[Side effects and risks of phototherapy]. / Nebenwirkungen und Risiken der Phototherapie.

Interference factors of UV-therapy are among others the absolutely unknown biological activities of visible and ultra red wavelengths, which represent the main part of the energy emitted from all UV-sources. They produce a rise of the skin surface temperature up to 42-44 centigrades immediately followed by a reticulate erythema as well as a proliferative response of basal cells, which goes synchronously with that after SUP or UVA application but does not result in hyperproliferation. Acute side effects are direct toxic activities of UV-light with sunburn, up to severe bullous reaction, but without scarring; exacerbation of UV-sensitive dermatoses, internal diseases, and modulations of the immune system.

[Acral bullae following PUVA-therapy (author's transl)]. / Akrale Blasenbildung unter PUVA-Therapie.

Six patients with mycosis fungoides, psoriasis or generalized granuloma anulare developed acral bullae showing the clinical and histological picture of bullous pemphigoid during systemically applied PUVA-therapy. Immunohistological investigations (Protein A-Per-oxidase, Immunofluorescence) produced no proof of bullous pemphigoid.

[Effect of PUVA and SUP therapy on nevocellular nevi (author's transl)]. / Verhalten von Naevuszellnaevi unter PUVA- und SUP-Therapie.

An increase of size from in average 4.7 to 5.3 mm2 was observed in 28 of 36 nevocellular nevi after selective ultraviolet phototherapy and photochemotherapy for psoriasis within 4 weeks. In 15 of 36 nevocellular nevi the moles revealed a significant darkening. Autoradiography showed an increased proliferation of melanocytes, keratinocytes and dermal cells in moles exposed to UV-light in comparison with unexposed.

[Selective ultraviolet phototherapy (SUP) for prophylaxis of polymorphous light eruption (author's transl)]. / Selektive Ultraviolet-Phototherapie (SUP) zur Prophylaxe der Polymorphen Lichtdermatose.

16 patients with polymorphous light eruption were prophylactically treated with selective ultraviolet phototherapy (SUP). Ten patients showed no or only minimal signs of their disease in a following holiday with high sun exposition; 4 patients had the same skin manifestations as in the years before. Indirect evaluation of the therapeutic success had to be performed in two patients, who did not have holidays in this year. Thus SUP may represent a new prophylactic treatment of polymorphous light eruption.

Effects of selective ultraviolet phototherapy (SUP) and local PUVA treatment on DNA synthesis in guinea pig skin.

The treatment with UV-light with wavelengths between 292.5--335 nm (known as selective UV-phototherapy, or SUP) and 320--390 nm (plus local treatment with 8-methoxypsoralen, known as PUVAex) gave rise to a biphasic reaction of epidermal cell proliferation in guinea pig skin. A decrease of proliferative activity was followed by a synchronized stimulation of DNA synthesizing cells after 2--4 h. These quantitative displacements were accompanied by qualitative changes in the proliferative behaviour of epidermal cells in the S-compartment.

[Treatment of psoriasis using vitamin A, vitamin A acid and oral retinoids]. / Behandlung der Psoriasis mit Vitamin A, Vitamin-A-Säure und oralen Retinoiden.

Vitamin A, Vitamin A acid (retinoic acid) and their synthetic derivatives were variously applied in the management of psoriasis with different therapeutic results. Obviously, they influence the proliferation rate and the differentiation of human keratinizing epithelia and have beneficial effects on skin diseases with disturbances of keratinization, including psoriasis. Systemic application of Vitamin A has been yet largely abandonned since high dosages leading to clearing develop evident systemic toxicity. The anti-psoriatic effect of Vitamin A acid is either moderate or restricted, because of side effects. Only its combined local application with topical corticosteroids may be considered. Oral application of newly synthesized retinoids, however, was beneficial in psoriasis, particularly in erythrodermic or pustular types. With this group of retinoids new pathways were opened in dermatotherapy which may help to replace cytostatic drugs in these cases. Additionally, oral retinoid treatment may be introduced as an adjuvans in the management of widespread psoriasis, in order to enhance the effect of anthralin, PUVA or UVB treatments.

[Beneficial effect of oral retinoid in psoriatic hyperproliferation. Autoradiographic studies on involved and non involved skin (author's transl)]. / Epidermale Zellproliferation unter oraler Retinoid-Therapie bei Psoriasis. Autoradiographische Befunde an befallener und nicht befallener Haut.

In 16 patients with generalized psoriasis treated with oral retinoid (Ro 10-9359; 1 mg/kg body weight/(day) autoradiographic studies were performed before, and 24 h, 48 h, 1 week and 3 weeks after beginning of treatment on involved and non involved epidermis. During the first week no significant changes of all cellular parameters were found. However, after 3 weeks of continuing medication the increased 3H-thymidine labelling index was markedly lowered and the prolonged DNA synthesis time was shortened; whereas, the cell cycle time remained unaffected. The findings revealed that oral retinoid has a distinct influence on epidermal cell proliferation towards normalization in both involved and non involved epidermis in psoriasis. The time needed for this effect indicates that the drug does not directly interfere with the cell cycle. It seems reasonable, therefore, to combine oral retinoids as a basic adjuvant drug with other antipsoriatic techniques, such as retinoid + anthralin, retinoid + PUVA, retinoid + UVB.

Oral retinoid and UVB radiation: a new, alternative treatment for psoriasis on an out-patient basis.

The combined application of an oral retinoid (Ro 10-9359) and phototherapy with predominantly UVB radiation (Selective Ultraviolet Phototherapy=SUP) is a new, highly effective method of treating psoriasis. It has few side effects and can be performed on an out-patient basis. With the aid of this combined treatment we achieved good or very good improvement in 19 out of 23 patients with generalized psoriasis (=82.6%). The average number of radiation sessions required to achieve this was 22.9, and the mean total therapeutic dose (TTD) was 73 J/cm2. In a control group of 40 psoriasis patients, who received only radiation therapy, we achieved good or very good results in only 60% with an average of 26 radiation sessions and 94 J/cm2 TTD. The effect of the oral retinoid and UVB radiation therapy is apparently additive, since the retinoid does not increase the sensitivity of the skin to light.

[Retinoid-selective ultraviolet phototherapy (SUP) in psoriasis]. / Retinoid-SUP-Therapie der Psoriasis.

27 patients with generalized psoriasis were treated with oral administration of Ro 10-9359 (50--75 mg/d) and daily radiations with a source emitting UVA and UVB light at 292.5--335 nm (so called selective UV-phototherapy, SUP). In 24 patients full remission was seen, partly with few remaining lesions at the predilection sites. The average number of sessions necessary for clearing was 21.6 in 5.3 weeks. The total energy required was 68 J/cm2. Only slight side effects, such as cheilitis and hair loss (4 cases) were seen. The clinical efficacy of this combined retinoid-UV-treatment is comparable to the therapeutic effect of systemic PUVA; however, its practicability seems to be higher, and its application on an out-patient basis better.