Treatment Of Psoriasis Vulgaris Research Articles

Successful treatment of psoriasis vulgaris with ixekizumab in a patient with concurrent Sjögren’s syndrome presenting with dry eye and incomplete SLE

Successful treatment of psoriasis vulgaris with ixekizumab in a patient with concurrent Sjögren’s syndrome presenting with dry eye and incomplete SLE

Google Search Trends About Systemic Psoriasis Treatment: What Do People Want to Know About Biologics and Janus Kinase Inhibitors?

This study investigates the most frequently asked questions regarding systemic treatments for psoriasis vulgaris using Google Trends and People Also Asked (PAA) tools, focusing on traditional DMARDs, biologics, and small-molecule inhibitors. Analyzing data from January 31, 2019, to January 31, 2024, Adalimumab was found to have the highest search volume, followed by Apremilast and Methotrexate in their respective categories. Based on Rothwell's Question Classification Criteria, questions about Adalimumab predominantly centered around their technical, factual details and cost of the medication. The study highlights significant public interest in these factors over their safety profile and it is likely influenced by Adalimumab's high direct-to-consumer marketing. Moreover, evaluation of 782 websites showed that potential patients were seeking commercial and government-based websites to learn more about systemic psoriasis treatment. According to the JAMA benchmark criteria, these source types also scored the highest in terms of information quality, while medical practice websites scored the lowest. The findings suggest the need for dermatologists to address factual details such as medication administration scheduling, dietary restrictions, and cost during patient consultations, and to guide patients towards high-quality online resources. Limitations include potential comprehensiveness of questions and evolving medication concerns.

Yinxieling attenuates psoriasis in mice by regulating oxidative stress and lipid mediators to correct immune cell disorder through the NF-κB/Nrf2 signaling pathways

BackgroundPsoriasis is a chronic skin disease that causes inflammation over time due to immune cell-mediated inflammation, oxidative stress, and lipid mediator imbalance. This study was to investigate the impact of Yinxieling (YXL), a reliable Chinese medicine for the treatment of psoriasis vulgaris, on the redox balance and lipid mediators in mice with IMQ-induced psoriasis. MethodsDaily application of aqueous extract of YXL on IMQ-induced psoriasis-like mice, the efficacy and mechanism of YXL were evaluated by appearance symptoms, oxidative stress indicators, immune balance, and lipid metabolism indicators. ResultsThe results demonstrated that YXL significantly enhanced therapeutic efficacy in a psoriasis mouse model, markedly improving the PASl scores and cutaneous inflammation. Upon YXL treatment, lipid peroxidation levels were significantly reduced, while antioxidant levels correspondingly increased. Additionally, YXL modulated the metabolic enzymes associated with 2-AG, which led to a decrease in CB1 receptor expression and an increase in CB2 receptor expression. In terms of immune modulation, YXL treatment promoted the regulation of T cell populations by down-regulating Th1, Th17, and γδT cells, while up-regulating Th2 and Treg cells, thereby facilitating the formation of an anti-inflammatory state. Further analysis indicated that these regulatory effects were closely associated with the down-regulation of NF-kB expression and the up-regulation of Nrf2 expression. ConclusionIn conclusion, YXL reduces mice dermatitis by inhibiting oxidative stress, elevating endocannabinoid levels and balancing T cell populations in IMQ-induced psoriasis through the NF-κB and Nrf2 signaling pathways. Our results suggest its potential as a therapeutic option for psoriasis by targeting multiple pathways involved in the disease's development.

Biologic anti-IL17 drugs in erythrodermic psoriasis

BackgroundErythrodermic psoriasis (EP) is a potentially life-threatening disease, and there is currently no consensus regarding its optimal treatment. Biological drugs approved for Psoriasis Vulgaris treatment have been used as alternatives to traditional medications. ObjectiveTo evaluate the clinical response and tolerability of anti-IL17 biologic drugs during a 2-year-follow-up. MethodsThis was a retrospective prospective study. EP cases, defined as >75% body surface area involvement, in patients ≥18 years old treated with anti-IL17 for at least six consecutive months were enrolled and then followed until 104 weeks. Patient characteristics, overall clinical responses, PASI score changes, and adverse events were analyzed. ResultsSixteen patients met the criteria, of which 50% had achieved the PASI 100 response at week 12 and in 93.7% at week 24. In the prospective observation of the cohort, 87.5% were still in remission at week 52 and 81.25% at 104 weeks, without adverse events. The three patients in whom the treatment was interrupted lost efficacy and were switched to other therapies. LimitationsOnly descriptive analysis was conducted due to the limited number of patients. ConclusionsA satisfactory long-term clinical response without adverse effects was observed in this case series, suggesting the interest of anti-IL17 in EP treatment.

Exploring the treatment strategy of liver-regulating wood-softening acupuncture method for psoriasis vulgaris based on the theory of "liver as the thief of five organs"

Inspired by the theory of "liver as the thief of five organs", the authors believe that although psoriasis vulgaris manifests externally, its root cause lies internally in liver disharmony. During the active and stable phases, conventional acupuncture combined with liver-regulating wood-softening acupuncture method is used to regulate blood and harmonize the liver, addressing both the symptoms and the root cause. During the remission phase, liver-regulating wood-softening acupuncture method is employed to soothe the liver and restrain the yin, while also regulating and nurturing the emotional state. This study provides a clinical approach to acupuncture treatment for psoriasis vulgaris.

Clinical efficacy observation of calcipotriol combined with AYJ sodium alginate repair dressing in the treatment of psoriasis vulgaris and its effect on patients’ neurological function

Objective To observe the clinical efficacy of calcipotriol combined with AYJ(An Yi Jia) sodium alginate repair dressing in the treatment of psoriasis vulgaris (PV) and its effect on patients’ neurological function. Methods A retrospective analysis was conducted on the clinical data of 103 patients with PV admitted to our hospital from January 2022 to January 2024. All patients met the inclusion and exclusion criteria. According to the treatment interventions received by the patients, they were divided into control group (n = 51, receiving calcipotriol monotherapy) and observation group (n = 52, receiving calcipotriol combined with AYJ sodium alginate repair dressing). The clinical treatment effects, severity of the disease (PSSI score), levels of T lymphocyte subsets (CD4+, CD8+), serum nerve growth factor (NGF), inflammatory factors [interferon-gamma (IFN-γ), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-α)], and adverse reactions were compared between the two groups. Results ① Clinical treatment effects: The total effective rate in the observation group was higher than that in the control group (p < 0.05). ② Severity of the disease: The PASI scores of both groups gradually decreased with prolonged treatment time, and the observation group showed a greater magnitude of change (p < 0.05). ③ T lymphocyte subset cells and serum nerve growth factor: The levels of CD4+ were increased after treatment in both groups, while CD8+ and NGF levels were decreased compared to before treatment, with a greater magnitude of change in the observation group (p < 0.05). ④ Inflammatory factors: The levels of IFN-γ, IL-8, and TNF-α were decreased after treatment in both groups, with a greater magnitude of change in the observation group (p < 0.05). ⑤ Adverse reactions: There was no significant difference in the incidence of adverse reactions between the two groups (p > 0.05). Conclusion Calcipotriol combined with AYJ sodium alginate repair dressing has ideal therapeutic effects in the treatment of PV. Compared with calcipotriol alone, the combined application of AYJ sodium alginate repair dressing can further improve patient efficacy, improve immune and neurological function, alleviate patient inflammatory responses, and does not increase the risk of adverse reactions in patients.

Vitamin D and Skin: An Review and Update

Vitamin D was recognized for its pivotal role in bone formation, but it is now recognized for its impact on the optimal functioning of various tissues throughout the body, including the brain, heart, muscles, immune system, and skin. Vitamin D is a fat-soluble prohormone steroid with endocrine, paracrine, and autocrine functions. Vitamin D receptors and the enzymes that can convert 25-hydroxyvitamin D [25(OH)D] into the active form, 1,25-hydroxyvitamin D [1,25(OH)D], have been identified in numerous cells throughout the body, including the skin. Vitamin D analogs are widely acknowledged for effective treatment of psoriasis vulgaris due to their anti-proliferative and pro-differentiating impact on keratinocytes. Beyond this, emerging roles for vitamin D in skin health include immunomodulatory and anti-apoptotic effects, suggesting potential applications in conditions like atopic dermatitis and infections including verucca vulgaris. Epidemiological studies have linked low vitamin D levels to autoimmune diseases like vitiligo, leading to the use of topical vitamin D in its treatment. Recent evidence also suggests that cutaneous vitamin D synthesis may contribute to preventing skin malignancies, and oral supplementation may reduce cancer mortality. Its role in the pathogenesis of various dermatological diseases has not been an exception and has been extensively studied in recent years. In this review, we will shed light on roles of vitamin D in various skin disorders.

Multiple Bowen's disease due to long-term narrow-band ultraviolet B phototherapy: A case report and literature review.

By presenting a case study on multiple instances of Bowen's disease and the consistent use of narrow-band ultraviolet B (NB-UVB) phototherapy over a three-year period, our aim is to enhance the comprehension of domestic clinicians regarding the disease. Additionally, we seek to review existing literature, encouraging dermatologists to consider clinical secondary primary lesion diagnoses. Our approach involves analyzing a diagnosed case of multiple Bowen's disease, examining clinical manifestations, histopathology, imaging results, and treatment methods related to NB-UVB phototherapy. We aim to facilitate discussion and understanding through a comprehensive literature analysis. An elderly male with a 30-year history of psoriasis vulgaris initiated continuous NB-UVB therapy three years ago. A year later, he developed red patches and plaques with distinct borders and scaly surfaces on his face, trunk, lower extremities, and scrotum. Histopathological examination confirmed Bowen's disease. Treatment involved liquid nitrogen cryotherapy, with no recurrence observed during the one-year follow-up. This case highlights that Bowen's disease, typically solitary, can manifest as multiple instances, especially in individuals with a history of psoriasis vulgaris. While NB-UVB stands as the primary treatment for psoriasis vulgaris, caution is warranted due to the potential risk of skin tumor induction with prolonged high-dose usage. Clinicians should be vigilant in monitoring and assessing the long-term implications of such therapies.

A Case Series of Patients With Eczematous Eruptions Following IL-17 Inhibitor Treatment for Psoriasis Vulgaris.

Psoriasis vulgaris and eczema are characterized by an imbalance in the Th1 and Th2 immune response and distinct cytokine profiles, where Th1 is more prominent in psoriasis and Th2 is more prominent in eczema. A common treatment for psoriasis is anti-IL-17 therapy, in which inhibition of IL-17 cytokines and the Th1/Th17 immune response may cause a paradoxical shift favoring the Th2 immune response and an eczematous phenotype. Our case series presents three patients who developed a cutaneous eczematous eruption 8-12 weeks following treatment of psoriasis with an IL-17 inhibitor (secukinumab, ixekizumab, or brodalumab) suggesting this phenomenon of shifting cytokine levels away from the phenotype of psoriasis toward the opposing disease. J Drugs Dermatol. 2023;22(12):1225-1227. doi:10.36849/JDD.7388.

Individualized Homeopathic Medicines in the Treatment of Psoriasis Vulgaris: Double-Blind, Randomized, Placebo-Controlled Trial

Introduction: Psoriasis is a chronic inflammatory skin disorder, affecting the trunk and extensor surfaces of the limbs and scalp predominantly. Worldwide prevalence ranges between 0.1 and 11.4%, and in India between 0.4 and 2.8%; this creates a serious health burden. Psoriasis remains a frequently encountered condition in homeopathy practice, but there is a dearth of conclusive efficacy data supporting its use. Methods: This 6-month, double-blind, randomized trial was conducted on 51 patients suffering from psoriasis at the National Institute of Homoeopathy, India. Patients were randomized to receive either individualized homeopathic medicines (IHMs; n = 25) in LM potencies or identical-looking placebos (n = 26). Psoriasis area and severity index (PASI; primary), psoriasis disability index (PDI), and dermatological life quality index (DLQI; secondary) were measured at baseline and every 2 months, up to 6 months. The intention-to-treat sample was analyzed using a two-way repeated measure analysis of variance. Results: Although intragroup changes were significant in both groups in the outcome measures, improvements were significantly higher in the IHMs group than in placebos in PASI scores after 6 months of intervention (F1, 49 = 10.448, p = 0.002). DLQI daily activity subscale scores also yielded similar significant results favoring IHMs against placebos after 6 months (F1, 49 = 5.480, p = 0.023). Improvement in PDI total (F1, 49 = 0.063, p = 0.803), DLQI total (F1, 49 = 1.371, p = 0.247), and all remaining subscales were higher in the IHMs group than placebos after 6 months, but nonsignificant statistically. Calcarea carbonica, Mercurius solubilis, Arsenicum album, and Petroleum were the most frequently prescribed medicines. Conclusions: IHMs exhibited better results than placebos in the treatment of psoriasis. Further research is warranted.

Topical treatment of psoriasis vulgaris.

Topical therapy plays an important role in the treatment of psoriasis. It is the gold standard in mild psoriasis cases and is also recommended in addition to UV and systemic therapy in cases of moderate to severe psoriasis. In this overview article we summarize the current therapeutic options, taking into account special localizations (scalp, facial, intertriginous/genital, or palmoplantar lesions) and situations (hyperkeratotic or inflammatory forms), as well as the therapy options during pregnancy and breastfeeding. In the initial phase, the combination of topical corticosteroids and vitamin D analogues has proven to be the therapy of choice, as well as monotherapy in each case. In maintenance therapy, fixed combination therapy is recommended once or twice a week. In addition to the right choice of active substances, the choice of the right formulation also plays an important role. To increase adherence, it is very important to consider the personal preferences and experiences of the patient. If topical therapy does not lead to a satisfactory result, additional UV therapy or systemic therapy should be considered.

Effectiveness and tolerability of calcipotriol/betamethasone aerosol foam in patients with psoriasis vulgaris in real‐life setting: A prospective, noninterventional, multicenter observational study in Austria

AbstractBackgroundFor the topical treatment of plaque psoriasis, vitamin D analogues and corticosteroids are used as a fixed combination, which is available in different galenic preparations.ObjectivesThe aim of this study was to investigate the effectiveness and tolerability of calcipotriol/betamethasone (Cal/BD) cutaneous foam in a real‐world setting.MethodsOverall, 107 adult patients with at least mild plaque psoriasis as measured by the Investigator Global Assessment (IGA) were included and treated for 4 weeks. Affected body surface area (BSA), plaque locations, and Psoriasis Area and Severity Index (PASI) were documented at baseline, after 4 weeks and at the end of the study. Pruritus, overall patient satisfaction, tolerability and convenience of use, as well as quality of life (DLQI) were also evaluated.ResultsIn total, 96% of the patients suffered from mild to moderate psoriasis vulgaris. Of all patients included, 76% had previously received topical therapy. Under treatment with Cal/BD aerosol foam, the mean IGA score was reduced from 2.49 to 1.28 points (p &lt; 0.001). The mean PASI score was reduced from 7.01 to 3.58 (p &lt; 0.001). BSA was improved from 9.92% to 4.19% (p &lt; 0.001) and the DLQI from 7.81 to 2.43 points (p &lt; 0.001). Over 88% (84/95 patients) were very satisfied or satisfied with Cal/BD aerosol foam. The treatment was described as soothing (63/89), cooling (70/89), and itch relieving (53/84). Lack of efficacy was documented as an adverse event (AE) in four of 107 patients. No other AEs were observed.ConclusionsThe treatment of psoriasis vulgaris with Cal/BD aerosol foam was demonstrated to be effective, well tolerated and associated with high patient satisfaction.

The Amazing History of Methotrexate – 75 Years Later from its Discovery, Still the “Golden Standard” Therapy

"More than 75 years after its accidental discovery, methotrexate remains an important treatment option for many diseases. Whether it is various hematological and non-hematological neoplasms, rheumatological, dermatological, or other conditions, methotrexate remains in scope. For rheumatoid arthritis, current clinical guidelines (EULAR, ACR) recommend methotrexate as the first therapeutic option. This article aims to highlight important moments in the history of this remarkable drug, to review the literature on its mechanisms of action and the arguments for which after more than half a century, methotrexate remains the gold standard in the treatment of rheumatoid arthritis but also an important option for treatment of psoriasis vulgaris (PV) and psoriatic arthritis (PsA)."

Efficacy and Safety of Calcipotriene/Betamethasone Dipropionate Foam in the Treatment of Psoriasis in Skin of Color.

There is a paucity of data on usage of topical medications in patients with darker phototypes. This single-center, randomized, double-blinded, vehicle-controlled clinical study investigated the efficacy of a combination calcipotriene/betamethasone dipropionate (Cal/BD) aerosol foam 0.005%/0.064% in the treatment of psoriasis vulgaris in Fitzpatrick skin types IV to VI. 25 adult subjects were randomized 4:1 to Cal/BD foam or foam vehicle once daily for 4 weeks followed by 4 weeks of open label treatment. From week 4 to week 8, subjects randomized to Cal/BD foam once daily switched to Cal/BD foam twice weekly for 4 weeks, while those randomized to vehicle applied Cal/BD foam once daily. At week 4, 4/19 (21%) of Cal/BD foam patients achieved clear/almost clear Investigator Global Assessment (IGA) status with &ge;2 grade improvement compared with 0/5 (0%) of vehicle patients (P=0.54). 12/19 (63%) of Cal/BD foam patients achieved a 50% reduction in Psoriasis Area and Severity Index (PASI 50) at week 4, compared with 0/5 (0%) of vehicle patients (P=0.04). Mean changes in melanin index at week 4 indicate a trend toward increased pigmentation in Cal/BD foam patients and decreased pigmentation in foam vehicle patients (P=0.30). All adverse events were mild and deemed unrelated to treatment by the investigators. The sample size was small and underpowered to detect statistically significant changes in most endpoints. Cal/BD foam was safe and well tolerated in plaque psoriasis patients with skin of color. Larger studies involving skin of color populations with psoriasis are warranted. Pigmentary changes (hyper- and hypopigmentation) in lesional skin were observed. J Drugs Dermatol. 2023;22(2): 165-173.doi:10.36849/JDD.6910.

Retracted: A Meta‐analysis of Xiaoyin Granules Combined with Acitretin Capsule in the Treatment of Psoriasis Vulgaris

Retracted: A Meta‐analysis of Xiaoyin Granules Combined with Acitretin Capsule in the Treatment of Psoriasis Vulgaris

Therapeutic possibilities and dermatological case studies in the municipality of Mitrovica, for the winter period from 01. 11. 2021 - 31. 01. 2022 and the spring/summer period from 01. 05. 2021 - 31. 07. 2022

Skin diseases are most often caused by microorganisms - bacteria, viruses and fungi. In these cases, the cure is certain and the therapy is based on antibiotics, antifungals or minor interventions. Another group of skin diseases are indicators of an excessive immune response of the body to various influences. Most often we encounter different types of eczema and urticaria. The treatment of such diseases is complex, based on antihistamines and corticosteroids. Tests and analyzes are always carried out to determine the existence of a focal point in the body that leads to the appearance of the skin manifestation of a certain disease. In my research related to two institutions, and in two age periods, I came to the following data: In the Family Medical Center-Dermatology Department in Mitrovica, for the period from November 1, 2021 to January 31, 2022, requested help 714 patients and in the spring/summer period from May 1, 2022 to July 31, 2022, 1,196 patients, suffering from skin eczema, hand and foot eczema, psoriasis, seborrheic dermatitis, acne vulgaris, fungal diseases, requested help. skin, Fibromas and papilloma’s, Keratoses, Condylomas, Rosacea, facial redness, etc. Of the total number of patients, 36.90% were men, and 63.10% were women. A significant difference was recorded in the number of people suffering from Eczema compared to Psoriasis vulgaris, Acne vulgaris, Erysipelas and Melanoma (p = &lt; 0.001). The highest consumption of medicines was for the treatment of patients with eczema (49.00%), for the treatment of psoriasis vulgaris (28.00%), acne vulgaris (11.00%), erysipelas (4.00%) and (7%) other (of the total consumption of medicines, it shows and a significant difference (p = &lt; 0.001).A significant difference was recorded between the two periods 01.11.2021 - 31.02.2022 and from 01. 05. 2022 - 31.08.2022.

A successful switch from guselkumab to tildrakizumab during the treatment of a patient with psoriasis vulgaris

This was the first case report in which an in-class IL-23 p19 inhibitor was switched (from guselkumab to tildrakizumab) during psoriasis vulgaris treatment. Four months after the switch, genital lesions, which were the patient's most significant complaint, improved with no subsequent worsening. We believe that our case will aid physicians who work in this problematic clinical setting.

Impact of quercetin spanlastics on livin and caspase-9 expression in the treatment of psoriasis vulgaris

Psoriasis is a chronic immune-mediated disease presented by erythematic lesions. It is an incurable disease; however, topical treatment attempts to stop the uncontrolled proliferation of skin cells. Quercetin (Qc) is a natural compound plentiful in several natural plant species and plays a vital role in treating psoriasis; however, it has poor aqueous solubility and penetrability. Consequently, our work aims to enhance Qc's dissolution and anti-psoriatic activity. In this work, Qc was isolated from Psidium guajava leaves, and spanlastics were prepared using the ethanol injection method. The % encapsulation efficiency (%EE) of Qc ranged from 76.40 ± 1.42 to 98.29 ± 0.2,4, and the Particle size (P.size) varied between 414.66 ± 1.94 to 748.33 ± 5.19 nm. In vitro release studies of Qc from spanlastic preparations were significantly higher than those from free drug dispersion. Selected Qc spanlastics formulation was included in Sodium carboxymethylcellulose (SCMC) 3.5% gel for biological application. Clinical improvement after eight weeks of treatment was powerfully distinguished. By the end of 8 weeks of treatment, Psoriasis Area and Severity Index (PASI) score decreased from 5.19 ± 1.14 at baseline to 2.26 ± 1.1. Qc is famous for its apoptotic-inducing activity, livin is one of the Inhibitors of apoptosis proteins (IAPs), and its function is mediated through the inhibition of caspase activation. Quantitative real-time polymer chain reaction (qrt- PCR) declared that the expression of livin (p = 0.002) was lowered while that of caspase-9 (P < 0.001) was elevated in comparison to those before treatment with QC spanlastics; thus, Qc spanlastics are promising easily prepared formulation for the treatment of psoriasis.

A Meta-analysis of Xiaoyin Granules Combined with Acitretin Capsule in the Treatment of Psoriasis Vulgaris.

Background Psoriasis is a chronic noncommunicable dermatological condition, and psoriasis vulgaris is the most common phenotype. Acitretin is the most widely used systemic retinoid in the treatment of psoriasis. This review evaluates the clinical therapeutic effects of Xiaoyin granule, a Chinese herbal medicine, combined with acitretin capsule in the treatment of psoriasis vulgaris. Methods Six databases including PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), Wan Fang, and China Biology Medicine disc (CBM) were searched for published studies on Xiaoyin granule and/or acitretin capsule in psoriasis vulgaris. The Cochrane Collaboration risk-of-bias instrument was used to assess the quality of the included RCTs. STATA 14.0 was used to conduct the statistical analysis. Results Twenty-eight trials with 3281 patients were included in this meta-analysis. The results of this study show that the combined treatment of Xiaoyin granule and acitretin capsule could improve the total effective rate (TER) and cure rate (CR) when compared with acitretin capsule (TER: RR = 1.15, 95% CI (1.10, 1.21); CR: RR = 1.8, 95% CI (1.62, 2.00)) or Xiaoyin granule (TER: RR = 1.24, 95% CI (1.11, 1.39); CR: RR = 1.75, 95% CI (1.54, 1.98)) alone. The combined therapy could decrease the PASI score (mean difference = −1.45, 95% CI (-2.09, -0.80)) and inhibit inflammation (IL-10: mean difference = 1.16, 95% CI (0.94, 1.38); IL-17: mean difference = −2.06, 95% CI (-2.60, -1.51)) in psoriasis vulgaris patients. Conclusions The combination of Xiaoyin granule and acitretin capsules could be a novel therapeutic strategy in the treatment of psoriasis vulgaris. However, the quality of trials in this study limited the conclusion, and more high-quality RCTs are needed for further evaluation.

284 A single-arm, prospective clinical study of blue light phototherapy as a novel treatment for Grover’s Disease and psoriasis vulgaris

Unlike ultraviolet radiation, blue light (380 nm to 500 nm) is non-ionizing representing a potentially safer and more accessible phototherapeutic modality. We investigated the feasibility, tolerability, and early efficacy of whole-body blue light for the treatment of psoriasis vulgaris and Grover’s disease in a single-arm, prospective, open-label clinical study. A total of 11 patients with Grover’s disease (mean baseline lesion count 27.4) and 9 patients with psoriasis (mean baseline Psoriasis Area and Severity Index (PASI) 6.1) completed a 2-week washout of all topical and systemic therapies and subsequently underwent whole body blue light phototherapy treatment for 15 sequential treatments over five weeks for 18 minutes using the DUSA BLU-U device.