Characteristics and clinical significance of augmentation spectra in solar urticaria.

Solar urticaria has unique spectra, such as inhibition and augmentation. The clinical significance of these spectra, especially augmentation, is not well understood. Reported cases of solar urticaria with augmentation spectra are extremely rare in the published English-language work. The purposes of this study were to evaluate the clinical features of solar urticaria with augmentation spectra and to elucidate the mechanisms and clinical importance of the spectra. We experienced 11 cases (five females, six males; mean age, 40.1 years; range, 1-74) of solar urticaria with augmentation spectra from April 2007 to July 2019. Augmentation spectra were UV-B in three cases, UV-A in two, visible light in four, UV-A and UV-B in one, and UV-A and visible light in one. Augmentation spectra were observed before action spectra in four cases, after in six, and before and after in one. Injection of sera irradiated with action spectra and augmentation spectra in vitro induced stronger immediate reactions than those of only action spectrum-irradiated sera in four of five cases. The results of injection tests suggested that augmentation spectra enhance the production of urticaria-forming factor. Clinically, we observed severe urticarial reactions in four cases, including anaphylaxis in three and moderate urticarial reactions in three. These results suggest that augmentation spectra are not as rare as previously thought and that they are associated with the severity of solar urticaria. Therefore, phototesting for both augmentation and action spectra should be performed to provide appropriate guidance for patients with solar urticaria.

Treatment of persistent severe atopic dermatitis in 113 Japanese patients with oral psoralen photo-chemotherapy.

Oral administration of psoralen and whole body exposure to UVA (oral PUVA) has been used for the treatment of 113 patients with severe atopic dermatitis (AD). 8-Methoxypsoralen (8-MOP) was given at a dose of 0.5-0.6 mg/kg two hours prior to UVA (3-8 J/cm2) irradiation. Patients were treated three times a week while hospitalized. Other medications which had been given before PUVA therapy were permitted. At four and eight weeks after PUVA therapy, the severity score of AD had decreased by 51% and 80%, and the cumulative doses of UVA were 51.2 J/cm2 and 115.3 J/cm2, respectively. The amounts and strength of topical cortico-steroids were decreased during PUVA therapy. No adverse effects that required discontinuation of the PUVA therapy were observed. After discharge, maintenance therapy with UVB phototherapy and/or conventional treatment of AD kept the patients in remission in the outpatient clinic. The QOL of patients was greatly improved. Photochemotherapy with oral 8-MOP can be indicated in patients with severe, widespread AD, especially if standard therapy fails. This is the first report of oral PUVA therapy in a large series of Japanese patients with AD.

Treatment of chronic actinic dermatitis with tacrolimus ointment.

BACKGROUND: Chronic actinic dermatitis (CAD) is difficult to treat. Topical corticosteroids induce adverse effects after long-term use, especially on light-exposed skin. OBJECTIVE: Our purpose was to study the effects of tacrolimus ointment in the treatment of elderly patients with CAD. METHODS: In an open trial, 6 male patients between 51 and 80 years old with CAD applied 0.1% tacrolimus ointment twice a day to the face and neck. According to improvements, the frequency of application was reduced. Sunscreen agents were also applied outdoors. RESULTS: Tacrolimus ointment effectively treated cutaneous changes in all patients. Symptoms were moderately improved in 2 weeks, and greatly in 4 weeks. A brief and localized irritating sensation occurred in all patients, but no other adverse events developed throughout the study course from 0.5 to 2.5 years. CONCLUSION: Topical tacrolimus ointment for facial lesions of CAD appears to be effective and well tolerated and may provide long-term benefits.