Phototherapy with ultraviolet radiation: a study of hormone parameters and psychological effects.

BACKGROUND AND OBJECTIVES: Patients report well-being as they are treated with phototherapy. We investigated hormone parameters and psychological well-being after phototherapy in a placebo-controlled study. METHODS: A total of 77 patients with dermatological conditions and 22 healthy volunteers were divided into four groups. The patients received phototherapy either on the whole body or only on hands and/or feet. The volunteers were given either whole-body phototherapy or placebo light. Serum or plasma samples were analysed for cortisol, calcium, magnesium, phosphate, TSH, T(4), T(3) and 25-hydroxyvitamin D, and urine samples for cortisol. Patients and volunteers answered a questionnaire before and 6 weeks after phototherapy/placebo light. Psychiatric ratings were performed according to the Comprehensive Psychopathological Self-rating Scale for Affective Syndromes, a self-report version of which has been transformed to correspond to the Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS: In the patients who received whole-body irradiation, we observed a significant improvement in both MADRS score and cognitive-symptom score after the completion of phototherapy. We also observed a significantly higher level of 25-hydroxyvitamin D after phototherapy, but no difference in the other hormone parameters. CONCLUSION: Whole-body phototherapy of patients with dermatological conditions results in improved well-being and significantly higher levels of 25-hydroxyvitamin D in serum.

Patients' perspective of pruritus in chronic plaque psoriasis: a questionnaire-based study.

BACKGROUND: Pruritus in psoriasis patients has not been regarded as a major symptom. Objective To study the pattern of pruritus in chronic plaque psoriasis. METHODS: A questionnaire was sent out to 109 patients with a diagnosis of chronic plaque psoriasis, who attended our outpatient departments during the period of January 2006 to January 2007. RESULTS: Out of 109 patients, 80 patients (74%) answered the questionnaire. Pruritus was found in 80% of the patients, with an intensity of 5.2 +/- 2.6 (+/-SD) using a visual analogue scale (0-10). The frequency and intensity of pruritus were higher in women. Lower leg and scalp were reported to be the most commonly affected sites. Major aggravating factors for pruritus were stress and dryness of skin. Sun, sleep and vacation could relieve pruritus. The most common antipruritic treatments used by the patients were topical steroids, topical vitamin D, emollients and ultraviolet light therapy, whereas antihistamines were used by a small number of patients. Mood, concentration and sleep were negatively affected by pruritus. CONCLUSION: Pruritus is a common symptom in patients with chronic plaque psoriasis.

Studies of DNA and chromosome damage in skin fibroblasts and blood lymphocytes from psoriasis patients treated with 8-methoxypsoralen and UVA irradiation.

Exposure of human lymphocytes and skin fibroblasts in vitro to a single, clinically used dose of PUVA, i.e., 0.1 micrograms/ml of 8-methoxypsoralen (8-MOP) plus 0.9-4 J/cm2 of longwave ultraviolet radiation (UVA), lead to the formation of DNA damage as determined by alkaline elution, and to chromosome aberrations and sister chromatid exchanges (SCE). When lymphocyte-enriched plasma was obtained from psoriasis patients 2 h after oral intake of 8-MOP and then UVA irradiated (1.8-3.6 J/cm2) in vitro, an increased frequency of chromosome aberrations and SCE was observed. Normal levels of chromosome aberrations and SCE were found in lymphocytes of psoriasis patients after 3-30 weeks of PUVA treatment in vivo. A small but statistically significant increase in the SCE frequency was observed in the lymphocytes of psoriasis patients treated for 1-6 years with PUVA (mean 18.0 SCE/cell) as compared with before PUVA (mean 15.8, p less than 0.05). Skin fibroblasts of psoriasis patients analyzed 5 years after the start of PUVA treatment showed a normal number of SCE but a high fraction of filter-retained DNA in the alkaline elution assay, suggesting the presence of cross-linked DNA.

Effect of food on kinetics of 8-methoxsalen.

Kinetics of 8-methoxsalen were studied in 5 healthy subjects under fasting and nonfasting conditions. The plasma concentration-time data could be fitted to a zero order absorption one-compartment model. The area under the curve (AUC) values were higher (p less than 0.05) under nonfasting compared to fasting conditions, indicating higher relative bioavailability of the drug in the presence of food. No significant differences were observed in the lag-time for the start of the absorption, the apparent zero-order absorption rate constant, or the elimination rate constant. It is suggested that the drug should be taken in a standardized way in relation to food during the ultraviolet (UV) light treatment.

Chloroquine in treatment of porphyria cutanea tarda. Long-term efficacy of combined phlebotomy and high-dose chloroquine therapy.

The combined treatment with phlebotomy and high-dose chloroquine for PCT is described and 21 patients treated were followed up for periods of up to 6 years. Clinical and laboratory remissions were experienced by all patients. The urinary excretion of porphyrin and serum hepatic enzyme levels rose rapidly during therapy and then fell, mostly to levels well below that before treatment. The periods required for normalization of laboratory tests, median value, were 1.5 months for liver enzymes and 7 months for uroporphyrins. Clinical symptoms soon disappeared, blistering within 3 weeks and skin fragility within 12. Mild nausea or subfebrility was noted in some cases, but no other serious acute or chronic adverse reactions were observed. Clinical or biochemical relapse appeared in 9/21 (43%) patients who were then retreated. Relapsing cases showed a symptomfree period of 1-2.5 years after each treatment. Liver biopsy was performed in 4 relapsing cases prior to the repeated treatment and showed only mild siderosis and a mild fatty infiltration consistent with pathological liver findings in PCT but no evidence of chloroquine-induced permanent liver damage. The longest symptomfree period observed up to date was assessed for 7 patients who were followed up for more than 2 years after 1 single treatment. Four (57%) of them were symptomfree 5-6 years and no clinical or biochemical signs of relapse were observed. Our data confirm the efficacy of the high-dose therapeutic procedure, and the combined regimen with 1-2 phlebotomies prior to the chloroquine administration seems to be a safe procedure without any serious side effects. Our findings are discussed in relation to other current therapeutic modalities.

[Porphyria cutanea tarda is the most common type of porphyria. Medical control is a team work]. / Porphyria cutanea tarda vanligaste porfyriformen. Den medicinska kontrollen ett lagarbete.

Porphyria cutanea tarda (PCT) is probably the most common of the porphyrias. The development of skin fragility and blisters are the symptoms that generally bring the patient to the notice of the dermatologist. During the past decade the disease has been recognised as being of heterogeneous aetiology, and a pathogenetic classification has been proposed. The significance of subtyping for the choice of management strategy is currently appreciated, as is the need of close monitoring owing to the risk of the common PCT-associated liver conditions. Preferably the PCT patient should be managed by a dermatologist and a hepatologist working in concert and supported by a specialised porphyria laboratory. The use of a structured management protocol should be considered.

Carotenoid treatment for light sensitivity: a reappraisal and six years' experience.

Long-term treatment with oral carotenoids in 57 patients suffering from a variety of photodermatoses and disorders associated with cutaneous light sensitivity was evaluated. All patients were treated for two or more 6-month periods in separate years. Best therapeutic results were seen in PMLE patients, a good to excellent therapeutic response was noted for 65% of all patients, increasing to 81% of those assigned to skin types III and IV, and decreasing to 47% of those with skin types I and II. The therapeutic effect observed in disorders characterized by other mechanisms than provocation by solar radiation per se was less conspicuous, viz. for light-sensitive psoriasis and lupus erythematosus. Even here, therapeutic failure seems to be more common in individuals with skin types I and II than for skin types III and IV. Photodermatoses such as persistent light reaction, actinic reticuloid and solar urticaria did not respond to any significant degree to carotenoid treatment. Our findings would appear to justify further treatment with oral carotenoids in selected cases of PMLE, and a higher dosage level may be tried for non-responding individuals with light-sensitive psoriasis and DLE or SLE. Serious side effects have not been observed in spite of long-term therapy lasting several years.

Photodynamic reactions induced by compounds derived from lichens.

Contact dermatitis from lichens is now well documented but the possible influence of exposure to sunlight is less clear. Positive reactions on photopatch testing has recently been described, but whether this represented an unspecific exacerbation or a true photoallergic response was difficult to evaluate. In this study 13 different substances derived from lichens commonly found in nature were investigated with regard to their capacity to induce photo-oxidative membrane damage, as revealed by the photohemolysis technique. It was found that the earlier suggested ability to induce photosensitization could be confirmed for several of the lichen compounds investigated. It was also shown that singlet state excited oxygen may participate to some degree in some of these reactions.

Membrane damage caused by 8-MOP and UVA-treatment of cultivated cells.

Treatment of red blood cells with a combination of 8-MOP and UVA did not cause any significant hemolysis under the experimental conditions used, and the deuterium test for identification of singlet oxygen mediated reactions was negative. However, similar experiments performed on in vitro cultivated human glia cells caused conspicuous surface membrane alterations, as revealed by scanning electron microscopy. The alterations were seen at higher concentration levels than was expected and might be secondary to earlier appearing intracellular events seen at lower concentrations. The clinical significance of membrane alterations for the results obtained with PUVA therapy require further investigation.

Photodynamic aspects of some metal complexes.

The potential phototoxic capacity of some metal compounds of clinical significance in dermatology has been investigated by means of the photohemolysis technique. No photosensitized hemolysis of erythrocytes was observed with the chromium, nickel, copper and cobalt compounds studied. On the contrary, nickel and cobalt compounds proved to be efficient in quenching singlet oxygen mediated photo-oxidative membrane damage of red blood cells. Cadmium compounds showed a pronounced photohemolytic activity and the reaction was oxygen dependent. The deuterium test for singlet oxygen showed a significant increase in photohemolytic efficiency. The addition of histidine, a known quencher of singlet oxygen, resulted in a significant inhibition of the photohemolysis. Pronounced photo-oxidative damage to plasma membranes was also observed in vitro cultivated cells by means of scanning electron microscopy.

The immediate action of long-wave ultraviolet radiation (UVA) on suprabasal melanocytes in human skin: a transmission electron microscopical study.

The immediate effects of long-wave ultraviolet irradiation (UVA) in non-erythemal doses on suprabasal melanocytes in normal skin of healthy caucasians with skin types II and III was investigated with the transmission electron microscopy (TEM) in order to detect possible morphological changes. In skin type III the melanocytes remained essentially unaltered, but in skin type II, multiple pinocytotic vesicles, large vacuoles, swelling, and partial to total dissolution of the inner membranes of the mitochondria and numerous small vesicles associated with an enlarged Golgi apparatus were observed after 3.6 to 14.5 J/cm2 of UVA irradiation. No IPD reaction was observed in any of the subjects with skin type II irradiated with UVA up to 20 J/cm2.

Clinical aspects of the immediate pigment darkening (IPD) reaction in normal individuals.

In order to investigate the clinical characteristics of the immediate pigment darkening (IPD) reaction for normal healthy Caucasian individuals and its conceivable relation to age, sex, skin type and to the minimal erythema dose (MED), a standardized light testing procedure was used and 72 subjects were studied. Skin type III was the most common, being found in 78% of the individuals; skin types II and IV were less common, found in only 12.5% and 9.5% respectively. Skin type I was not observed at all. Individuals with skin type II were found to have a significantly lower mean MED than those with skin types III and IV, and the IPD threshold dose was 9.0 J/cm2 or more, which was significantly more than for skin types III and IV. The IPD reaction was absent in several individuals with skin type II under the experimental conditions used. Some differences were observed concerning the mean MED and IPD threshold doses between skin types III and IV but they were not statistically significant. Age or sex did not appear to be significantly related to the MED and IPD threshold doses observed, and, furthermore, no significant correlation, either positive or negative, was found between the MED and the IPD threshold doses when investigated for individuals with skin type III.