Standardization of regimens in Narrowband UVB and PUVA in early stage mycosis fungoides: position paper from the Italian Task Force for Cutaneous Lymphomas.

UV-based (PUVA and narrowband UVB) phototherapy is broadly and commonly used in the treatment of Cutaneous T-cell Lymphomas (CTCL), yet unfortunately, the evidence for the efficacy of these treatments is based only on case series or prospective but non-randomized studies. Therefore, no internationally approved guidelines exist and no standardization of schedules has been proposed. Recently, consensus guidelines have been published by the United States Cutaneous Lymphoma Consortium. The aim of this study was to review the biological and clinical evidences on PUVA and NB-UVB in CTCL and to critically evaluate acceptability and feasibility of these guidelines in the real-life setting from the perspective of the Cutaneous Lymphoma Task Force of the Italian Lymphoma Foundation (Fondazione Italiana Linfomi, FIL).

Comparison of Phototherapy Guidelines for Psoriasis: A Critical Appraisal and Comprehensive Review.

Psoriasis is a common, chronic immune-mediated inflammatory skin disorder that significantly impacts quality of life and has potential systemic complications. The majority of psoriatic patients have mild to moderate disease and are adequately controlled with topical medications. However, approximately 20% of patients have moderate-to-severe disease. Phototherapy has remained a mainstay option for patients with moderate-to-severe psoriasis resistant to topical treatments due to its efficacy, cost-effectiveness, and relative lack of side effects, in particular a lack of systemic immunosuppression seen with traditional and biologic systemic therapies. There are several well-established guidelines for phototherapy treatment of psoriasis proposed in the United States by the American Academy of Dermatology (AAD), in Europe by the European S3, and in the United Kingdom by the National Institute for Health and Care Excellence (NICE). The guidelines set by these groups are largely based on current evidence or expert panel consensus where evidence is lacking. This article reviews and compares the current recommendations of these guidelines for psoriasis phototherapy in regards to the initial clinical encounter, dosage, adverse reactions, and special considerations.

J Drugs Dermatol. 2016;15(8):995-1000.

Phototherapy for atopic dermatitis.

The beneficial effects of ultraviolet (UV) radiation on atopic dermatitis has been appreciated for many years. While broadband UVB and psoralen UVA have been the mainstay of phototherapy for some time, the past 5 years have seen the introduction of phototherapeutic modalities, including UVA-1 and 311nm UVB. The best modality and mode of usage is dependent on the type of atopic dermatitis, severity and body site. T lymphocytes play an important role in disease pathogenesis and UV radiation has profound effects on skin and systemic immune responses.

Guidelines for topical PUVA: a report of a workshop of the British photodermatology group.

Psoralen photochemotherapy [psoralen ultraviolet A (PUVA)] plays an important part in dermatological therapeutics, being an effective and generally safe treatment for psoriasis and other dermatoses. In order to maintain optimal efficacy and safety, guidelines concerning best practice should be available to operators and supervisors. The British Photodermatology Group (BPG) have previously published recommendations on PUVA, including UVA dosimetry and calibration, patient pretreatment assessment, indications and contraindications, and the management of adverse reactions.1 While most current knowledge relates to oral PUVA, the use of topical PUVA regimens is also popular and presents a number of questions peculiar to this modality, including the choice of psoralen, formulation, method of application, optimal timing of treatment, UVA regimens and relative benefits or risks as compared with oral PUVA. Bath PUVA, i.e. generalized immersion, is the most frequently used modality of topical treatment, practised by about 100 centres in the U.K., while other topical preparations tend to be used for localized diseases such as those affecting the hands and feet. This paper is the product of a recent workshop of the BPG and includes guidelines for bath, local immersion and other topical PUVA. These recommendations are based, where possible, on the results of controlled studies, or otherwise on the consensus view on current practice.

Psoriasis: therapeutic aspects.

Some of the more common features of psoriasis are reviewed here as an introduction to therapeutic modalities that can be employed in the management of this disorder in the New Zealand situation. An approximate indication of costs for the various therapies is included. This article is sponsored by the therapeutics section of the Department of Health, however, the views of the contributors do not necessarily reflect departmental policies.

Topical PUVA therapy for vitiligo.

Vitiligo, a pigmentary disorder of the skin, causes the appearance of white patches which are profoundly devastating to the person afflicted with this disease. This article outlines the safe use of topical PUVA therapy in the office for treating those patients with less than 20% skin surface involvement. This treatment has a response rate of approximately 50%.

Long-term efficacy of PUVA treatment in lichen planus: comparison of oral and external methoxsalen regimens.

Forty-three patients with lichen planus (LP) were treated with either oral methoxsalen PUVA (10 cases), bath methoxsalen PUVA (13 cases) or no PUVA (20 cases). In the bath treatment series, a good or excellent clearing of the lesions was registered in 10 out of 13 cases after courses of 8-46 irradiations, while in the orally medicated group only 5 out of 10 had a similar response after 8-30 irradiations. In addition, 11 of the 23 PUVA-treated patients showed progressive improvement of their condition during the first few months after PUVA therapy. A clinical follow-up study was made 15 and 10 months later in the oral and bath PUVA groups, respectively, and at 10 months in the no-PUVA group. Six of the 23 PUVA-treated patients (23%) were found to be totally clear, but the remaining 17 patients (74%) had clinical signs of LP. Eleven of the 20 no-PUVA-treated patients (55%) showed total clearing. It is concluded that while both oral and bath methoxsalen PUVA regimens have a distinct immediate (1-2 months) clearing effect on LP, the late outcome of the rash is not better than with no UV treatment; PUVA treatment may possibly even prolong the ultimate course of LP.

In vitro assay of the effects of psoralens plus ultraviolet radiation on human lymphoid cells.

An in vitro assay system that mimics some of the features of in vivo oral methoxsalen photochemotherapy (PUVA) in relation to human lymphoid cells was developed. In this assay, suspension cultures of human lymphoid cells were subjected to therapeutic concentrations of 8-MOP and to a UVA radiation spectrum modified to approximate the dermal exposure. The assay permitted correlation and quantitation of multiple 8-MOP plus UVA-induced biological and physical alterations in the same assay system. Thus were demonstrated inhibition of DNA synthesis, reduction of cell survival, production of DNA cross-links, and loss of mixed leukocyte reactivity induced by combinations of 8-MOP and UVA in or near the presumed therapeutic range. This assay may be useful for predicting lymphoid cellular toxicity of other photoactive agents as well as for examining the molecular effects of these agents.