Ultraviolet A1 phototherapy: a British Photodermatology Group workshop report.

Whole-body ultraviolet (UV)A1 (340-400 nm) phototherapy was first introduced 30 years ago, but is currently available in the UK in only three dermatology departments. A workshop to discuss UVA1 was held by the British Photodermatology Group in May 2009, the aim of which was to provide an overview of UVA1 phototherapy and its role in practice, and to identify areas in which further studies are required. The conclusions were that UVA1 phototherapy is an effective treatment in several inflammatory skin diseases, including localized scleroderma and atopic eczema (AE); however, deficiencies and limitations exist in the published evidence base. For most diseases, such as AE, other treatments also exist, which are generally more effective than UVA1. However, for some diseases, particularly morphoea, the evidence of efficacy is stronger for UVA1 than for other treatments. Acute adverse effects of UVA1 are minimal. The risk of long-term adverse effects, particularly skin cancer, is unknown. Medium to high doses of UVA1 are needed for efficacy in most situations, but the equipment to deliver such doses is large, expensive and difficult to install. UVA1 is currently underprovided, and the recommendation of the workshop is that more tertiary centres should have access to UVA1 phototherapy in the UK.

A survey of the availability of sunscreen filters in the UK.

The frequency, and thus availability to patients, of ultraviolet (UV) filters contained within sunscreens changes over time. Obtaining current data on filter availability is necessary when considering which agents to include in sunscreen series for patch and photopatch testing of patients. A survey of sunscreen products was undertaken in Dundee, UK, in 2010. In total, 337 products were identified, with a median sun-protection factor of 30 (range 2-50+). In these products, 19 UV filters were identified, of which the most common was butyl methoxydibenzoylmethane. Compared with data from 2005, most filters had an increase in frequency of inclusion, with a trend towards broader spectrum protection. This information should be of use to clinicians considering investigation of contact and photocontact allergy. It also aids determination of the allergenic potential of these filters when reports of allergy and photocontact allergy arise in the literature.

Occupational carprofen photoallergic contact dermatitis.

BACKGROUND: The nonsteroidal anti-inflammatory drug carprofen was used in humans in the 1980s, before its withdrawal due to adverse effects. It re-emerged for veterinary uses, for which it is still widely prescribed, in the 1990s. There has been one previous report published of photoallergic contact dermatitis (PACD) in a pharmaceutical factory worker exposed to carprofen. OBJECTIVES: Investigation of carprofen as a cause of PACD in pharmaceutical factory workers presenting with facial dermatitis. METHODS: Photopatch testing to carprofen dilutions in two pharmaceutical factory workers and three healthy volunteer controls using the European consensus methodology. This was followed by testing of eight further employees, referred by occupational health services, in the same factory. RESULTS: The index patient suspected a problem with carprofen and was found to have PACD to carprofen. The second patient presented with a widespread, although especially photoexposed site, dermatitis and was initially labelled as having an 'unclassified dermatitis'. Only subsequently was her exposure (indirect; she did not work in the packaging section of the factory like the first patient) to carprofen recognized and testing confirmed both contact allergy and PACD to carprofen. One of three healthy volunteer controls had an active photoallergy sensitization event to carprofen starting 10 days after photopatch testing. Three of eight factory employees subsequently referred because of skin problems had carprofen PACD. CONCLUSIONS: Carprofen is a potent photoallergen. These cases emphasize the importance of photopatch testing, and considering agents not included in standard series, when investigating patients presenting with a photoexposed site dermatitis.

Incidence of skin cancers in 3867 patients treated with narrow-band ultraviolet B phototherapy.

BACKGROUND: Narrow-band ultraviolet B (NB-UVB) phototherapy is a widely used treatment. Psoralen-UVA photochemotherapy (PUVA) increases skin cancer risk and some animal studies have raised the possibility of an increased risk with NB-UVB. The risk of skin cancer in humans following treatment with NB-UVB is unknown. OBJECTIVES: This current analysis forms part of an ongoing study ultimately aiming to define the long-term carcinogenic risk of NB-UVB treatment in humans. METHODS: Details of all patients receiving NB-UVB treatment until 31/12/2002 in Tayside, Scotland, were accessed from a treatment database and linked to the Scottish Cancer Registry. Indirect standardization was used to compare skin cancer incidence in the study population with age and sex matched cancer registry data for the Tayside population. We also assessed the effect of NB-UVB exposure treatment numbers on the risk of developing skin cancer. RESULTS: Of 4690 records reviewed, 4665 were suitable for analysis with 3886 records linked with the cancer registry and 3867 followed-up for at least 6 months before 31/12/02 (the date at which cancer registration was deemed to be complete). The median number of NB-UVB treatments was 29 with 352 patients receiving > or = 100 treatments. The study gave 24,753 person-years of follow up. First skin cancers recorded in study patients were 27 basal cell carcinomas (BCC), seven squamous cell carcinomas (SCC) and six melanomas. No association was found between NB-UVB exposure alone (without PUVA) and any skin cancer. For NB-UVB and PUVA treated patients there was an association with BCC, with 27 BCCs found compared with 14.1 expected in the matched population. CONCLUSION: We found no significant association between NB-UVB treatment and BCC, SCC or melanoma. There was a small increase in BCCs amongst those also treated with PUVA. These reassuring results do not demonstrate the early increase in skin cancers that was found associated with PUVA treatment. However, cautious interpretation is required as the cohort contained relatively few patients who had a high treatment number and because the slow evolution of skin cancers may result in a delayed incidence peak. Ongoing risk assessment is therefore essential.

The quality of life of 790 patients with photodermatoses.

BACKGROUND: Polymorphic light eruption and erythropoietic protoporphyria (EPP) have been demonstrated to have a moderate and large impact on the quality of life (QoL) of patients, respectively. However, there is little information available about the impact of other photodermatoses on QoL. OBJECTIVES: To assess and compare the impact of all forms of photodermatoses on patients' QoL using the standard 1-week Dermatology Life Quality Index (DLQI) questionnaire and a modified questionnaire to assess the impact over the previous year. METHODS: All patients with photodermatoses seen between 2001 and 2005 at five U.K. photobiology centres were contacted by post on the same day during a forecasted sunny week across the U.K. and asked to complete DLQI questionnaires. RESULTS: A total of 1877 patients were contacted. Seven hundred and ninety-seven (42%) patients replied, with a range from 30% to 48% for the five individual centres. Nearly two-thirds of patients with actinic prurigo (AP) and more than one-third of patients with photoaggravated dermatoses (PAD), chronic actinic dermatitis, EPP and solar urticaria had a DLQI of > 10, confirming a very large effect of the disorders on QoL. Of the cutaneous porphyrias, both variegate porphyria (median DLQI 3) and porphyria cutanea tarda (median DLQI 1.5) had a much lower impact on QoL than EPP. CONCLUSION: This is the first large-scale study to attempt to measure the impact of a range of photodermatoses on QoL. Photodermatoses have a major impact on QoL. This impact is highest in AP and PAD.

Differential expression of CYP1A1, CYP1A2, CYP1B1 in human kidney tumours.

The presence of mRNA of individual members of the CYP1 gene family in normal and neoplastic kidney has been investigated by RTPCR. CYP1B1 mRNA was consistently expressed in both normal and neoplastic kidney while CYP1A1 was present in the majority of normal and neoplastic whereas CYP1A2 was infrequently expressed. Expression of the Ah receptor and Arnt which are involved in the transcriptional activation of the CYP1 genes was also studied. The Ah receptor mRNA and Arnt mRNA were consistently expressed both in kidney tumours and normal kidney. These results indicate differential expression of individual members of the CYP1 gene family in normal and neoplastic kidney and suggest that several mechanisms including the Ah receptor complex could be involved in their regulation.

Cytochrome P450 CYP3A in human renal cell cancer.

Renal cell cancer is the main malignant tumour of the kidney and has an increasing incidence. This type of tumour has a poor prognosis and shows intrinsic resistance to several anti-cancer drugs. The CYP3A P450 family, which consists of three closely related forms, is involved in the oxidative activation and deactivation of a variety of carcinogens and several anti-cancer drugs. In this study the presence and cellular localization of CYP3A has been investigated using a combination of immunohistochemistry, immunoblotting and reverse transcriptase polymerase chain reaction (RT-PCR) in renal cell cancer and corresponding normal kidney. CYP3A was consistently expressed in both renal call cancer and in normal kidney. In renal cell cancer, CYP3A was localized to tumour cells and in normal kidney the predominant cellular localization of CYP3A was to proximal tubular epithelial cells. RT-PCR showed that both CYP3A5 mRNA and CYP3A7 mRNA were consistently present in both tumour and normal samples, while CYP3A4 mRNA was present in 65% of tumours and 90% of normal samples. This study indicates that individual members of the CYP3A family are expressed in renal cell cancer. The presence of CYP3A in renal cell cancer might be important in the metabolic potentiation as well as the detoxification of chemotherapeutic agents used to renal cancer.