[Phototoxic reaction due to solar radiation exposure in a psoriatic patient treated with PUVA therapy]. / Reakcja fototoksyczna po ekspozycji na promieniowanie sloneczne u pacjentki leczonej metoda PUVA z powodu luszczycy.

A phototoxic reaction may be induced by additional exposure to solar radiation during photochemotherapy (psoralen, ultra-violet A - PUVA treatment). A woman was admitted to Dermatology and Venereology Clinic in Lódz as an emergency case due to extensive erythematous-vesicular lesions on the skin of the lower limbs, accompanied by pain, itching and burning of the skin. The interview found that the patient was undergoing PUVA phototherapy for psoriatic lesions, with hypertension and nicotine dependence. Physical examination revealed large blisters, filled with serum and congestive erythematous lesions located on the lateral surfaces of the thighs and backs of the feet, as well as marked swelling of the lower limbs. Also, discs coated with thin scales were found on the upper and lower limbs and on the trunk. The entire body was intensely tanned. The patient was diagnosed with acute phototoxic reaction and general corticosteroids, antihistamine drugs, an antibiotic, antihypertensive drugs and topical treatment were introduced. Immunological tests were performed during the first days of hospitalization following the emergence of new blisters. Negative results ruled out bullous pemphigoid and pemphigus. Gradual clinical improvement was observed. To avoid the occurrence of acute phototoxicity during phototherapy, patients require education about the need to avoid UV exposure and to use photoprotection, when receiving UV-sensitizing treatment. Med Pr. 2019;70(6):763-8.

Laser-Assisted Photodynamic Therapy: Two Novel Protocols for Enhanced Treatment Results.

Photodynamic therapy (PDT) uses a topical photosensitizing agent which is activated by a light source to cause destruction of specific cells. Commonly used for the treatment of actinic keratoses and photodamage, PDT can also be used for other conditions including acne and sebaceous hyperplasia. Here we report our experience with two treatment protocols. The first protocol utilizes laser assisted delivery of topical 5-aminolevulinic acid for enhanced efficacy of blue light photodynamic therapy in the treatment of actinic keratoses and photodamage. The second protocol utilizes red light photodynamic therapy followed by pulsed dye laser to effectively target sebaceous glands in patients with extensive sebaceous hyperplasia.

J Drugs Dermatol. 2017;16(4):329-331.

[Eczematous skin diseases]. / Ekzemás megbetegedések.

The skin, as one of the most important barriers of the human body, protects the inner homeostasis from the harmful environmental influences as well as physical, chemical and biological factors. When the impact of these factors exceeds the tolerance and reproducing capacity of the skin, pathological alterations will develop. If follows from this that dermatology can surely be considered to be a part of environmental medicine. Eczematous diseases are mostly pathological pictures of varied mechanisms developing as a result of environmental influences (irritants, contact allergens, microbes). Since their clinical appearance is similar, it is a serious professional challenge to diagnose them. In this article we present the clinical features, provoking factors of these skin diseases as well as therapeutical possibilities.

Documento de consenso sobre fototerapia: terapias PUVA y UVB de banda estrecha / Consensus document on phototherapy: PUVA therapy and narrow-band UVB therapy

La elaboración de un documento de consenso en fototerapia resulta imprescindible en el objetivo de adaptar este procedimiento a las peculiaridades, necesidades y realidad de nuestro ámbito. Tomando como referencia la revisión de la literatura existente al respecto y la experiencia propia de sus miembros, el Grupo Español de Fotobiología (GEF) de la Academia Española de Dermatología y Venereología (AEDV) ha elaborado unas guías terapéuticas para las modalidades de fototerapia más empleadas: terapia con psoraleno y radiación ultravioleta de longitud de onda A (PUVA) y terapia con radiación ultravioleta de longitud de onda B de banda estrecha (UVB-BE). En ellas se abordan generalidades acerca del utillaje, calibración y reglamentación en las cabinas de fototerapia, se revisan el concepto y las indicaciones de estas formas de tratamiento y se proponen recomendaciones referidas a la selección de pacientes, los procedimientos terapéuticos, las asociaciones farmacológicas de interés y la prevención y manejo de los efectos adversos. El documento de consenso se concibe como un instrumento flexible y práctico destinado a su empleo en la clínica diaria con el objetivo de optimizar las posibilidades de la fototerapia reduciendo los riesgos para pacientes y terapeutas

It is essential to develop a consensus document on phototherapy in order to adapt this procedure to the specific characteristics, needs and reality of our milieu. Using a review of existing literature on the subject and the experience of its own members as a reference, the Spanish Photobiology Group (GEF) of the Spanish Academy of Dermatology and Venereology (AEDV) has developed some therapeutic guidelines for the most widely used modes of phototherapy: PUVA therapy and narrow-band UVB (NBUVB) therapy. These guidelines deal with generalities about the equipment, calibration and regulation in phototherapy booths, and the concept and indications for these forms of treatment are reviewed. Recommendations are also proposed regarding patient selection, therapeutic procedures, associated pharmacological agents of interest and the prevention and management of adverse effects. The consensus document is designed as a flexible and practical instrument intended for use in daily clinical practice, aimed at optimizing the possibilities of phototherapy while reducing risks for patients and therapists

Assessment of minimal phototoxic dose following 8-methoxypsoralen bath: maximal reaction on average after 5 days.

An essential procedure before starting bath psoralen ultraviolet (UV) A (PUVA) photochemotherapy is the evaluation of the minimal phototoxic dose (MPD), which is traditionally assessed 3 days after irradiation. However, there are no controlled studies supporting the 72 h peak of bath-PUVA erythema. The aim of this study was therefore to determine the exact time course of the erythematous reaction in human skin following bath-PUVA. For this purpose, the skin of 10 volunteers was exposed to 0.5-3.0 J/cm2 UVA directly after a 20-min 8-methoxypsoralen bath (0.5 mg/L, 37 degrees C). At 24, 48, 72, 96, 120 and 144 h (1-6 days) after irradiation, the MPD and the erythema sum score (ESS) were determined in each subject. The results showed a maximal erythematous reaction on average 5 days after irradiation. The mean MPD gradually decreased from day 2 (> 3.0 J/cm2) to day 5 (mean +/- SD 1.15 +/- 0.63 J/cm2) and started to increase at day 6 (mean +/- SD 1.6 +/- 0.52 J/cm2). The mean +/- SD ESS correspondingly increased from day 2 (0 +/- 0) to day 5 (10.5 +/- 3. 7) with a decrease at day 6 (7.5 +/- 3.1) (difference between day 3 and beyond statistically significant at P < 0.05). As our study indicates a maximal erythematous reaction to the bath-PUVA up to 5 days after irradiation, the traditional MPD assessment at 3 days generates a risk of phototoxic side-effects within the phototherapy course by underestimating the phototoxic effect in some patients. These findings contribute towards a more defined understanding of the kinetics of the phototoxic reaction in bath-PUVA therapy.