UVA-1 phototherapy for the management of atopic dermatitis: a large retrospective study conducted in a low-middle income country.

BACKGROUND: Medium-dose ultraviolet light A - 1 (UVA-1) phototherapy, given in short courses, has shown efficacy in atopic dermatitis flares; little is known about its use, efficacy, and side effects in prolonged exposure used in the chronic disease despite its extensive use. METHODS: A descriptive retrospective study was conducted; convenience sampling of patients with atopic dermatitis treated with UVA-1 phototherapy was made; evaluation of clinical response by SCORAD, adverse effects, and protocols used in each patient were evaluated. RESULTS: Patients exposed to UVA-1 phototherapy showed a decrease in the SCORAD (30.1 points) - total cumulative dose-dependent (P < 0.0001) - regardless of multiple variables studied. There were low rates of relapse and adverse effects. The most frequent doses were 30 and 60 J/cm2 , three times per week; patients had similar clinical responses and adverse effects in these groups independent of the other variables studied (P = 0.057). CONCLUSION: UVA-1 phototherapy can be an alternative for patients with severe atopic dermatitis even at lower doses than those described in other series (30 J/cm2 ) and not only for acute flares. Cumulative total dose is a variable that affects the clinical response directly. Large prospective studies are needed.

Predictive Model for Response Rate to Narrowband Ultraviolet B Phototherapy in Vitiligo: A Retrospective Cohort Study of 579 Patients.

Vitiligo is an acquired depigmenting disorder. To date, there is no predictive model for its response rate to narrowband ultraviolet B (NBUVB) phototherapy. The aim of this study was to investigate the different types of response of patients with non-segmental vitiligo undergoing NBUVB 3 times a week. Many patients who were previously considered non-responders were given the opportunity to continue the treatment. Long-term maintenance of treatment and follow-up of a cohort of 579 patients enabled different subtypes of response (very rapid, rapid, average, slow and "non-responders") to be described for the first time, and a predictive model of response to be constructed based on repigmentation rate in the first 48 sessions of NBUVB. Among those patients who did not respond during the first 48 sessions, a new subgroup of patients was found, termed "very-slow" responders, who achieved a low, but significant, level of repigmentation after 96 sessions of NBUVB.

Escalating dosimetry of UVA-1 in the treatment of alopecia areata.

BACKGROUND: Phototherapy can be an option in unresponsive alopecia areata (AA); however, variable results have been reported with its use. We could not find literature of treatment with UVA-1 in AA. A study was designed to evaluate progressive dosimetry to determine the initial dose and its increments. METHODS: Patients with unresponsive AA were recruited. Twenty-five sessions of 30 J/cm2 were administered. If hair regrowth was <75%, the dose was escalated to 60 J/cm2 . If hair improvement remained <75%, an additional 25 sessions at 120 J/cm2 were indicated. If total hair regrowth occurred before 75 sessions, a final visit was performed for biopsies and severity of alopecia tool (SALT) evaluation. Clinical and histopathological assessments were performed blindly. Adverse effects were recorded. RESULTS: Nine men and 13 women were included; 16 were initially S1 , one S3 , and five S4 . Median age was 32 years and median evolution 10 months. Nine patients achieved an S0 , eight S1 , and five S4 (P = 0.005). The most notable improvement was with 60 J/cm2 (P = 0.02). Biopsies exhibited an absence of inflammation in five patients and mild persistence in 17. An increase of 43.75% in anagen hairs (P ≤ 0.001) was achieved, telogen hairs decreased 16.3% (P = 0.06), and catagen hairs were reduced 22.7% (P = 0.005). Pearson's correlation was -0.82 and P ≤ 0.001, when correlating anagen hairs with final SALT. Improvement has continued for 6 months post treatment. Mild xerosis was observed in all patients, and six (28.6%) developed transient mild hyperpigmentation. CONCLUSIONS: This study provides a basis for UVA-1 dosimetry evaluating its therapeutic value in AA.

Efficacy and Safety of 308-nm Monochromatic Excimer Lamp Versus Other Phototherapy Devices for Vitiligo: A Systematic Review with Meta-Analysis.

BACKGROUND: Various phototherapy methods are used to treat vitiligo; however, the recent emergence of new devices has heightened debate concerning the best treatment method. OBJECTIVE: We aimed to systematically review and meta-analyze published data comparing the efficacy and adverse effects of monochromatic excimer lamps versus excimer laser and narrowband ultraviolet B (NB-UVB) in treating vitiligo. METHODS: A systematic search of PubMed, EMBASE, LILACS, Cochrane Central Register of Controlled Trials (CENTRAL), and clinical trials registries identified randomized controlled trials that included vitiligo patients, regardless of age, sex, or study language. We evaluated studies comparing excimer lamps with excimer laser or NB-UVB phototherapy. RESULTS: The review included six studies (411 patients, 764 lesions). No study found significantly different efficacy between excimer lamps and excimer laser using the outcomes of ≥50% repigmentation [risk ratio (RR) = 0.97, 95% confidence interval (CI) 0.84-1.11] and ≥75% repigmentation (RR = 0.96, 95% CI 0.71-1.30). Likewise, no study found significant differences between excimer lamps and NB-UVB (RR = 1.14, 95% CI 0.88-1.48 for ≥50% repigmentation; RR = 1.81, 95% CI 0.11-29.52 for ≥75% repigmentation). Adverse effects were mild, including pruritus, burning sensation, and dryness, none of which interrupted treatment. CONCLUSIONS: To our knowledge, this is the first systematic review of the efficacy and safety of excimer lamp treatment for vitiligo. Excimer lamps, excimer laser, and NB-UVB are all safe and effective in repigmentation of vitiligo lesions. Safety, effectiveness, and cost are considerations when choosing treatment. PROSPERO REGISTRATION NUMBER: CRD42014015237.

La radiación UVA-1: un nuevo aporte en la fototerapia dermatológica / Ultraviolet radiation A1 (UVA-1): therapeutic use in dermatology

La radiación ultravioleta ha sido usada durante décadas para el tratamiento de diversas enfermedades cutáneas. La radiación ultravioleta A1 (UVA-1) que tiene una longitud de onda entre los 340nm y 400 nm está disponible desde el año 1981, pero recién en las últimas dos décadas se ha estudiado, publicado y reportado su potencial uso terapéutico en la dermatología. Los primeros beneficios de su uso se reportaron en la dermatitis atópica donde se utilizaron dosis altas de UVA-1 para tratar las exacerbaciones severas de esta condición. Luego, nuevas indicaciones terapéuticas de su uso se fueron expandiendo a otras enfermedades cutáneas tales como: morfea, liquen escleroso, queratosis liquenoide, linfomacutáneo de células T y otras dermatopatías. La radiación UVA-1 al tener una longitud de onda más larga penetra a las capas más profundas de la dermis, lo que le permite una acción en la modificación de la respuesta inflamatoria, la respuesta inmunológica y los mecanismos de reparación cutánea.

Ultraviolet light radiation has been used for decades for the treatment of several cutaneous diseases. The ultraviolet radiation A1 (UVA-1) with a wave length between 340 nm-400 nm has been available since 1981, but only in the last two decades it has been studied and published for therapeutic use in dermatology. The first reported benefits of its use were reported in atopic dermatitis in which high doses of UVA-1were used to treat severe exacerbations of this condition. Thereafter, new therapeutic indications expanded its use for other cutaneous diseases like: morphea, lichen sclerosus, lichenoid keratosis, cutaneous T cell lymphoma and other skin conditions. The UVA-1 radiation has a long wavelength that make possible to reach the deep dermis and to modify the inflammatory response, immunological response and the cutaneous repair mechanisms.

Eficacia terapéutica con el método de Goeckerman en pacientes con psoriasis en placas: Trabajo realizado en el servicio de dermatología del Hospital Carlos Andrade Marín (Ecuador) Agosto-Noviembre de 2001 / Therapeutic efficacy of Goeckerman's method in patients with plaque psoriasis

Se trata de un estudio experimental, longitudinal, prospectivo, simple ciego y controlado aleatoriamente, en el que se propuso demostrar los beneficios del tratamiento con alquitrán de hulla más rayos UVB (Método de Goeckerman ), en comparación con el uso de PUVA en pacientes con psoriasis en el servicio de Dermatología del Hospital Carlos Andrade Marín (HCAM Quito-Ecuador), durante el período de agosto-noviembre de 2001. El estudio trabajó con valores de significancia del 99% y de potencia de un 90%. La selección de la muestra fue intencionada y la asignación de los grupos fue aleatoria mediante el programa de asignación aleatoria PEPI. Se realizó el estudio con 26 pacientes, en quienes se aplicó el regimen de Goeckerman en la mitad de pacientes, mientras que en los 13 restantes se trató con la terapia de PUVA. Se compararon los grupos en base a medias de proporciones, utilizando como prueba de significancia a Kruskar Wallis. Además, los pacientes elegidos tuvieron que cumplir con criterios de inclusión y ser considerados aptos para este estudio. Finalmente se procedió a analizar los datos mediante los programas EPIINFO y EXCELL. La edad media del total de pacientes fue de 44.7 años, correspondiendo a 45.3 años para el grupo PUVA y a 44.1 años para el grupo Goeckerman. La media del PASI de entrada de ambos grupos fue de 22.9 puntos, correspondiendo a 20.27 para PUVA y a 25.69 para Goeckerman. Respecto al sexo 5 fueron mujeres (19.2%) y 21 fueron hombres (80.8%); la distribución en los grupos fue aleatoria con lo cual 1 mujer y 12 hombres pertenecieron al grupo PUVA y 4 mujeres y 9 hombres pertenecieron al grupo Goeckerman. Durante el estudio se obtuvieron algunos efectos adversos, siendo el prurito el más común en ambos grupos con una prevalencia de 62.9% para la terapia PUVA y de 100% en la terapia Goeckerman, seguido del eritema con un 42.2% de prevalencia en PUVA y un 84.6% en Goeckerman. Efectos adversos como naúseas y mareos se presentaron únicamente en la terapia PUVA con porcentajes de 46.2 y de 30.8% respectivamente. El porcentaje de reducción de la escala de PASI fue de 51.16%.

This is an experimental, prospective, double blind, placebo-controlled, experimental study to demonstrate the effects of coal tar plus UVB treatment (Goeckerman's method) compared with PUVA in patients with psoriasis. The study was performed at the Department of Dermatology of the Hospital Carlos Andrade Marín (HCAM Quito-Ecuador) during August - November 2001. The study considered 99% significance levels and a potency of 90%. The selection of the samples was unintentional and subjects were assigned to the treatment groups using PEPI random assignment package. The sample was consisted in 26 subjects equally assigned to both arms of the study (Goeckeremans vs PUVA). The difference among treatment groups were measured using Krusal Wallis tests using EPI-INFO and EXCEL software. Mean age for each group were 45.3 for PUVA, and 44.1 for Goeckerman (average 44.7). The initial PASI score for both groups was 22.9 (PUVA: 20.27, Goeckerman: 25.69). The group was composed by 5 women and 21 men distributed randomly among treatment arms. The adverse events included pruritus (62.9% PUVA, 100% Goeckerman), erythema (42.2% PUVA, 84.6% Goeckerman). Systemic adverse effects included nausea and dizziness only in PUVA 46.2% and 30.8 respectively. The percentage of PASI score reduction was 51.6%.

Discromía paradojal inducida por rayos ultravioleta: relato de tres casos en Argentina / Paradoxical dyschromia induced by UV light: report of 3 cases in Argentina

Se presentan tres pacientes con lesiones discrómicas asociadas con la exposición a rayos ultravioleta en "cama solares". Las máculas, aparentemente hipocrómicas y asintomáticas, se localizan en diferentes áreas anatómicas sometidas a hiperpresión durante la sesión. Postulamos que representan zonas de piel normal que no se broncea por efecto de la presión, a diferencia de la piel adyacente normalmente bronceada. Las lesiones remiten cuando se suspende la exposición. Denominamos a este fenómeno: "Discromía Paradojal inducida por Rayos Ultravioleta" (AU)

Discromía paradojal inducida por rayos ultravioleta: relato de tres casos en Argentina / Paradoxical dyschromia induced by UV light: report of 3 cases in Argentina

Se presentan tres pacientes con lesiones discrómicas asociadas con la exposición a rayos ultravioleta en "cama solares". Las máculas, aparentemente hipocrómicas y asintomáticas, se localizan en diferentes áreas anatómicas sometidas a hiperpresión durante la sesión. Postulamos que representan zonas de piel normal que no se broncea por efecto de la presión, a diferencia de la piel adyacente normalmente bronceada. Las lesiones remiten cuando se suspende la exposición. Denominamos a este fenómeno: "Discromía Paradojal inducida por Rayos Ultravioleta"

"Camas solares" o camillas de radiaciones? / "Sunbeds" or radiation stretchery?

El "broceado" es desde hace algunas décadas un mandato de la moda con enorme aceptación por parte, principalmente, pero no en forma exclusiva, de las jóvenes. En la actualidad, y para satisfacer la demanda de un bronceado intenso y duradero, la industria de las "camas solares" ha proliferado en forma alarmante, con la ayuda de campañas publicitarias convincentes, estratégicamente diseñadas, que promocionan un "bronceado sin riesgos". A partir de estos mensajes tentadores para el público pero erróneos y peligrosos para la salud, planteamos desde el análisis de los términos nuestro punto de vista sobre el tema. Es nuestro deseo estimular su consideración y debate (AU)

"Camas solares" o camillas de radiaciones? / \"Sunbeds\" or radiation stretchery?

El "broceado" es desde hace algunas décadas un mandato de la moda con enorme aceptación por parte, principalmente, pero no en forma exclusiva, de las jóvenes. En la actualidad, y para satisfacer la demanda de un bronceado intenso y duradero, la industria de las "camas solares" ha proliferado en forma alarmante, con la ayuda de campañas publicitarias convincentes, estratégicamente diseñadas, que promocionan un "bronceado sin riesgos". A partir de estos mensajes tentadores para el público pero erróneos y peligrosos para la salud, planteamos desde el análisis de los términos nuestro punto de vista sobre el tema. Es nuestro deseo estimular su consideración y debate

Técnica combinada para reparación de fístula cisto-recto-vaginal actínica: operación de Parks y gastrocistoplastia / Combinated technic in actinic cysto-recto-vaginal fistula repair: parks technic and gastrocystoplasty

Se presenta 3 casos de pacientes con fístula cisto-recto-vaginal por daño actínico, reparadas en forma simultánea con técnica de Parks y gastrocistoplastia. Entre marzo de 1990 y junio de 1991 se operaron tres mujeres con fístulas complejas luego de tratamiento con radioterapia por cáncer cervicouterino. La técnica consiste en resección del sigmoides y parte del recto, mucosectomía del recto remanente, descenso del colon y anastomosis coloanal. En el tiempo urológico se abre o reseca la vejiga, incluyendo la fístula, y se procede a la cistoplastia con un segmento de estómago vascularizado con una de las arterias gastroepiploicas. Todas las pacientes están en buenas condiciones y sólo una presentó como complicación una infección leve de la herida operatoria. La técnica combinada permite mejorar la calidad de vida de las pacientes, evitando la colostomía permanente y la incontinencia urinaria

Oral methoxsalen photochemotherapy for the treatment of psoriasis: a cooperative clinical trial

Extensive psoriasis in 1,308 patients has been treated two or three times a week with oral 8-methoxypsoralen followed by high intensity, long-wave ultraviolet light (PUVA). Excluding 169 patients still under early treatment, psoriasis cleared in 88% and failed to clear in 3%. One percent dropped out due to complications of treatment, and 8% for other reasons. The twice-a-week schedule was superior for patients with lighter skin types. Once a remission was induced, there was no difference in its maintenance when patients were treated once a week, once every other week, or once every third week. Each of these schedules was superior to no maintenance treatment. Immediate side effect of the 45,000 treatments administered in the first 18 months of this study were uncommon, temporary, and generally mild. No clinically significant changes in laboratory screening or eye examinations attributable to PUVA have been uncovered.