Photoadaptation of vitiliginous skin to targeted ultraviolet B phototherapy.

BACKGROUND: Increasing doses of ultraviolet (UV) radiation are tolerated in patients with vitiligo, due to photoadaptation. In this pilot study, five patients with Fitzpatrick skin phototypes IV-VI with vitiligo received six treatments of targeted UVB phototherapy over a 3-week period. METHODS: To investigate photoadaptation, minimal erythema dose (MED) testing was conducted on treated and untreated vitiliginous and normal skin at baseline and after three and six treatments. One patient had unattainable MED values, and was hence excluded. RESULTS: Percent change in MED from before to after all treatments in vitiliginous skin ranged from 0% to 128%, with a mean of 48.8%. CONCLUSION: The pilot phase of this study suggests possible photoadaptation of vitiliginous skin of some patients to targeted UVB phototherapy.

UVA1 phototherapy for cutaneous diseases: an experience of 92 cases in the United States.

BACKGROUND: The efficacy and safety of UVA1 (340-400 nm) phototherapy were established by studies from European countries. PURPOSE: Evaluate experience with UVA1 phototherapy for patients with cutaneous diseases in the United States. METHODS: A retrospective analysis of 92 cases of UVA1-treated cutaneous conditions from four medical centers in the United States was performed. RESULTS: Two-third of the patients showed a fair to good response (26-100% improvement) and one-third of the patients showed a poor response (0-25% improvement). Diseases with a moderate to good response (51-100% improvement) included scleredema adultorum, hand or foot dermatitis, atopic dermatitis, morphea (medium or medium- to high-dose UVA1), systemic sclerosis, and urticaria pigmentosa. Besides tanning, other adverse effects were found in 15% of patients, which include pruritus, erythema, tenderness, and burning sensation. Patients with skin types I-III responded better that those with a darker skin type. CONCLUSION: UVA1 phototherapy is a useful and well-tolerated treatment option for a variety of skin conditions.

Tacrolimus ointment 0.1% alone and in combination with medium-dose UVA1 in the treatment of palmar or plantar psoriasis.

Psoriasis is a common skin condition affecting approximately 2.6% of the population in the US. The most effective current therapies for psoriasis have suppressive activity against T lymphocytes directly or by modulating the biologic effects of inflammatory cytokines. Tacrolimus has been used successfully to treat a number of T cell-mediated diseases. UVA1 has been shown to induce T lymphocyte apoptosis. Combination treatment is commonly used in the management of psoriasis. Therefore, this pilot study was performed to evaluate if the combination of medium-dose UVA1 (50 J/cm2) and tacrolimus ointment is effective for the treatment of palmar plantar psoriasis. A total of 5 patients completed the study of 30 UVA1 treatments, and another patient completed half of the treatments. No dramatic changes in plaque thickness or scaling were seen with either tacrolimus alone or with the combination of tacrolimus and medium dose UVA1 on palmar or plantar psoriasis.

The use of 308-nm excimer laser for dermatoses: experience with 34 patients.

Targeted phototherapy has been utilized in the past few years for the treatment of various dermatoses. In this article, we summarize the experience of using 308-nm excimer laser at Henry Ford Hospital, Detroit, MI, for the treatment of psoriasis, vitiligo, palmoplantar psoriasis, and hand dermatitis. A total of 34 patients were treated between January 2003 and February 2005. Of the 28 patients with psoriasis, over 80% had greater than 75% improvement after an average of 12 treatments. While the number of patients was small, excimer laser showed promising results for palmoplantar psoriasis. Possibly due to patient selection bias, we have not had the same success as other studies for the treatment of vitiligo with this modality.

Henry Ford Hospital dermatology experience with Levulan Kerastick and blue light photodynamic therapy.

Photodynamic therapy (PDT) takes advantage of our understanding of the cutaneous response to topically applied porphyrins to selectively destroy malignant or premalignant cells. This type of therapy has been used to treat a variety of cutaneous diseases, including actinic keratoses, basal cell carcinoma, acne, and others. The treatment protocols are not standardized across institutions. We present the Henry Ford Dermatology protocol and early results of our first 150 treatments with PDT.

Ultraviolet phototherapy for pruritus.

Ultraviolet-based therapy has been used to treat various pruritic conditions including pruritus in chronic renal failure, atopic dermatitis, HIV, aquagenic pruritus and urticaria, solar, chronic, and idiopathic urticaria, urticaria pigmentosa, polycythemia vera, pruritic folliculitis of pregnancy, breast carcinoma skin infiltration, Hodgkin's lymphoma, chronic liver disease, and acquired perforating dermatosis, among others. Various mechanisms of action for phototherapy have been posited. Treatment limitations, side effects, and common dosing protocols are reviewed.