development of cutaneous malignancy (p=0.01). Ozgun Arastirma / Original Investigation 12 Turk J Dermatol 2015; 1: 12-7 • DOI: 10.4274/tdd.2413 13 Umarova Aslan ve ark. PUVA Tedavisinde Deri Kanseri Riski. Turk J Dermatol 2015; 1: 12-7 Conclusion: Cutaneous malignancies were detected in 4% of MF patients followed up approximately 10 years. Due to this low risk, we conclude that PUVA therapy is relatively safe in patients with MF in our country. However, UVA should not be applied in high total doses and patients should be followed-up lifelong.

Scleral cross-linking using riboflavin and ultraviolet-A radiation for prevention of progressive myopia in a rabbit model

Our study demonstrates the effect of scleral cross-linking using riboflavin and ultraviolet-A radiation on the development of axial myopia in a rabbit model. Axial length of the eyeball was measured by A-scan ultrasound in 22 New Zealand white rabbits aged 13 days. The right eyes then underwent 360-degree conjunctival peritomy with (experimental group, n = 11) or without (control group, n = 11) scleral cross-linking, followed by tarsorrhaphy. The left eyes served as a control eye. In the experimental group, the right eyeballs were divided into quadrants, and every quadrant had either 2 (n = 8) or 6 (n = 3) scleral irradiation zones, each with an area of 0.2 cm² and radius of 4 mm. Cross-linking was performed by dropping 0.1% dextran-free riboflavin-5-phosphate onto the irradiation zones at 20 s before ultraviolet-A irradiation and every 20 s during the 200-s irradiation time. UVA radiation (370 nm) was applied perpendicular to the sclera at 57 mW/cm² (total UVA light dose, 57 J/cm²). Tarsorrhaphies were removed on day 55, followed by repeated axial-length measurement.In the control group, mean axial length in the right eyes increased from 10.50 ± 0.67 mm at baseline to 15.69 ± 0.39 mm 55 days later, for a mean change of 5.19 ± 0.85 mm. In the experimental group, corresponding values were 10.68 ± 0.74 mm and 14.29 ± 0.3 mm, for a mean change of 3.61 ± 0.76 mm. The between-group difference in the change in mean axial length was statistically significant (p < 0.001, Mann–Whitney nonparametric test).The present manuscript demonstrates that scleral cross-linking with riboflavin and ultraviolet-A radiation effectively prevents occlusion-induced axial elongation in a rabbit model.

Photo-Fenton process for simultaneous colored wastewater treatment and electricity and hydrogen production

The decolorization of Orange II (azo-dye) using a combination of the photo-Fenton process and electrochemical corrosion of iron, which can be used for wastewater treatment and electricity and hydrogen gas production simultaneously, was investigated. In order to quantitatively estimate experimental parameters such as ultraviolet (UV-A) light intensity, total iron ion concentration, hydrogen peroxide concentration, and Orange II concentration, a dynamics simulation of the proposed combined process for continuous decolorization was developed. As the total iron ion concentration and UV-A light intensity increased, the decolorization rate constant increased. The decolorization improved as the hydrogen peroxide concentration increased until a critical hydrogen peroxide concentration was achieved. An increase in the initial Orange II concentration depressed the photo-Fenton decolorization. The proposed model satisfactorily simulated the present experimental results for both batch and continuous systems. It can provide valuable information for reaction kinetics, start-up and shut-down operations, and operability studies, as well as steady-state performance. The electric current and amount of hydrogen gas obtained using the combined process were 3.8mA and 1.88×10−3mmol/min, respectively.

Long-Term Follow-Up of Refractory Mycosis Fungoides Which Achieved Remission with the Addision of Isotretinoin to Methotrexate and Psoralen Plus Ultraviolat A Therapy

Dear Editor: Mycosis fungoides (MF) is the most common cutaneous T cell lymphoma. Many therapies are considered based on the patient's individual presentation1. Early stage MF is known to be easily responsive to conventional therapy. However, there is some early stage MF refractory to conventional therapy and thus need other treatment modalities2. A 38-year-old man was presented with a 3-year history of asymptomatic multiple erythematous to dusky red edematous patches over his trunk, legs, neck and face (Fig. 1A). The skin involvement measured about 45% of total body surface. Skin biopsy specimens from the leg showed clustered epidermotrophic atypical lymphocytes in the epidermis with a band-like dense lymphocytic infiltrate in the dermis (Fig. 2A). In immunohistochemical staining, lymphocytes were positive for CD3 and CD4. A T-cell receptor-gamma gene rearrangement revealed the monoclonality in the polymerase chain reaction (PCR) analysis (Fig. 2B). The biopsy finding on the left palpable inguinal lymph node was dermatopathic lymphadenitis. According to TMNB staging, the patient was diagnosed as MF stage IIA (T2N1M0B0). Initially, he was treated with low-dose methotrexate (7.5 mg/wk) and psoralen plus ultraviolet A (PUVA) twice a week, with maximum doses of 1.3 J/m2. However, the disease showed no response during the 5 weeks of therapy. As first generation retinoids, such as isotretinoin, have been shown to be effective in early stage MF for a long period of time1, isotretinoin (20 mg/day) was newly added to his treatment regimen for the following 6 weeks; consequently, the lesions showed remission (Fig. 1B). According to a recent study, many conventional treatments become ineffective when the skin involvement is over 10%, even in early stage MF2. Likewise, although the patient was diagnosed as an early stage MF in this case, the skin lesions were refractory to the initial treatment. Eventually, after the addition of isotretinoin, the skin lesions showed a dramatic improvement without relapse for 2 years. Retinoids are the so-called biological response modifiers with different mechanisms of action than traditional cytotoxic chemotherapies. The biological effects of retinoids in MF are related to its boosting immune function by inducing anti-tumor responses and leading to the apoptosis of tumor cells3. When the retinoid is combined with methotrexate or PUVA, it strengthens the effectiveness of treatment by exhibiting combined actions of each agent and decreasing the side effects by lowering the doses of total UVA irradiation4. Nowadays, many studies have focused on retinoid X receptor-selective rexinoid, bexarotene. However, the efficacy of bexarotene compared to traditional retinoids, such as isotretinoin, has yet to be determined3. Thomsen et al.5 reported the effectiveness of isotretinoin on MF. However, no study has yet reported about the effectiveness of isotretinoin as a component of this combination therapy for refractory early stage MF. As we observed the dramatic therapeutic effect with the addition of isotretinoin for refractory MF, we suggest that isotretinoin could still be a type of effectual therapeutic option for combination therapy of early stage MF, particularly when the skin involvement is over 10% or refractory to the conventional treatment. Fig. 1 (A) Edematous dusky red to erythematous patches on the back and the left leg before treatment. (B) Remission on the back and left leg with addition of isotretinoin to methotrexate and psoralen plus ultraviolet A therapy. Fig. 2 (A) Epidermotrophism with clustered atypical lymphocytes in the epidermis and dense lymphocytic infiltrate with hyperchromatic nuclei in the dermis (HE inset: H&E, ×200). (B) The result of T-cell receptor-gamma gene ...

Phototherapy for pityriasis lichenoides: our experience

Pityriasis lichenoides is a benign disease that includes a continuous spectrum with two polar ends: pityriasis lichenoides et varioliformis acuta (PLEVA) and pityriasis lichenoides chronica (PLC). Although its benign and self-limited character, treatment is required, both for itch relief and for cosmetic issues. The present study is a retrospective analysis of 13 patients (11 PLC and 2 PLEVA) treated in our institution with psoralen plus ultraviolet A (PUVA) or ultraviolet A combined with ultraviolet B (UVA/UVB) during the period 1998–2011. In the PUVA group, complete response was achieved in five patients and partial response in two. Total cumulative UVA dose was 84.4 J/cm2. One patient quit therapy without therapeutic response. In the UVA/UVB group, complete response was achieved in two patients and partial response in an equal number of patients. One patient did not reach a significant improvement. Total cumulative doses were: 26.1 J/cm2 for UVA and 3.62 J/cm2 for UVB. There were no acute side effects in either therapeutic group. In the present study, PUVA phototherapy was preferred for patients with more widespread or long-evolving disease, while UVA/UVB was selected for patients who presented more recent disease or contraindications for PUVA therapy. Regardless of the absence of clinical guidelines, both therapeutic options proved to be successful, ascertaining phototherapy as an effective and safe option for pityriasis lichenoides patients.

Efficacy and safety of bexarotene combined with psoralen-ultraviolet A (PUVA) compared with PUVA treatment alone in stage IB-IIA mycosis fungoides: final results from the EORTC Cutaneous Lymphoma Task Force phase III randomized clinical trial 21011 (NCT00

Psoralen plus ultraviolet A (PUVA) is the standard treatment for early stages of mycosis fungoides. There have been no adequate randomized controlled trials with sufficient power comparing this modality with other therapies. To assess disease response and to compare the response rates of patients treated with PUVA alone or PUVA and bexarotene. EORTC 21011 (NCT 00056056) was a randomized phase III study comparing combined bexarotene (Targretin(®) ) and PUVA vs. PUVA alone in patients with stage IB and IIA mycosis fungoides (MF). The primary endpoint was the overall response rate [complete clinical response (CCR) plus partial response (PR)]. The study was prematurely closed due to low accrual after 93 of 145 required patients (65%) were randomized. Of the 93 randomized patients, 87 started treatment, 41 received PUVA and 46 received PUVA + bexarotene. Total UVA doses received were 107 J cm(-2) (range 1·4-489·9) in the PUVA arm vs. 101·7 J cm(-2) (0·2-529·9) in the combination arm. The safety profile was acceptable with few grade 3-4 toxicities observed in either arm. More drop-outs due to toxicity were observed in the combination arm compared with the PUVA-alone arm. The best overall response (CCR + PR) rate was 71% for PUVA alone and 77% for the combination arm (P = 0·57). The median duration of response was 9·7 months for PUVA vs. 5·8 months for the combination arm (P = 0·33). CCR was seen in 25 patients of whom 10 received PUVA alone (CCR 22%) and 15 received combination therapy (CCR 31%) (P = 0·45). CCR was sustained in 25% of patients regardless of therapy. There was a trend towards fewer PUVA sessions needed to achieve CCR in the combination arm (median 22) compared with the PUVA arm (median 27·5) (P = 0·11). Similarly, a trend towards lower UVA dose required to achieve CCR in the combination arm (median 55·8 J cm(-2) ) compared with the PUVA arm alone (median 117·5 J cm(-2) ) (P = 0·5) was observed. No significant difference in response rate or response duration was observed in this study. However, there was a trend towards fewer PUVA sessions and lower UVA dose required to achieve CCR in the combination arm (PUVA + bexarotene) but this did not achieve statistical significance due to insufficient power.

Efficacy and safety of bexarotene combined with psoralen/ultraviolet A light (PUVA) compared to PUVA treatment alone in stage IB-IIa mycosis fungoides (MF): Final results from EORTC cutaneous lymphoma task force (CLTF) phase III clinical trial 21011.

8076 Background: Skin-directed treatment with methoxsalen (PUVA) is the current treatment standard in stage IB-IIA MF. A combination of PUVA and bexarotene might be of additional clinical benefit for MF stage I/II patients (pts). Methods: EORTC 21011 was a randomised, open label phase III study comparing combined bexarotene and PUVA versus PUVA alone in pts with stage IB and IIA MF. Study primary endpoint was response (complete clinical + partial response, CCR+PR) rate; secondary endpoints: cumulative dose of UVA and number of PUVA sessions necessary to achieve a CCR, duration of CCR, time to relapse, safety and percentage of drop-outs. Results: The study recruited stage IB/IIA MF pts and was prematurely closed due to low accrual after 93/145 required pts (65%) were randomized; 45 to PUVA, 48 to PUVA+bexarotene. Median number of PUVA weeks were 12 (1-17) in PUVA vs. 10.5 (1-16) in combination arm. Total UVA doses were 107J/cm2 (1.4-489.9) in PUVA vs. 101.7J/cm2 (0.2-529.9) in combination arm. Few grade 3-4 toxicities were observed in both arms (liver enzyme elevation, neutropenia, anemia, increased cholesterol, photosensitivity, pruritus, rash, hypertriglyceridemia). Best overall response (CCR/PR) rate was 71.1% (33/45) for PUVA alone and 77.1% (37/48) for combination arm (p-value=0.57). The median of duration of response was 9.6 for PUVA vs 5.8 months for combination arm (p value=0.33). CCR was seen in 25 pts, 10 in PUVA (CCR 24%) and 15 in combination therapy (CCR 33%) (pvalue=0.45). Similarily, a lower UVA dose was required to achieve a CCR in the combination arm (median of 55.8 J/cm2) compared to the PUVA arm (median of 117.58 J/cm2) (p value=0.5). Conclusions: No significant difference in response rate was observed in this study. There was a trend towards fewer PUVA sessions and lower UVA dose to achieve CCR in the PUVA/bexarotene combination arm (median of 27.5 vs. 22,p-value = 0.11) but this did not achieve statistical significance due to insufficient power. The safety profile was acceptable, as there were only few grade 3-4 toxicities observed in both arms.

Is the efficacy of psoralen plus ultraviolet A therapy for vitiligo enhanced by concurrent topical calcipotriol? A placebo-controlled double-blind study

Background Encouraging results of previous uncontrolled trials suggest that calcipotriol may potentiate the efficacy of psoralen plus ultraviolet (UV) A (PUVA) therapy in patients with vitiligo. Objectives We performed a placebo-controlled double-blind study to investigate whether the effectiveness of PUVA treatment could be enhanced by combination with topical calcipotriol in the treatment of vitiligo. Methods Thirty-five patients with generalized vitiligo enrolled in the study. Symmetrical lesions of similar dimensions and with no spontaneous repigmentation on arms, legs or trunk were selected as reference lesions. In this randomized left-right comparison study, calcipotriol 0·05 mg g−1 cream or placebo was applied to the reference lesions 1 h before PUVA treatment (oral 8-methoxypsoralen and conventional UVA units) twice weekly. Patients were examined at weekly intervals. The mean number of sessions and the cumulative UVA dosage for initial and complete repigmentation were calculated. Results Twenty-seven patients (nine women, 18 men; mean ± SEM age 29·8 ± 13·5 years) were evaluated. The mean ± SEM cumulative UVA dose and number of UVA exposures for initial repigmentation were 52·52 ± 6·10 J cm−2 and 9·33 ± 0·65 on the calcipotriol side, and 78·20 ± 7·88 J cm−2 and 12·00 ± 0·81 on the placebo side, respectively (P < 0·001). For complete repigmentation, respective values were 232·79 ± 14·97 J cm−2 and 27·40 ± 1·47 on the calcipotriol side and 259·93 ± 13·71 J cm−2and 30·07 ± 1·34 on the placebo side (P = 0·001). Treatment with calcipotriol and PUVA resulted in significantly higher percentages of repigmentation for both initial (81%) and complete pigmentation (63%), compared with placebo and PUVA (7% and 15%, respectively). Conclusions Our results have shown that concurrent topical calcipotriol potentiates the efficacy of PUVA in the treatment of vitiligo, and that this combination achieves earlier pigmentation with a lower total UVA dosage.

Measurements of UV radiation on rotating vertical plane at the ALOMAR Observatory (69° N, 16° E), Norway, June 2007

Abstract. Erythemaly weighted UV and total UV-A irradiance measured at the ALOMAR (Arctic Lidar Observatory for Middle Atmosphere Research; 69° N, 16° E) in June 2007 by two Kipp &amp;amp; Zonen UV broadband meters type, UV-S-EA-T, are examined. One unit is mounted on rotating vertical plane and the other is permanently fixed horizontally. The UV broadband meters measure simultaneously to compare UV irradiances on vertical and horizontal planes. The entire range of such relative exposure variations during clear-sky and overcast conditions over ALOMAR in the period March–June 2007 is examined using STAR and Radonic1 model (developed at the Meteorological Institute, University of Munich) for various action spectra: erythema, UV-A, and vitamin D3. The model and observations support that the daily means of relative exposures are quite stable, i.e., vary within the range 0.4–0.6 with the mean around 0.5 when the averaged intra-day, day-to-day, and seasonal changes of the relative erythemal exposures are considered. It seems that multiplication of the daily mean dose from a broadband meter placed horizontally by the factor of 0.5 gives reasonable estimation of the daily mean exposure on a vertically oriented receiver randomly oriented towards the Sun. The model studies during clear-sky conditions show that the extreme value and daily variability of relative exposure are the highest for UV-A, next for erythemal UV, then for vitamin D3 weighed UV irradiance. The minima of relative exposure (~0.20–0.30) are almost the same for all weighting functions. The comparison of model simulations and measurements suggests that specific cloud configuration could lead to significant enhancement of UV exposure of rotating receiver.