Topical tacrolimus vs medium-dose ultraviolet A1 phototherapy in the treatment of atopic dermatitis - a preliminary study in relation to parameters of the epidermal barrier function and high-frequency ultrasonography.

INTRODUCTION: Atopic dermatitis (AD) is a chronic, relapsing skin disorder, which is characterized by intense pruritus, skin dryness and concomitant epidermal barrier dysfunction. The basic therapy involves the application of anti-inflammatory topical drugs like; glucocorticosteroids and calcineurin inhibitors. Phototherapy in AD is regarded as an additional form of treatment. The latest invention, ultraviolet A1-UVA1 phototherapy (340-400 nm), was introduced to the treatment of AD by Krutmann et al in 1992. It appears that the main mode of action of UVA1 phototherapy in AD is through activation of apoptosis of T lymphocytes. Additionally, new studies show that UVA1 can also inhibit the activity of calcineurin phosphatase, similarly to calcineurin inhibitors such as cyclosporin A or tacrolimus. The aim of this study is to, for the first time, compare the efficacy of medium dose UVA1 phototherapy and tacrolimus ointment in patients with moderate-severe AD. PATIENTS AND METHODS: This study involved 20 AD patients. Half of the patients were treated with UVA1 phototherapy, while another 10 participants were treated with the application of tacrolimus ointment. The severity of the disease progress was assessed on the basis of EASI score (Eczema Area Severity Index). Moreover, the clinical condition of patients was assessed using non-invasive techniques such as measurement of transepidermal water loss - TEWL and skin capacitance, as well as high-frequency ultrasonography (20 MHz). RESULTS: This study described above confirmed the beneficial influence of both therapies on the course of moderate-severe AD. Tacrolimus induced a greater reduction in TEWL, while phototherapy caused the reduction of subepidermal low echogenic band-SLEB within sites affected with pathological lesions. CONCLUSIONS: Both tacrolimus and phototherapy treatment seemed to significantly reduce EASI.

Ultraviolet A1 phototherapy for mycosis fungoides.

BACKGROUND: Mycosis fungoides (MF) is the most common form of primary cutaneous lymphoma, and is characterized by a malignant proliferation of CD4+ cells. Psoralen ultraviolet A (PUVA) irradiation is the most common treatment for cutaneous lesions. However, PUVA carries the risk of adverse reactions to psoralens and long-term risk of skin cancer. UVA1 may be a safer alternative. AIM: To assess the efficacy of UVA1 phototherapy in patients with early-stage MF (T1-T2). METHODS: Four patients with early-stage MF were treated with 1630-2710 J/cm(2) UVA1 given in 29-40 fractions, and the effect was assessed by clinical examination and by high-resolution ultrasonography. RESULTS: Complete clinical remission of MF was achieved in all cases. CONCLUSIONS: This preliminary report indicates that UVA1 phototherapy might be an efficient treatment for early-stage MF.

Prevalence of Artemisia species pollinosis in western Poland: impact of climate change on aerobiological trends, 1995-2004.

BACKGROUND: Artemisia species pollen represents a major cause of allergy in Central Europe. Variations in the pollen season, the influence of climate variables and the prevalence of pollinosis to it were analyzed in Poznan, in western Poland between 1995 and 2004. METHODS: A Hirst volumetric spore trap was used for atmospheric sampling. Pollination date trend analysis and Spearman correlation tests were performed. Skin prick tests (SPT) and allergen specific immunoglobulin (lg)E antibody measurements were performed in 676 and 524 patients, respectively. RESULTS: The Artemisia species pollen season grew longer due to a clear advance in the starting day and only a slightly earlier end point; the peak day also came slightly earlier. Rainfall in the first fortnight of July highly influenced pollen season severity. Temperature was directly correlated with daily Artemisia species pollen levels; relative humidity was inversely correlated. Twelve percent of patients had a positive SPT reaction to Artemisia species. Their symptoms were rhinitis and conjunctivitis (15%), atopic dermatitis (15%), chronic urticaria (14.3%), bronchial asthma (2.4%), and facial and disseminated dermatitis (1.3%). Elevated specific IgE concentrations were detected in the sera of 10.1% of patients. CONCLUSIONS: Artemisia species pollen is an important cause of pollinosis in western Poland. Pollen season intensity is highly influenced by rainfall in the previous weeks. Trends towards earlier season starts and longer duration, possibly caused by climate change, may have an impact on the allergic population.

[Antigen specific immunoglobulin E to grass and weed pollens in the plasma of patients with seasonal allergic rhinitis]. / Swoiste immunoglobuliny E skierowane przeciwko alergenom pylku traw i chwastów w surowicy krwi chorych na alergiczny sezonowy niezyt nosa.

The study involved 22 patients with seasonal allergic rhinitis between 13 and 53 years of age. The level of antigen specific IgE (AS IgE) to 5 grass and 3 weed pollens was determined with the use of CAP FEIA (Pharmacia, Uppsala, Sweden). The control group consisted of 20 persons. All above AS IgE were significantly higher in the patients with seasonal allergic rhinithis than in the control group. The most commonly present hypersensitivities were to Meadow fescue (Festuca elatior), Meadow grass (Poa pratensis), Cocksfoot (Dactylis glomerata), Ribwort (Plantago lanceolata) and Mugwort (Artemisia vulgaris) allergens. The authors believe that the pathomechanism of the development of seasonal allergic rhinithis is governed to a large degree by hypersensitivity to grass and weed pollens and suggest that precise determination of AS IgE to these allergens in patients blood sera should form the basis of the construction of the vaccine used in their immunotherapy.