Serum 25-hydroxyvitamin D levels in patients with atopic eczema and the influence of narrowband ultraviolet B phototherapy.

BACKGROUND: Narrowband ultraviolet B phototherapy (nbUVB) is an established treatment modality for patients with severe atopic dermatitis (AD) and is known to increase serum vitamin D levels (SVD). The relationship between SVD and AD remains unclear. OBJECTIVES: To assess SVD and disease severity in patients with AD before and after nbUVB and establish whether a change in SVD correlates to response to nbUVB. Methods: A single-centre, open observational study recruited 21 male and 17 female patients with AD between November and April. Eczema severity was measured using the SCORAD tool, and serum 25-hydroxyvitamin D3 levels were determined before and after nbUVB, which was administered thrice weekly. RESULTS: Nine patients had severe AD, 23 moderate and six mild, as indicated by SCORAD measurements. Seventeen patients completed the study. Median SVD increased from 45 nmol/l pre-treatment to 169 nmol/l post-treatment (95% CI 2.9­5.0 times baseline) (P < 0.0001). Mean SCORAD reduction following nbUVB was significant at 21.9 units (95% CI, 14.9­28.9) (P < 0.0001). No evidence of a relationship between change in SCORAD and change in SVD was found. LIMITATIONS: A significant number of patients failed to complete the study. CONCLUSIONS: Patients with AD are at risk of vitamin D deficiency. Correlation between this and disease severity has been postulated, but this study does not provide confirmatory evidence.

A review of the materials and allergens in protective gloves.

The ingredients previously reported to cause protective glove allergy are presented and evaluated for strength of evidence. Allergens that have caused both delayed hypersensitivity and contact urticaria are considered for rubber, plastic, leather, and textile gloves. The current guidelines regarding glove manufacture are described. A list of materials confirmed by the industry to be used in glove production is presented together with a suggested series for investigating patients with delayed type hypersensitivity and contact urticaria secondary to glove use.

Narrowband ultraviolet B phototherapy does not influence serum and red cell folate levels in patients with psoriasis.

BACKGROUND: Narrowband ultraviolet (UV) B phototherapy (nbUVB) is a widely used modality in the treatment of psoriasis and is generally accepted to be safe in pregnancy. Previous studies have described photodegradation of serum folate after exposure to UVA radiation but the effect of UVB is not known. Insufficient folate levels predispose to neural tube defects in pregnancy. In addition, folate deficiency may increase the risk of colorectal carcinoma and influence serum homocysteine levels, which are thought to be a risk factor for cardiovascular disease. OBJECTIVE: We sought to determine whether exposure to nbUVB reduces folate levels. METHODS: This single-center, open observational study was conducted in a teaching hospital setting. Serum and red cell folate levels were measured in patients with psoriasis attending for nbUVB at baseline and after a minimum of 18 exposures. RESULTS: A total of 35 patients completed the study. Mean serum and red cell folate levels at baseline were 6.34 and 410 ng/ml, respectively. After nbUVB, mean serum and red cell folate levels were 6.35 and 423 ng/ml, respectively. This was not significantly different from baseline measurements (P = .99 serum folate and P = .57 red cell folate). LIMITATIONS: This study examined the effect of a standard course of 18 exposures of nbUVB on folate levels, rather than prolonged treatment. Adult patients with psoriasis only were investigated. CONCLUSION: A standard course of nbUVB does not have an effect on serum and red cell folate levels in patients with psoriasis.

Low-dose UVA1 phototherapy for proximal and acral scleroderma in systemic sclerosis.

Previous studies report the benefit of UVA1 phototherapy in treating acrosclerosis in patients with systemic sclerosis. We carried out a retrospective study to examine the effectiveness of UVA1 phototherapy in scleroderma affecting acral and proximal sites in patients with this disease. Patients with systemic sclerosis (diffuse type, n=5; limited type, n=3) underwent low-dose UVA1 radiation (30-40 J/cm(2)) thrice weekly. In all patients skin lesions improved, demonstrated by a fall in the modified Rodnan skin score ranging from 8 to 18 points in diffuse systemic sclerosis and 6 to 10 points in limited disease. This study would suggest that UVA1 phototherapy is effective for scleroderma affecting proximal and acral sites in patients with systemic sclerosis.

The spontaneous resolution of photosensitivity and contact allergy in a patient with chronic actinic dermatitis.

Chronic actinic dermatitis (CAD) is an uncommon photodermatosis in which patients typically exhibit photosensitivity together with contact allergy. Improvement of the photosensitivity over time is well recognized in a proportion of patients but the concurrent resolution of contact allergy is rare. We report on a 46-year-old female with longstanding CAD who demonstrated resolution of both of these features.

Basal cell carcinoma with a sarcomatous component (carcinosarcoma): a series of 5 cases and a review of the literature.

Cutaneous carcinosarcomas are rare biphasic malignant tumors with a malignant epithelial component together with malignant stroma. Five cases treated in the Yorkshire region of England between 2003 and 2006 are presented. The patients were male with an age range from 58 to 84 years. Four lesions occurred on the face and one on the trunk. Each tumor had an epithelial component resembling a typical nodular basal cell carcinoma. The stromal components demonstrated atypical spindle cells and tumor giant cells, undifferentiated stroma, or osteoid formation. All underwent surgical excision and none showed evidence of recurrence (follow-up 3-17 months, one death from unrelated causes). The recent literature concerning the pathogenesis and prognosis of these unusual tumors is reviewed.