5-aminolaevulinic acid nanoemulsion is more effective than methyl-5-aminolaevulinate in daylight photodynamic therapy for actinic keratosis: a nonsponsored randomized double-blind multicentre trial.

BACKGROUND: Daylight photodynamic therapy (DL-PDT) with methyl-5-aminolaevulinate (MAL) is an effective treatment for mild and moderate actinic keratosis (AK). OBJECTIVES: To assess the clinical efficacy, tolerability and cost-effectiveness of 5-aminolaevulinic acid nanoemulsion (BF-200 ALA) compared with MAL in DL-PDT for grade I-II AKs. METHODS: This nonsponsored, prospective randomized double-blind multicentre trial included 69 patients with 767 grade I-II AKs located symmetrically on the face or scalp. A single DL-PDT was given in a randomized split-face design. The primary outcome was clearance of the AKs at 12 months as assessed by a blinded observer. The secondary outcomes were pain, treatment reactions, cosmetic outcome and the cost-effectiveness of the therapy. RESULTS: In the per-patient (half-face) analysis, clearance was better for the BF-200 ALA sides than for those treated with MAL (P = 0·008). In total, BF-200 ALA cleared 299/375 AKs (79·7%) and MAL 288/392 (73·5%) (P = 0·041). The treatment was practically painless with both photosensitizers, the mean pain visual analogue scale being 1·51 for BF-200 ALA and 1·35 for MAL (P = 0·061). Twenty-six patients had a stronger skin reaction on the BF-200 ALA side, seven on the MAL side and 23 displayed no difference (P = 0·001). The cosmetic outcome was excellent or good in > 90% of cases with both photosensitizers (P = 1·000). The cost-effectiveness plane showed that the costs of DL-PDT were similar for both photosensitizers, but the effectiveness was slightly higher for BF-200 ALA. CONCLUSIONS: Our results indicate that BF-200 ALA is more effective than MAL in DL-PDT for grade I-II AKs. BF-200 ALA provides slightly better value for money than MAL.

Comparison of narrowband ultraviolet B exposure and oral vitamin D substitution on serum 25-hydroxyvitamin D concentration.

BACKGROUND: A short course of narrowband ultraviolet B (NB-UVB) exposures increases the serum 25-hydroxyvitamin D [25(OH)D] concentration in patients with psoriasis and healthy subjects. OBJECTIVES: To compare the effects of NB-UVB and oral vitamin D substitution in healthy subjects in winter. METHODS: Healthy adult hospital employees and medical students were screened for serum 25(OH)D concentration. Those with 25(OH)D below 75 nmol L(-1) were randomly given either 12 NB-UVB exposures or 20 µg of oral cholecalciferol daily for 4 weeks. The NB-UVB exposures were given with a Waldmann UV 7001 cabin and the mean cumulative dose was 48·4 standard erythema doses. Serum 25(OH)D was measured before and after the treatments by radioimmunoassay. RESULTS: The baseline serum 25(OH)D concentrations were 52·9 ± 10·4 (mean ± SD) in the 33 NB-UVB-treated and 53·5 ± 12·7 nmol L(-1) in the 30 oral cholecalciferol-treated subjects. The mean increase in serum 25(OH)D was 41·0 nmol L(-1) [95% confidence interval (CI) 34·8-47·2; P < 0·001] in the NB-UVB group and 20·2 nmol L(-1) (95% CI 14·6-26·0; P < 0·001) in the cholecalciferol group. The difference between the two treatments was significant at 2 weeks (P = 0·033) and at 4 weeks (P < 0·001). One month after the treatments the 25(OH)D concentrations had increased further. CONCLUSIONS: The present study shows that 12 NB-UVB exposures given during 4 weeks increase serum 25(OH)D concentration significantly more than 20 µg of oral cholecalciferol daily. A short NB-UVB course is an effective way to improve vitamin D balance in winter and the response is still evident 2 months after the course.

Narrowband ultraviolet B course improves vitamin D balance in women in winter.

BACKGROUND: Vitamin D insufficiency is common in winter in the Nordic countries. OBJECTIVES: To examine whether a short course of narrowband ultraviolet B (NB-UVB) improves vitamin D balance. METHODS: Fifty-six healthy, white women (mean age 41 years) volunteered and 53 completed the study. NB-UVB exposures were given on seven consecutive days either on the whole body (n = 19), on the head and arms (n = 9) or on the abdomen (n = 14). Similarly, seven solar simulator exposures were given on the face and arms (n = 11). The cumulative UVB dose was 13 standard erythema doses in all regimens. Serum calcidiol (25-hydroxyvitamin D) concentration was measured by radioimmunoassay before and after the NB-UVB exposures. Follow-up samples were taken from the whole-body NB-UVB group at 2 months. RESULTS: At onset 41 women (77%) had vitamin D insufficiency (calcidiol < 50 nmol L(-1)) and six (11%) had vitamin D deficiency (calcidiol < 25 nmol L(-1)). Calcidiol concentration increased significantly, by a mean of 11.4 nmol L(-1) when NB-UVB was given on the whole body, by 11.0 nmol L(-1) when given on the head and arms and by 4.0 nmol L(-1) when given on the abdomen. Solar simulator exposures given on the face and arms increased calcidiol by 3.8 nmol L(-1). After 2 months serum calcidiol was still higher than initially in the group who received NB-UVB exposures on the whole body. CONCLUSIONS: NB-UVB exposures given on seven consecutive days on different skin areas of healthy women significantly improved serum calcidiol concentration. A short low-dose NB-UVB course can improve vitamin D balance in winter.

Heliotherapy improves vitamin D balance and atopic dermatitis.

BACKGROUND: Vitamin D insufficiency during winter is common in the Nordic countries. Heliotherapy (HT) may heal atopic dermatitis (AD) but its effect on vitamin D balance has not been examined. OBJECTIVES: To study the effect of HT on serum calcidiol (25-hydroxyvitamin D) concentration and on healing of AD. METHODS: Twenty-three adult patients with AD received a 2-week course of HT in the Canary Islands in either January or March 2005. Daily solar ultraviolet (UV) radiation was measured and personal UV exposure calculated as standard erythema doses (SED). Blood samples were taken during HT and during a 1-2 month follow-up. Serum calcidiol concentration was measured by radioimmunoassay. Healing of AD was examined by SCORAD index. RESULTS: Before HT 17 (74%) AD patients had vitamin D insufficiency (calcidiol < 50 nmol L(-1)) and four patients high (> 80 nmol L(-1)) serum calcidiol values. The median personal UV dose during the 2-week HT course was 60 SED in the January group and 109 SED in the March group. Serum calcidiol concentration increased significantly in both groups, by 13.4 and 24.0 nmol/L(-1), respectively, and after HT only four (17%) patients had vitamin D insufficiency. SCORAD improved from 34 to 9 in the January HT group and from 30 to 9 in the March group. CONCLUSIONS: A 2-week course of HT significantly improved vitamin D balance by increasing serum calcidiol concentration, and caused a marked healing of AD. These parallel positive responses should be taken into account when the benefits of HT are considered.

Increased UV exposure in Finland in 1993.

Exceptionally low total ozone, up to 40% below the normal level, was measured over Northern Europe during winter and spring in 1992 and 1993. In 1993 the depletion persisted up to the end of May, resulting in a significant increase of biologically effective UV radiation. The increases were significantly smaller in 1992 and 1993 than in 1993. The UV exposure of the Finnish population was evaluated through measurements and theoretical calculations. The increase in measured erythemal (International Lighting Commission) UV falling onto horizontal surfaces on clear day was determined relative to model calculations for an average ozone amount. The increase was on average 10% from April to May 1993, and the maximal measured increase was 34%. Theoretical calculations for both erythemal and carcinogenic (Skin Cancer Utrecht--Philadelphia) UV indicated that in 1993 the theoretical annual increase to a vertical (cylinder) surface ranged from 8 to 13% in Finland. The reflection of UV from snow considerably increases facial UV doses in Northern Finland.

Diurnal discrepancies in spectral solar UV radiation measurements.

Unexpected diurnal discrepancies between high-quality spectroradiometers were observed during the 2000 Nordic Ozone Group Intercomparison campaign. The spectral ratios of the irradiances showed a diurnal variation of approximately 2-9%. This cannot be explained by the nonideal angular response of the instruments' input optics in one plane (cosine effect). Instead, by using a radiative transfer model, we show that differences in the angular response in four azimuth planes have the potential to bias the measured data by up to 4.4% (azimuth effect). Other relevant factors are also discussed and quantified and are shown to be significant when diurnal changes in radiation are explained by environmental factors, or when measured data are compared with model or satellite data. Again, intercomparison campaigns have the potential to reveal errors that would otherwise remain undetected.