UV Phototherapy Research Articles

The influence of phototherapy on circadian melatonin and sleep regulation and potential benefits of these pathways in the management of vitiligo: a narrative review : Vitiligo, phototherapy, sleep and melatonin.

Ultraviolet B narrow band (UVB-NB) phototherapy is the gold standard treatment for vitiligo, primarily due to its immunomodulatory effects. Additionally, it may influence circadian melatonin balance, that may indirectly induce sleep regulation, which in turn could potentially contribute to vitiligo improvement. The association between melatonin, vitiligo and phototherapy has been little investigated. The aim of this study was to evaluate the current evidence regarding the effects of circadian melatonin regulation and sleep, particularly during vitiligo treatment with phototherapy. We undertook a narrative review to synthetize the evidence on this association through the MEDLINE/PubMed database, using combined search terms: melatonin, vitiligo, phototherapy, and circadian rhythm (sleep). A total of 56 articles were included. There are few studies on this relationship, and conflicting findings. Some studies have suggested that UV exposure and phototherapy might benefit vitiligo by stimulating melanocytes, which have melatonin receptors, and this could potentially synchronize the circadian regulation of melatonin. This improved melatonin balance could result in better sleep quality further enhancing the antiinflammatory properties of melatonin and contributing to vitiligo improvement. Less is known about the possible effects of the use of topical melatonin, with or without phototherapy, to treat vitiligo lesions. In conclusion, there is some evidence that circadian melatonin regulation plays an important role in the course of vitiligo, both through sleep regulation and its anti-inflammatory properties. The evidence suggests that the systemic and physiological properties of melatonin, especially its circadian behavior regulated by phototherapy, may be more effective in respect of vitiligo improvement than the use of topical melatonin. However, the effects of the oral intake of melatonin are less clear. Phototherapy, as a potential modulator of circadian melatonin rhythm, that influences sleep and clinical improvement of vitiligo, needs further examination, as does the use of melatonin as an adjuvant treatment to UVB phototherapy in vitiligo.

An innovative design and metrological testing to evaluate the performance of UV phototherapy devices

Narrowband UVB is the main type of light used to treat various dermatological conditions by administering appropriate doses. In this study, a new design was developed for an open-plan phototherapy device and assessed whether this could improve uniformity and deliver a higher dose, thus reducing treatment times. On the other hand, the uniformity and irradiation dose of a current model of (UV) phototherapy device were investigated. A simulation software was used to present the comparison of the simulated irradiation measurements and uniformity estimation for both the present device and the proposed device. In comparison to a present model of UV therapy device measurements, the results showed that the suggested (UV) phototherapy design device increased the irradiation dose value by 10%, improved the uniformity by 9.3%, and consequently reducing the exposure time by 13%. On the other hand, for both the current (UV) phototherapy equipment and the suggested design device, the irradiation loss value resulting from any UV lamp inefficiency was also calculated. The current model device’s loss value percentage was 15%, however, the loss value of the suggested design for the UV phototherapy device was between 3 and 4%. Based on the results discussed throughout the paper, the findings indicate that the suggested design is promising for UV phototherapy applications.

Changes in the Skin Microbiome Following Dermatological Procedures: A Scoping Review

The skin microbiome consists of bacteria, fungi, viruses, and mites, which play a crucial role in maintaining skin health and immune function. Imbalances in this microbial community, known as dysbiosis, are implicated in various dermatological conditions. While skincare products are known to influence the skin microbiome, the effects of dermatological procedures have not been extensively studied. Here, we perform a scoping review to outline the studies investigating the impacts of dermatological interventions on the skin microbiome. Phototherapy emerged as the most studied intervention, encompassing UV phototherapy, light therapy, laser therapy, and photodynamic therapy. Chemical interventions, such as chemical peels, micropigmentation, and debridement, have comparatively limited studies describing their impacts on the skin microbiome. To date, no studies have been done on a wide variety of common dermatological procedures such as cryotherapy, skin grafts, and dermabrasion, which may have stronger likelihoods of affecting the skin microbiome. This underscores the need for further research on the influences of dermatological procedures, especially chemical and physical interventions, on the skin microbiome. More comprehensive pre-clinical and clinical studies are essential not only for understanding the long-term consequences of these procedures, but also for optimizing patient outcomes in dermatological care.

Spectrally-Selective and High-Resolution Visualization Detection of UVR Based on Efficient Photo-Oxidation

Ultraviolet radiation (UVR) is like a double-edged sword, which has dual significance to human life and health. Current UV sensors struggle to accurately discriminate and quantify UVA, B, and C simultaneously. Additionally, common colorimetric sensors have low visualization resolution. Herein, we constructed a ratiometric fluorescent UVR sensing strategy with spectrally-selective, accuracy, significant color change, and adjustable sensitivity based on the photo-induced fluorescence quenching properties of carbon dots (CDs) and the photosensitization of protoporphyrin IX (PPIX). For daily UVR monitoring, a portable fluorescence reader is developed, which can simultaneously detect dose and intensity. Unlike conventional radiometers, it can sensitively and rapidly discriminate and quantify UVA, B, and C in complex light sources at a lower cost (< 100 $). To ensure the safety of UVR use, wearable fluorescent film sensors (< 0.5 $/piece) we developed for real-time visual monitoring of the cumulative dose of UVA/B during UV phototherapy. Considering individuals with color vision deficiency, we propose a strategy to transform “color analysis” into “count analysis” through creative design, making quantification easier. CDs-PPIX composite offers great potential for UVR detection in our daily lives due to its excellent performance.

Italian S3-Guideline on the treatment of Atopic Eczema - Part 2: non-systemic treatments and treatment recommendations for special AE patient populations, adapted from EuroGuiDerm by the Italian Society of Dermatology and STD (SIDEMAST), the Italian Association of Hospital Dermatologists (ADOI) and the Italian Society of Allergological and Occupational Dermatology (SIDAPA).

SIDeMaST (Società Italiana di Dermatologia Medica, Chirurgica, Estetica e delle Malattie Sessualmente Trasmesse) contributed to the development of the present guideline on the systemic treatment of chronic plaque psoriasis. With the permission of EuroGuiDerm, SIDeMaST adapted the guideline to the Italian healthcare context to supply a reliable and affordable tool to Italian physicians who take care of patients affected by atopic dermatitis. The evidence- and consensus-based guideline on atopic eczema was developed in accordance with the EuroGuiDerm Guideline and Consensus Statement Development Manual. Four consensus conferences were held between December 2020 and July 2021. Twenty-nine experts (including clinicians and patient representatives) from 12 European countries participated. This second part of the guideline includes recommendations and detailed information on basic therapy with emollients and moisturizers, topical anti-inflammatory treatment, antimicrobial and antipruritic treatment and UV phototherapy. Furthermore, this part of the guideline covers techniques for avoiding provocation factors, as well as dietary interventions, immunotherapy, complementary medicine and educational interventions for patients with atopic eczema and deals with occupational and psychodermatological aspects of the disease. It also contains guidance on treatment for pediatric and adolescent patients and pregnant or breastfeeding women, as well as considerations for patients who want to have a child. A chapter on the patient perspective is also provided. The first part of the guideline, published separately, contains recommendations and guidance on systemic treatment with conventional immunosuppressive drugs, biologics and janus kinase (JAK) inhibitors, as well as information on the scope and purpose of the guideline, and a section on guideline methodology.

The burning truth about light therapy: a retrospective analysis of the MAUDE database on UV phototherapy and photodynamic therapy complications 2013-2023.

Phototherapy and photodynamic therapy (PDT) are ultraviolet light (UV) based therapies for patients with skin diseases, and are sometimes associated with potential adverse events (AE)s, including erythema, pain, pruritus, burns, and photoaging. We investigated UV phototherapy and PDT safety using the United States (US) Food and Drug Administration's (FDA)'s Manufacturer and User Facility Device Experience (MAUDE) database. The MAUDE database, including medical device reports (MDR)s informed by voluntary and obligatory reporters since 1991, was searched for AEs associated with UV phototherapy and PDT 1/1/91-3/1/23. There were 59 UV phototherapy and 33 PDT related MDRs. Burns were the most common AE type for both phototherapy and PDT. The majority of phototherapy AEs occurred during 2021 (52.3%), and were significantly more likely to occur at home than in the clinic. Overall, 76.1% of MDRs associated with home light boxes were prescribed by online retailers, most of the MDRs (59.3%) mentioned that it is prohibited to sell phototherapy devices not prescribed by physicians, and only 8.5% noted poorly written home light box instructions. The COVID-19 pandemic prohibited in-person light treatments, and social distancing requirements may have resulted in increased frequency of home-based light treatments. Hence, while at home treatment may be easier and more accessible, in-office physician supervised UV treatments are associated with less frequent AEs. Moreover, some phototherapy MDRs reported poorly written instructions accompanying the home light box, and some PDT MDRs documented patients receiving inadequate education regarding the procedure. With the rise of at-home treatment options and the ease of obtaining devices on the internet, it is physicians' duty to advise patients against self-treating with home light boxes without prescribed treatment regimens and educate patients that are considering home phototherapy to ensure safer patient experiences.

Research Progress of AlGaN-Based Deep Ultraviolet Light-Emitting Diodes

AlGaN-based deep ultraviolet light-emitting diodes (DUV LEDs) have great application prospects in sterilization, UV phototherapy, biological monitoring and other aspects. Due to their advantages of energy conservation, environmental protection and easy miniaturization realization, they have garnered much interest and been widely researched. However, compared with InGaN-based blue LEDs, the efficiency of AlGaN-based DUV LEDs is still very low. This paper first introduces the research background of DUV LEDs. Then, various methods to improve the efficiency of DUV LED devices are summarized from three aspects: internal quantum efficiency (IQE), light extraction efficiency (LEE) and wall-plug efficiency (WPE). Finally, the future development of efficient AlGaN-based DUV LEDs is proposed.

UVA-emitting composite film based on LaB3O6:Ce3+ phosphor for X-ray imaging

A series of UVA-emitting LaB3O6:Ce3+ phosphors and La0.96Ce0.04B3O6/PMMA films were prepared. The calcining temperature, activator concentration and PL test temperature were studied for the luminescence properties of the phosphor. And the effect of phosphor content on transmittance and X-ray radiation capacity of the composite films was also studied. The results show that LaB3O6:Ce3+ emits continuous double peaks at 358 nm and 380 nm when excited at 333 nm, the fluorescence lifetime is about 10 ns, and the luminescence intensity at 150 °C is 73.71% of that at room temperature, which can be used as phosphors for UV phototherapy applications. Under X-ray excitation, the integrated intensity of the La0.96Ce0.04B3O6/PMMA composite film has a good linear relationship with the X-ray tube current and tube voltage, and the X-ray imaging of a car key taken by La0.96Ce0.04B3O6/PMMA composite film has good signal-to-noise ratio, which can be used for X-ray detection and imaging.

UV Irradiation of Nevi: Impact on Performance of Electrical Impedance Spectroscopy and a Convolution Neural Network.

UV irradiation of nevi induces transient melanocytic activation with dermoscopic and histological changes. We investigated whether UV irradiation of nevi may influence electrical impedance spectroscopy (EIS) or convolution neural networks (CNN). Prospective, controlled trial in 50 patients undergoing phototherapy (selective UV phototherapy (SUP), UVA1, SUP/UVA1, or PUVA). EIS (Nevisense, SciBase AB) and CNN scores (Moleanalyzer-Pro, FotoFinder Systems) of nevi were assessed before (V1) and after UV irradiation (V2). One nevus (nevusirr) was exposed to UV light, another UV-shielded (nevusnon-irr). There were no significant differences in EIS scores of nevusirr before (2.99 [2.51-3.47]) and after irradiation (3.32 [2.86-3.78]; P = 0.163), which was on average 13.28 (range 4-47) days later. Similarly, UV-shielded nevusnon-irr did not show significant changes of EIS scores (V1: 2.65 [2.19-3.11]), V2: 2.92 [2.50-3.34]; P = 0.094). Subgroup analysis by irradiation revealed a significant increase of EIS scores of nevusirr (V1: 2.69 [2.21-3.16], V2: 3.23 [2.72-3.73]; P = 0.044) and nevusnon-irr (V1: 2.57 [2.07-3.07], V2: 3.03 [2.48-3.57]; P = 0.033) for patients receiving SUP. In contrast, CNN scores of nevusirr (P = 0.995) and nevusnon-irr (P = 0.352) showed no significant differences before and after phototherapy. For the tested EIS system increased EIS scores were found in nevi exposed to SUP. In contrast, CNN results were more robust against UV exposure.

European guideline (EuroGuiDerm) on atopic eczema - part II: non-systemic treatments and treatment recommendations for special AE patient populations.

The evidence- and consensus-based guideline on atopic eczema was developed in accordance with the EuroGuiDerm Guideline and Consensus Statement Development Manual. Four consensus conferences were held between December 2020 and July 2021. Twenty-nine experts (including clinicians and patient representatives) from 12 European countries participated. This second part of the guideline includes recommendations and detailed information on basic therapy with emollients and moisturizers, topical anti-inflammatory treatment, antimicrobial and antipruritic treatment and UV phototherapy. Furthermore, this part of the guideline covers techniques for avoiding provocation factors, as well as dietary interventions, immunotherapy, complementary medicine and educational interventions for patients with atopic eczema and deals with occupational and psychodermatological aspects of the disease. It also contains guidance on treatment for paediatric and adolescent patients and pregnant or breastfeeding women, as well as considerations for patients who want to have a child. A chapter on the patient perspective is also provided. The first part of the guideline, published separately, contains recommendations and guidance on systemic treatment with conventional immunosuppressive drugs, biologics and janus kinase (JAK) inhibitors, as well as information on the scope and purpose of the guideline, and a section on guideline methodology.

UV phototherapy : UV phototherapy and photodiagnostics-apractical overview

UV phototherapy is an essential and efficient therapeutic option in the treatment of dermatological diseases. It is an integral part of multiple guidelines and maintains its high clinical significance despite the development of new therapeutic options for systemic treatment. Due to the difficult revenue situation, the market for ready-to-use products of psoralen and UV therapy devices is constantly changing.

Tissue Optical Clearing in the Ultraviolet for Clinical Use in Dentistry to Optimize the Treatment of Chronic Recurrent Aphthous Stomatitis

The immersion optical clearing (OC) treatment with a highly concentrated glycerol solution has induced three new tissue windows in the UV spectral range of gingival tissues – from 200 to 250 nm, from 250 to 300 nm and from 300 to 400 nm. By combining the immersion OC technique in human tissues with UV-spectroscopy, it was possible to verify and study the major OC mechanisms – tissue dehydration and refractive index matching, and that the OC efficiency is higher in the deep-UV than in the visible-NIR range. Since all biological tissues present high scattering in the UV range, the presented technology, which basically reduces the strong light scattering in the UV range, has a broad application area in medicine. The effectiveness of the developed technology combining UV phototherapy and OC in application to treatment of aphthous recurrent stomatitis in children was demonstrated.

SnapshotDx Quiz: December 2020

SnapshotDx Quiz: December 2020

Therapeutic application of cannabidiol on UVA and UVB irradiated rat skin. A proteomic study

UV phototherapy used in chronic skin diseases causes redox imbalance and pro-inflammatory reactions, especially in the case of unchanged skin cells. To prevent the harmful effects of UV radiation, cannabidiol (CBD) has been used, which has antioxidant and anti-inflammatory properties. Therefore, the aim of this study was to evaluate the effect of CBD on the metabolism of skin keratinocytes in nude rats exposed to UVA/UVB radiation using a proteomic approach. The results obtained with SDS-PAGE/nanoHPLC/QexactiveOrbiTrap show that exposure of rat’s skin to UVA/UVB radiation, as well as the action of CBD, significantly modified the expression of proteins involved in inflammation, redox balance and apoptosis. UVA/UVB radiation significantly increased the expression and biological effectiveness of the nuclear factor associated with erythroid factor 2 (Nrf2) and cytoprotective proteins being products of its transcriptional activity, including superoxide dismutase (Cu,Zn-SOD) and the inflammatory response (nuclear receptor coactivator-3 and paralemmin-3), while CBD treatment counteracted and partially eliminated these changes. Moreover, cannabidiol reversed changes in the UV-induced apoptotic pathways by modifying anti-apoptotic and pro-apoptotic factors (apoptosis regulator Bcl-2 and transforming growth factor-β). The results show that CBD maintains keratinocyte proteostasis and therefore could be suggested as a protective measure in the prevention of UV-induced metabolic changes in epidermal keratinocytes.

A thermal radiation exchange model of whole-body UV phototherapy

A novel model of the skin dose in whole-body UV phototherapy treatment cabins is presented. The model is based on an analysis of the thermal radiation exchange between two surfaces, in this case the UV source and the patient. It is shown to allow analytical treatment of the multiple internal reflections in a treatment cabin that account for around 40% of the skin irradiance. The model provides predictions of the absolute irradiance at the skin and shielding factors in seven different UVA and NB-UVB cabins that are within 6% of those measured using a calibrated radiometer and within 12% for all nine cabins. The model predicts reducing skin irradiances with increasingly patient size, a trend demonstrated in clinical measurements. The exact sensitivity to patient size in automated cabin dosimetry systems, however, varies with in-built sensor positioning. The potential to extend the use of the model to investigate improved design of automated dosimetry systems is discussed.

Therapie des Handekzems

The treatment of hand eczema represents agreat challenge in the daily clinical practice for dermatologists. There are various forms of local, physical and systemic treatment, such as alitretinoin which is the only registered systemic treatment option for severe chronic hand eczema. In 2017 dupilumab was approved for the treatment of moderate to severe atopic dermatitis and can theoretically also be applied for atopic hand eczema. The first and most important step in treatment is to identify the underlying etiology of the hand eczema with the appropriate diagnostic measures, ranging from skin biopsy to allergy testing including occupational products. An important component of treatment is the basic treatment in the form of consistent and stage-adapted skin care. Treatment of hand eczema should follow astep by step procedure whereby the basic treatment should be maintained and, depending on the etiology and clinical type, should be supplemented by topical, systemic and physical treatment forms, also often used in parallel. Mild to moderate forms of hand eczema are usually treated with the basic treatment, emollients and topical glucocorticoids according to various guidelines. In moderate to severe forms of hand eczema UV phototherapy and systemic treatment should be implemented. This article summarizes the most important treatment modalities based on case reports and series, clinical studies, guidelines and expert recommendations.

Induction of Light Tolerance Using Narrowband UV-B in Solar Urticaria

IntroductionSolar urticaria is an uncommon photodermatosis. First-line treatment is with antihistamines; second-line treatment includes induction of light tolerance using UV phototherapy. ObjectivesWe aimed to describe and evaluate the effectiveness of a desensitization protocol with narrowband UV-B in patients with solar urticaria. Material and methodsWe performed a retrospective study of patients with solar urticaria with an action spectrum in the UV-A range, the visible light range, or both who had received therapy with narrowband UV-B for induction of light tolerance. Short courses of treatment were administered (<20 sessions, 3 per week) during spring. The initial dose was determined according to the skin type. The Skindex-29 was administered before treatment and after summer; a nonvalidated questionnaire was also administered after summer to evaluate disease activity and satisfaction with treatment. ResultsWe included 8 patients with an action spectrum (4 with visible light and 4 with UVA plus visible light). Seventeen courses (1-6 per patient) were administered per year. The number of sessions per year ranged from 11 to 20. The mean dose of narrowband UV-B per course was 7.45J/cm2. No patients experienced flares or adverse effects during treatment. The response was satisfactory in 6 patients. The improvement in the overall Skindex-29 score was greater than 20% in 78.6% of cases. The improvement in the function and symptoms subscales was over 20% in 71% and 64% of cases, respectively. ConclusionInduction of light tolerance with narrowband UV-B in solar urticaria is safe and effective in a high percentage of patients.

Psoriatic arthritis onset in psoriatic patients receiving UV phototherapy in Italy

Psoriasis is a chronic, recurrent, and immune-mediated inflammatory disease that affects 2-3% of the world population. A substantial proportion of patients with psoriasis, approximately 40%, develop a form of inflammatory arthritis known as psoriatic arthritis (PsA), the arthritis follows the development of psoriasis, and it will develop simultaneously or possibly before the appearance of skin lesions. The presence of PsA indicates a need for more active intervention rather than purely topical therapies or UV-based therapies. The aim of this multicenter, retrospective, epidemiological study was to estimate the incidence of PsA in psoriatic patients receiving UV treatment as monotherapy. A retrospective epidemiological study was performed in 8 dermatological reference center, located throughout Italy (2 from Northern, 3 from Center, 3 from Southern); a period of 1 year was considered. Data from the overall study population including 326 patients with a diagnosis of psoriasis were analyzed. Furthermore, data coming from follow-up visits, including screening for PsA onset through specific questionnaires were analyzed. PsA screening was positive in 27 patients (8.3%), whereas PsA diagnosis was confirmed by a rheumatologist in only 22/27 (81.5%) being therefore found in 22/326 (6.7%). Patients diagnosed with PsA had a statistically significantly higher abdominal circumference (96±15.3 vs. 88.9±18.3, P=0.048) and more commonly presented a positive past medical history for phototherapy (90.9% vs. 57.6% P=0.004). Our study showed that phototherapy is not able to prevent or slow down the risk of PsA development in psoriatic patients. PsA screening should be always carried out in those patients even if asymptomatic, especially in obese subjects which are at great risk to develop PsA due to their increased systemic inflammatory state.

Inducción de fototolerancia con ultravioleta B de banda estrecha en urticaria solar

IntroductionSolar urticaria is an uncommon photodermatosis. First-line treatment is with antihistamines; second-line treatment includes induction of light tolerance using UV phototherapy. ObjectivesWe aimed to describe and evaluate the effectiveness of a desensitization protocol with narrowband UV-B in patients with solar urticaria. Material and methodsWe performed a retrospective study of patients with solar urticaria with an action spectrum in the UV-A range, the visible light range, or both who had received therapy with narrowband UV-B for induction of light tolerance. Short courses of treatment were administered (<20 sessions, 3 per week) during spring. The initial dose was determined according to the skin type. The Skindex-29 was administered before treatment and after summer; a nonvalidated questionnaire was also administered after summer to evaluate disease activity and satisfaction with treatment. ResultsWe included 8 patients with an action spectrum (4 with visible light and 4 with UVA plus visible light). Seventeen courses (1-6 per patient) were administered per year. The number of sessions per year ranged from 11 to 20. The mean dose of narrowband UV-B per course was 7.45J/cm2. No patients experienced flares or adverse effects during treatment. The response was satisfactory in 6 patients. The improvement in the overall Skindex-29 score was greater than 20% in 78.6% of cases. The improvement in the function and symptoms subscales was over 20% in 71% and 64% of cases, respectively. ConclusionInduction of light tolerance with narrowband UV-B in solar urticaria is safe and effective in a high percentage of patients.

The 308 nm Excimer laser for the treatment of psoriasis and inflammatory skin diseases

Overall, the 308 nm Excimer laser enables not only a more effective and safer UVB therapy than classical UV phototherapy, but also targeted irradiation in higher doses with a lower cumulative load, which results in faster healing of mainly circumscribed skin changes. This also applies to therapy-resistant residual lesions which, despite systemic therapy, did not diminish. Combination therapies usually improve the result and enable the dose of UVB and systemic medication to be reduced. Excimer laser therapy can be used for an increasing number of skin diseases, especially those that respond to phototherapy or photochemotherapy.