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1.
Exp Dermatol ; 33(1): e15012, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38284204

RESUMO

Phototherapy is a useful treatment modality for atopic dermatitis (AD). This is a prospective randomised double-blind study comparing the clinical efficacy of combined ultraviolet-A (UVA)/narrowband ultraviolet-B (NBUVB) versus NBUVB phototherapy in the treatment of chronic AD. Patients with moderate-to-severe AD were randomised to receive either UVA/NBUVB or NBUVB phototherapy twice weekly over 12 weeks. At baseline, weeks 6 and 12, Eczema Area And Severity Index (EASI), itch score and adverse effects were assessed. At baseline and week 12, disease-related quality of life was evaluated using the Dermatology Life Quality Index (DLQI). Nine patients were randomised to receive UVA/NBUVB and 10 received NBUVB. At week 12, both groups showed significant improvement in EASI and itch scores (p < 0.05). Significant improvement in DLQI was seen in the UVA/NBUVB arm (p = 0.009) with a trend towards improvement in the NBUVB arm (p = 0.11). The efficacy of both modalities were comparable, as were reported adverse effects aside from skin dryness which was higher in the NBUVB arm (40% vs. 0%, p = 0.033). Combined UVA/NBUVB and NBUVB phototherapy have comparable clinical efficacy and safety in the treatment of chronic AD. NBUVB may induce greater skin dryness.


Assuntos
Dermatite Atópica , Eczema , Terapia Ultravioleta , Humanos , Dermatite Atópica/radioterapia , Estudos Prospectivos , Método Duplo-Cego , Qualidade de Vida , Terapia Ultravioleta/efeitos adversos , Fototerapia , Prurido/etiologia , Prurido/radioterapia , Resultado do Tratamento
2.
Photodermatol Photoimmunol Photomed ; 40(4): e12986, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38874329

RESUMO

BACKGROUND/PURPOSE: Phototherapy has emerged as a safe yet effective form of treatment of atopic dermatitis (AD). Few studies have been done to evaluate the efficacy of phototherapy in Asian children. The aim of this study was to review the phototherapy experience in a cohort of Asian pediatric patients with AD at a tertiary dermatologic center in Singapore. METHODS: A retrospective study of patients 18 years and below with AD who had undergone phototherapy at KK Women's and Children's Hospital, Singapore, over a 4-year period was performed. RESULTS: Sixty-two patients were identified, between ages 4 and 16 years (mean age 11 years) at the time of commencement of phototherapy. Thirty-five (60%) patients were males and 23 (40%) were females. Most patients had moderate to severe disease, with 60.3% of the patients with an initial body surface area (BSA) involvement of 31%-60% and 13.8% of the patients with an initial BSA involvement of 61%-90%. For patients who had undergone narrowband ultraviolet B (NBUVB) and combined ultraviolet A (UVA) and NBUVB phototherapy, the mean reduction of the Eczema Area and Severity Index (EASI) scores were 11.4 and 7.9, respectively. Common side effects experienced include xerosis, pruritus, erythema, and pain. Other reasons for cessation of therapy in the NBUVB group included time commitment difficulty (9.3%), hyperactivity (2.3%), and claustrophobia (2.3%). Two patients that had photochemotherapy (psoralen + UVA) [PUVA] suffered from post-UVA burns requiring cessation of treatment. More than half of the patients (56.9%) treated with phototherapy experienced treatment success with improvement in Investigator Global Assessment and EASI scores. 86.2% of the patients had good compliance to the treatment regime, 12% had poor-compliance, and 3.4% were lost to follow-up. CONCLUSION: Phototherapy is a useful treatment adjunct for moderate to severe AD in Asian children.


Assuntos
Dermatite Atópica , Humanos , Dermatite Atópica/terapia , Dermatite Atópica/radioterapia , Criança , Feminino , Adolescente , Masculino , Singapura , Pré-Escolar , Estudos Retrospectivos , Fototerapia , Terapia Ultravioleta/efeitos adversos
3.
J Am Acad Dermatol ; 89(3): 496-503, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37236426

RESUMO

BACKGROUND: UV-B phototherapy is a common treatment modality for patients with atopic dermatitis (AD), but its long-term safety in terms of cutaneous carcinogenic risk has not been studied. OBJECTIVE: To investigate the risk of skin cancer among patients with AD receiving UV-B phototherapy. METHODS: We conducted a nationwide population-based cohort study from 2001 to 2018 to estimate the risk of UV-B phototherapy for skin cancer, nonmelanoma skin cancer, and cutaneous melanoma in patients with AD. RESULTS: Among 6205 patients with AD, the risks of skin cancer (adjusted hazard ratio [HR], 0.91; 95% CI, 0.35-2.35), nonmelanoma skin cancer (adjusted HR, 0.80; 95% CI, 0.29-2.26), and cutaneous melanoma (adjusted HR, 0.80; 95% CI, 0.08-7.64) did not increase among patients with AD treated with UV-B phototherapy, compared with those who did not receive UV-B phototherapy. Additionally, the number of UV-B phototherapy sessions was not associated with an increased risk of skin cancer (adjusted HR, 0.99; 95% CI, 0.96-1.02), nonmelanoma skin cancer (adjusted HR, 0.99; 95% CI, 0.96-1.03), or cutaneous melanoma (adjusted HR, 0.94; 95% CI, 0.77-1.15). LIMITATIONS: Retrospective study. CONCLUSION: Neither UV-B phototherapy nor the number of UV-B phototherapy sessions was associated with an increased risk of skin cancers among patients with AD.


Assuntos
Dermatite Atópica , Terapia Ultravioleta , Humanos , Dermatite Atópica/epidemiologia , Dermatite Atópica/radioterapia , Raios Ultravioleta , Estudos Retrospectivos , Melanoma/epidemiologia , Melanoma/etiologia , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/etiologia , Fatores de Risco , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Taiwan/epidemiologia
4.
Acta Derm Venereol ; 103: adv9403, 2023 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-37358394

RESUMO

Narrowband-ultraviolet B has shown increased efficacy over broadband-ultraviolet B in pruritic skin diseases, such as psoriasis and atopic dermatitis. In patients with chronic pruritus, e.g. in end-stage renal disease, broadband-ultraviolet B is recommended, but narrowband-ultraviolet B has also shown efficacy in reducing pruritus. This randomized, single blinded, non-inferiority study investigated the effects of narrowband-ultraviolet B compared with broadband-ultraviolet B. Patients with chronic pruritus were treated with either broadband- or narrowband-UVB 3 times a week for 6 weeks and clinical response was monitored. Pruritus, sleep disturbance, and the patients' subjective overall response to treatment were evaluated by the patients on a visual analogue scale (0-10). Skin excoriations were evaluated by investigators on a 4-point scale (0-3). Both phototherapeutic modalities showed significant antipruritic activity (itch reduction 48% and 66.4%, respectively) by broadband-ultraviolet B and narrowband-ultraviolet B. Narrowband-ultraviolet B proved to be not inferior to broadband-ultraviolet B in treating pruritus in patients with chronic pruritus, assuming a 20% non-inferiority margin.


Assuntos
Dermatite Atópica , Psoríase , Terapia Ultravioleta , Humanos , Terapia Ultravioleta/efeitos adversos , Prurido/diagnóstico , Prurido/tratamento farmacológico , Prurido/etiologia , Psoríase/terapia , Dermatite Atópica/diagnóstico , Dermatite Atópica/radioterapia , Dermatite Atópica/etiologia , Coleta de Dados , Resultado do Tratamento
5.
Dermatology ; 238(1): 109-120, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-33887725

RESUMO

BACKGROUND: The pathophysiology in atopic dermatitis (AD) is not fully understood, but immune dysfunction, skin barrier defects, and alterations of the skin microbiota are thought to play important roles. AD skin is frequently colonized with Staphylococcus aureus (S. aureus) and microbial diversity on lesional skin (LS) is reduced compared to on healthy skin. Treatment with narrow-band ultraviolet B (nb-UVB) leads to clinical improvement of the eczema and reduced abundance of S. aureus. However, in-depth knowledge of the temporal dynamics of the skin microbiota in AD in response to nb-UVB treatment is lacking and could provide important clues to decipher whether the microbial changes are primary drivers of the disease, or secondary to the inflammatory process. OBJECTIVES: To map the temporal shifts in the microbiota of the skin, nose, and throat in adult AD patients after nb-UVB treatment. METHODS: Skin swabs were taken from lesional AD skin (n = 16) before and after 3 treatments of nb-UVB, and after 6-8 weeks of full-body treatment. We also obtained samples from non-lesional skin (NLS) and from the nose and throat. All samples were characterized by 16S rRNA gene sequencing. RESULTS: We observed shifts towards higher diversity in the microbiota of lesional AD skin after 6-8 weeks of treatment, while the microbiota of NLS and of the nose/throat remained unchanged. After only 3 treatments with nb-UVB, there were no significant changes in the microbiota. CONCLUSION: Nb-UVB induces changes in the skin microbiota towards higher diversity, but the microbiota of the nose and throat are not altered.


Assuntos
Dermatite Atópica/microbiologia , Dermatite Atópica/radioterapia , Microbiota/efeitos da radiação , Pele/microbiologia , Terapia Ultravioleta , Adulto , Idoso , Biodiversidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nariz/microbiologia , Faringe/microbiologia , Staphylococcus aureus/crescimento & desenvolvimento , Staphylococcus aureus/efeitos da radiação , Resultado do Tratamento , Adulto Jovem
6.
Photodermatol Photoimmunol Photomed ; 38(3): 233-240, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34653289

RESUMO

BACKGROUND: Phototherapies could represent an efficient option for the treatment of atopic dermatitis (AD), but the evidences available for clinical choices were contradictory. OBJECTIVE: This study aimed to evaluate the efficacy of different phototherapies on AD. METHODS: This systematic review and network meta-analysis included randomized controlled trials (RCTs) through searching keywords from PubMed, EMBASE, and the Cochrane library. We summarized different phototherapy types and scoring systems. Scoring Atopic Dermatitis (SCORAD) absolute score changes were estimated by mean differences (MDs) and standard deviations (SDs) and then included in the network meta-analysis. The effect sizes of comparison of different phototherapies were presented as MDs and 95% confidence intervals (CIs). Egger's test was used to evaluate publication bias. RESULTS: Eleven RCTs were included in the systematic review and 4 studies in the network meta-analysis. Based on the pooled estimates, medium-dose ultraviolet A1 (UVA1) cold light was superior to medium-dose UVA1 (MD 8.92; 95% CI: 5.60-12.24) but no significant difference between high-dose (UVA1) and medium-dose UVA1 cold light (MD 0.66; 95% CI: -5.57 to 6.90). Publication bias was not supported by Egger's test (P = .168). CONCLUSIONS: Due to possible long-term adverse effects of high-dose UVA1, medium-dose UVA1 cold light appears to be the superior form for AD.


Assuntos
Dermatite Atópica , Terapia Ultravioleta , Dermatite Atópica/radioterapia , Humanos , Metanálise em Rede , Fototerapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
7.
Artigo em Russo | MEDLINE | ID: mdl-36538407

RESUMO

For the treatment of patients with atopic dermatitis of moderate and heavy severity level, narrow-band medium-wave ultraviolet therapy (narrow-band phototherapy) can be used. An analysis of the results of studies of the efficacy and safety of narrow-band medium-wavelength ultraviolet therapy in patients with atopic dermatitis is presented, and a characteristic of the regimens of the phototherapy carried out is given. It has been shown that narrow-band phototherapy is an effective and safe method of treating patients with atopic dermatitis, but its effectiveness varies widely. Data were obtained on the absence of an increase in the effect during therapy with higher doses of radiation, about the higher efficiency of narrow-band phototherapy with concurrent medication, with an increase in the number of irradiation procedures, as well as in patients with a higher minimum erythemal dose, which indicates the possible existence of factors characterizing the individual characteristics of the response of patients to narrow-band phototherapy.


Assuntos
Dermatite Atópica , Terapia Ultravioleta , Humanos , Dermatite Atópica/radioterapia , Terapia Ultravioleta/efeitos adversos , Terapia Ultravioleta/métodos , Fototerapia/métodos , Resultado do Tratamento
8.
Exp Dermatol ; 30(2): 249-261, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33067891

RESUMO

Phototherapy with narrow-band Ultraviolet B (nb-UVB) is a major therapeutic option in atopic dermatitis (AD), yet knowledge of the early molecular responses to this treatment is lacking. The objective of this study was to map the early transcriptional changes in AD skin in response to nb-UVB treatment. Adult patients (n = 16) with AD were included in the study and scored with validated scoring tools. AD skin was irradiated with local nb-UVB on day 0, 2 and 4. Skin biopsies were taken before and after treatment (day 0 and 7) and analysed for genome-wide modulation of transcription. When examining the early response after three local UVB treatments, gene expression analysis revealed 77 significantly modulated transcripts (30 down- and 47 upregulated). Among them were transcripts related to the inflammatory response, melanin synthesis, keratinization and epidermal structure. Interestingly, the pro-inflammatory cytokine IL-36γ was reduced after treatment, while the anti-inflammatory cytokine IL-37 increased after treatment with nb-UVB. There was also a modulation of several other mediators involved in inflammation, among them defensins and S100 proteins. This is the first study of early transcriptomic changes in AD skin in response to nb-UVB. We reveal robust modulation of a small group of inflammatory and anti-inflammatory targets, including the IL-1 family members IL36γ and IL-37, which is evident before any detectable changes in skin morphology or immune cell infiltrates. These findings provide important clues to the molecular mechanisms behind the treatment response and shed light on new potential treatment targets.


Assuntos
Dermatite Atópica/genética , Dermatite Atópica/radioterapia , Interleucina-1/genética , Transcrição Gênica/efeitos da radiação , Terapia Ultravioleta , Adulto , Idoso , Defensinas/genética , Dermatite Atópica/patologia , Feminino , Perfilação da Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Proteínas S100/genética , Fatores de Tempo , Raios Ultravioleta , Adulto Jovem
9.
Dermatology ; 237(3): 407-415, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33401279

RESUMO

BACKGROUND: Since the best clinical response to dupilumab is achieved after 12-16 weeks, a combination therapy at the beginning of the treatment could be a helpful strategy to reach a faster response in patients with severe atopic dermatitis (AD). OBJECTIVES: To quantify the benefit of a combination of dupilumab treatment with a short course of narrow-band ultraviolet B (NB-UVB) phototherapy. METHODS: In the present pilot study adult patients suffering from severe AD were enrolled with a 2:1 ratio to receive treatment with dupilumab alone or dupilumab plus NB-UVB phototherapy, for 12 weeks. After the twelfth week, all patients received dupilumab only. A follow-up visit took place after 16 weeks. Both clinician-oriented and patient-oriented scores were assessed at baseline (T0) and after 4 (T1), 12 (T2) and 16 (T3) weeks. RESULTS: Forty-five adult patients were enrolled in the study. Both treatment regimens were well tolerated and very effective on all measured scores (EASI, SCORAD, BSA, NRS of itching, NRS of sleep loss, DLQI, POEM and HADS), but the combined regimen led to a more robust clinical improvement of lesions and relief of symptoms after 4 weeks. However, after 12 and 16 weeks, the additional therapeutic effect of phototherapy weakened. CONCLUSION: NB-UVB phototherapy can provide a faster remission of severe AD in the first few weeks of dupilumab therapy.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/radioterapia , Terapia Ultravioleta , Adulto , Terapia Combinada , Dermatite Atópica/patologia , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Resultado do Tratamento
10.
Clin Exp Dermatol ; 46(6): 1067-1074, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33837558

RESUMO

BACKGROUND: Despite decades of use, the magnitude of efficacy of narrowband ultraviolet B (NB-UVB) phototherapy for atopic dermatitis (AD) beyond industry-sponsored trials remains unclear. AIM: To evaluate the clinical efficacy of NB-UVB in AD under real-world conditions. METHODS: We conducted a historical inception cohort study using automated recording of dispensed drugs to provide an objective treatment outcome in a large population catchment of 420 000 people over 15 years. We analysed clinical treatment outcomes, recorded multicentre and prospectively over 15 years, of a large AD treatment cohort (n = 844), along with the drugs dispensed to this cohort. RESULTS: The majority (70%) of patients with AD received significantly fewer topical corticosteroids (TCS) during the 12-month window after finishing NB-UVB compared with the 12-month window before starting the treatment (median reduction from 37.5 to 19.7 g/month). The number of patients dispensed with oral corticosteroids and antihistamines also dropped significantly (from 20% to 10% and from 69% to 31%, respectively), while all AD-unrelated drugs dispensed remained unchanged. Clinically, NB-UVB treatment achieved a 'clear' or 'almost clear' status in 48.7% of patients, while 20.4% achieved 'moderate clearance'. Treatment outcomes scores were validated by a strong correlation with reduction in AD-specific drug treatment. CONCLUSION: Our data confirm the significant efficacy of NB-UVB for AD under conditions of routine care.


Assuntos
Corticosteroides/administração & dosagem , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/radioterapia , Fármacos Dermatológicos/administração & dosagem , Terapia Ultravioleta , Administração Cutânea , Administração Oral , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Antagonistas dos Receptores Histamínicos/administração & dosagem , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
11.
Photodermatol Photoimmunol Photomed ; 36(4): 263-270, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32141113

RESUMO

BACKGROUND/PURPOSE: Atopic dermatitis (AD) is an inflammatory skin disease characterized by a chronic course of exacerbations and remissions. High-dose ultraviolet A-1 (UVA-1) phototherapy has been effective in the treatment of acute exacerbations of AD. However, there have been no case studies in Asian patients to date. We investigated the effectiveness of high-dose UVA-1 phototherapy for treating acute exacerbation of AD in Asian patients. METHOD: This study included 16 patients with acute exacerbation of AD. High-dose (100 J/cm2 ) regimens of UVA-1 therapy were employed. Therapeutic effectiveness was assessed based on the findings of clinical examinations and scoring of AD (SCORAD) index before treatment and after the 5th and 10th sessions of treatment. Additionally, side effects and recurrence during follow-up were retrospectively evaluated. RESULTS: The patients were between 7 and 50 years of age, with a mean age of 25.8 years. The SCORAD index was between 41 and 89.5, with a mean score of 64.9. Among the 16 patients, two patients discontinued treatment due to the aggravation of erythema and pruritus. Of the 14 patients who completed the 10 sessions of high-dose UVA-1 phototherapy, nine patients (64.3%) showed complete remission and five patients (35.7%) showed partial remission. The mean SCORAD index reduced from 64.9 (before treatment) to 23.3 (after the 10th session of treatment). CONCLUSION: This is the first case study of high-dose UVA-1 phototherapy for acute exacerbation of AD in Asian patients, suggesting that high-dose UVA-1 phototherapy can be a well-tolerated and effective treatment for acute exacerbated AD. Future large-scale prospective studies are needed.


Assuntos
Dermatite Atópica/radioterapia , Terapia Ultravioleta/métodos , Adolescente , Adulto , Povo Asiático , Criança , Progressão da Doença , Feminino , Humanos , Hiperpigmentação/etiologia , Masculino , Pessoa de Meia-Idade , Prurido/etiologia , Recidiva , Índice de Gravidade de Doença , Resultado do Tratamento , Terapia Ultravioleta/efeitos adversos , Adulto Jovem
12.
Photodermatol Photoimmunol Photomed ; 36(3): 185-191, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31880842

RESUMO

BACKGROUND: The skin microbiome has been implicated in the pathophysiology of atopic dermatitis (AD). Although 308 nm excimer light treatment is an effective phototherapy for AD, its effects on the skin microbiome currently remain unclear. Therefore, we investigated the effects of the excimer light treatment on the skin bacterial and fungal microbiome of lesional skin of AD. METHODS: Swab samples were collected from 11 healthy controls, non-lesional and lesional skin of 11 AD patients. The excimer light treatment was administered to the lesional skin. The composition of the skin microbiome, the clinical score and skin barrier function of the lesional skin were examined before and after the treatment. The composition of the skin microbiome was determined by sequencing bacterial 16S and fungal internal transcribed spacer regions. RESULTS: The excimer light treatment significantly changed the composition of the bacterial microbiome in the lesional skin of AD, as well as improved the clinical score and skin barrier function. The treatment increased the relative abundance of the phylum Cyanobacteria and decreased that of the phylum Bacteroidetes in lesional skin. At the species level, the treatment significantly decreased the relative abundance of Staphylococcus aureus (S aureus) in lesional skin. There was also a significant correlation between the reduction of S aureus and improvement of the clinical outcomes. CONCLUSION: Our findings suggest that alterations of the skin microbiome with excimer light treatment, specifically the decrease in the abundance of S aureus, are partly involved in the improvement of AD lesions.


Assuntos
Dermatite Atópica/microbiologia , Dermatite Atópica/radioterapia , Lasers de Excimer/uso terapêutico , Microbiota/efeitos da radiação , Pele/microbiologia , Adulto , Bacteroidetes/isolamento & purificação , Cianobactérias/isolamento & purificação , Feminino , Humanos , Malassezia/isolamento & purificação , Masculino , Fenômenos Fisiológicos da Pele/efeitos da radiação , Staphylococcus aureus/isolamento & purificação , Resultado do Tratamento , Perda Insensível de Água/efeitos da radiação , Adulto Jovem
13.
Acta Derm Venereol ; 99(2): 139-145, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30250963

RESUMO

This study investigated serum 25-hydroxyvitamin D (25(OH)D) concentrations and circulating regulatory T cells in patients with atopic dermatitis receiving narrow-band ultraviolet B (nbUVB) phototherapy. Thirty adult patients with atopic dermatitis were included. Blood samples were collected at baseline and at weeks 2 and 4 of nbUVB phototherapy. Skin biopsies were taken at baseline and at week 4. Serum 25(OH)D concentrations increased significantly following nbUVB phototherapy (estimate of change from baseline to week 2: 32.00 nmol/l, confidence interval (CI) 20.48-43.52, p < 0.0001, n = 25; and from baseline to week 4: 50.30 nmol/l, CI 37.28-63.33, p < 0.0001, n = 18). This increase was independent of the filaggrin gene FLG loss-of-function mutation status. Flow cytometry showed no significant change in regulatory T cells or cytokine profiles of T cells in blood. Real-time quantitative PCR showed no change in skin cytokine levels. In conclusion, nbUVB phototherapy was associated with increased serum 25(OH)D concentrations, but not changes in circulating regulatory T cells in patients with atopic dermatitis.


Assuntos
Dermatite Atópica/radioterapia , Linfócitos T Reguladores/efeitos da radiação , Terapia Ultravioleta , Vitamina D/análogos & derivados , Adulto , Biomarcadores/sangue , Contagem de Linfócito CD4 , Dermatite Atópica/sangue , Dermatite Atópica/diagnóstico , Dermatite Atópica/imunologia , Feminino , Proteínas Filagrinas , Humanos , Masculino , Pessoa de Meia-Idade , Linfócitos T Reguladores/imunologia , Fatores de Tempo , Resultado do Tratamento , Vitamina D/sangue , Adulto Jovem
14.
Clin Exp Dermatol ; 44(4): 363-369, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30706549

RESUMO

This review is part of a series of annual updates summarizing the evidence base for atopic eczema (AE). It provides a summary of key findings from 28 systematic reviews that were published or indexed during 2016 with a focus on treatment and prevention of AE. There is reasonable evidence of benefit for topical corticosteroids, calcineurin inhibitors, a glycyrrhetinic acid-containing preparation (Atopiclair® ), oral ciclosporin, oral azathioprine, narrowband ultraviolet B radiation and education programmes. Overall, there is evidence that topical corticosteroids and calcineurin inhibitors have similar efficacy and that both can prevent AE flares when used twice weekly as maintenance therapy. However, topical calcineurin inhibitors are costlier and have more adverse reactions, thus topical corticosteroids should remain the standard of care for patients with AE. There is no evidence that multiple applications are better than once-daily application of topical corticosteroid. There is inconsistent evidence to support omalizumab and specific allergen immunotherapy use in AE. There is some evidence that vitamin D supplementation and synbiotics reduce AE severity, although the margin of improvement may not be clinically meaningful. There is little evidence to support the use of wet wraps or of complementary/alternative medicine (including Chinese herbal medicine). There is some evidence to suggest that a diet high in fish in infancy may be preventative for AE, but other dietary interventions for the prevention of AE show little promise. This review provides a succinct guide for clinicians and patients wishing to remain up to date with the latest evidence for the treatment and prevention of AE.


Assuntos
Corticosteroides/uso terapêutico , Inibidores de Calcineurina/uso terapêutico , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/prevenção & controle , Administração Oral , Administração Tópica , Corticosteroides/administração & dosagem , Antialérgicos/uso terapêutico , Azatioprina/administração & dosagem , Azatioprina/uso terapêutico , Inibidores de Calcineurina/administração & dosagem , Pré-Escolar , Terapias Complementares , Ciclosporina/administração & dosagem , Ciclosporina/uso terapêutico , Dermatite Atópica/radioterapia , Gorduras na Dieta/administração & dosagem , Gorduras na Dieta/uso terapêutico , Ácido Glicirretínico/administração & dosagem , Ácido Glicirretínico/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Lactente , Recém-Nascido , Omalizumab/administração & dosagem , Omalizumab/uso terapêutico , Extratos Vegetais/administração & dosagem , Extratos Vegetais/uso terapêutico , Terapia Ultravioleta/métodos , Vitamina D/uso terapêutico
16.
J Eur Acad Dermatol Venereol ; 33(4): 718-724, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30468530

RESUMO

BACKGROUND: The current evidences attest UVA1 phototherapy as effective in the treatment of severe atopic dermatitis (AD). Furthermore, in this indication, 'medium dose' is as effective as 'high dose' regimen. To date, a randomized comparison study evaluating the effectiveness as well as safety of different UVA1 protocols in different skin types in the treatment of adult patients with severe AD is still lacking. OBJECTIVE: The aim of the present study was to compare the safety and the efficacy of medium and high dose UVA1 either in fair or in dark skin types. METHODS: Twenty-seven adult patients with severe AD were consecutively included in a randomized, controlled, open, two arms trial Severity of AD was determined by means of SCORAD index and clinical improvement was also monitored. A total of 13 out of 27 patients were treated with high dose (130 J/cm2 ) UVA1 protocol while 14 out of 27 patients received medium dose (60 J/cm2 ) UVA1 protocol. Phototherapy was performed five times weekly up to 3 weeks. Before and after UVA1 treatment each patient was evaluated for skin pigmentation through Melanin Index (MI) quantitative evaluation. RESULTS: Skin status improved in all patients resulting in a reduction of SCORAD index in all groups. Our results demonstrated that among patients with darker skin types and higher MI, high dose UVA1 was significantly more effective than medium dose (P < 0.0001) while within the groups with skin type II, no significant differences between high and medium dose protocols were observed. CONCLUSION: Our study, confirms previous observations that UVA1 phototherapy should be considered among the first approaches in the treatment of patients with severe generalized AD and also demonstrates that in darker skin types, high dose UVA1 phototherapy is more effective than medium dose in the treatment of adult patients with severe AD.


Assuntos
Dermatite Atópica/radioterapia , Pigmentação da Pele , Terapia Ultravioleta/métodos , Adulto , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Dosagem Radioterapêutica , Índice de Gravidade de Doença , Resultado do Tratamento , Terapia Ultravioleta/efeitos adversos , Adulto Jovem
17.
Dermatol Online J ; 25(3)2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30982300

RESUMO

OBJECTIVE: To measure adherence using a novel home UVB phototherapy system designed to promote adherence. STUDY DESIGN: A retrospective, observational study conducted to evaluate patients' adherence to a prescribed three-times-per-week treatment protocol using a novel home phototherapy system with integrated features designed to improve adherence. METHODS: Data was collected from 18 psoriasis patients, 27 vitiligo patients, and three atopic dermatitis patients using a novel home phototherapy system under normal use conditions. Adherence was also calculated using two alternative methods to allow for comparison between published phototherapy adherence studies. RESULTS: The median patient adherence (N= 48) to treatment with the home phototherapy system was 80%. There were no significant differences in adherence between different ages, genders, or diseases (P>0.05). Early adherence (N=48) to the home phototherapy system was 90% and dichotomous adherence (N=32) was 71%. CONCLUSIONS: By implementing a smartphone application and web-based portal with the home phototherapy system, patients have multiple mechanisms in place to ensure adherence.


Assuntos
Dermatite Atópica/radioterapia , Cooperação do Paciente/estatística & dados numéricos , Psoríase/radioterapia , Terapia Ultravioleta/métodos , Vitiligo/radioterapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis , Portais do Paciente , Fototerapia/métodos , Estudos Retrospectivos , Smartphone , Terapia Ultravioleta/instrumentação
18.
Ann Dermatol Venereol ; 146(12S3): 12S85-12S95, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31997737

RESUMO

Atopic dermatitis is a chronic disease with an alteration of the skin barrier and an abnormal immune response. The European guidelines for treatment of atopic dermatitis in children and adults recommend basic hygiene rules including daily use of emollient. Then in the first therapeutic line, for mild or acute atopic dermatitis, the prescription of local care by topical corticosteroids or topical calcineurin inhibitors is recommended. A proactive treatment is now recommended. If the atopic dermatitis is moderate or recurrent, the use of phototherapy in addition to topical treatment is recommended. Each therapeutic step can be added to improve the lesions and reduce the burden of the disease on the patient's daily life. © 2019 Elsevier Masson SAS. All rights reserved.


Assuntos
Dermatite Atópica/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Fototerapia , Administração Cutânea , Administração Tópica , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Adulto , Inibidores de Calcineurina/administração & dosagem , Inibidores de Calcineurina/uso terapêutico , Criança , Ensaios Clínicos como Assunto , Dermatite Atópica/radioterapia , Dermatite Atópica/terapia , Fármacos Dermatológicos/administração & dosagem , Emolientes/administração & dosagem , Emolientes/uso terapêutico , Humanos , Higiene , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Inibidores da Fosfodiesterase 4/uso terapêutico , Fototerapia/efeitos adversos , Fototerapia/métodos , Guias de Prática Clínica como Assunto , Irrigação Terapêutica , Terapia Ultravioleta/efeitos adversos
20.
Dermatol Ther ; 29(1): 19-23, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26301893

RESUMO

The phototherapy is a safe and effective technique for the treatment of adult patients with atopic dermatitis (AD). The treatment of chronic forms of the disease is most often done with narrow-band UVB (NB-UVB). There also exist effective phototherapy options against the AD. The aim of this study was to asses if the combination of NB-UVB with UVA was more effective than the treatment with only NB-UVB against adult chronic AD. We carried out a prospective and observational study. Adult patients with chronic AD with more than 50% of the total body surface area affected (TBSA) were included. The affected TBSA was calculated using the so-called "rule of nines." Patients with a clearance rate >75% of the initial affected TBSA or complete clearance rate were considered as complete response (CR). An analogue scale from 0 to 10 was used to measure the improvement grade of the pruritus. The treatments were repeated three times a week. The initial doses of NB-UVB and UVA were determined by patient's phototype. The treatments were performed using a phototherapy booth (UV7002, Walmann, Villingen-Schwenningen, Germany(®) ) with TL01 and UVA fluorescent lamps. Statistical analysis was performed with SPSS(®) (IBM, New York, NY) for Windows 21.0. A total of 26 patients with adult chronic AD were included in the study, 16 patients were treated with UVB-BE and 10 patients with the combined treatment option NB-UVB/UVA. The mean value of cumulative doses and the mean number of performed treatments were similar between both groups of patients (p > 0.05). The mean value of duration of response was significantly higher in the patients treated only with NB-UVB, 101 versus 6.8 months (p ≥ 0.05). No differences were observed for the patients that showed complete response (p = 0.42) and in the analogue scale of pruritus (p > 0.005). In our study, the patients treated with the combination of NB-UVB and UVA were similar to the patient that were only treated with NB-UVB e. Further prospective and controlled studies have to be performed in order to determine the dosing regimens of phototherapy in adult patients with AD.


Assuntos
Dermatite Atópica/radioterapia , Terapia PUVA , Pele/efeitos da radiação , Terapia Ultravioleta , Adulto , Doença Crônica , Dermatite Atópica/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia PUVA/efeitos adversos , Estudos Prospectivos , Doses de Radiação , Indução de Remissão , Índice de Gravidade de Doença , Pele/patologia , Fatores de Tempo , Resultado do Tratamento , Terapia Ultravioleta/efeitos adversos
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