A 308-nm monochromatic excimer light in the treatment of palmoplantar psoriasis

BACKGROUND: Various reports have shown the efficacy of narrow-band UVB (311-313 nm) and excimer laser (308 nm) in the treatment of psoriasis. OBJECTIVE: To prove the efficacy of light produced by xenon-chloride excimer at 308 nm (monochromatic excimer light, MEL) in the treatment of palmoplantar psoriasis (PP). METHODS: Fifty-four patients (29 male and 25 female) affected by PP were treated with MEL every 7-14 days. A mean number of 10 sessions was performed with an increase of the dose depending on patient's skin type and response. RESULTS: All 54 patients completed the treatment. After 4 months of MEL we observed a complete remission in 31 patients, a partial remission in 13 patients, and a moderate improvement in 10 patients. CONCLUSIONS: These results suggest that MEL can be considered as a valid therapeutic option for treatment of selected forms of PP.     

Evaluation of 308-nm monochromatic excimer light in the treatment of psoriasis vulgaris and palmoplantar psoriasis

Background: The purpose of this study is to evaluate the efficacy and safety of 308‐nm monochromatic excimer light (MEL) in the treatment of psoriasis vulgaris and palmoplantar psoriasis. Methods: Thirty‐five patients with psoriasis vulgaris and 15 patients with palmoplantar psoriasis were recruited for this study. Thirty patients with psoriasis vulgaris completed a total of 16 treatments with 308‐nm MEL twice a week, and 15 patients palmoplantar psoriasis completed 25 treatments administered once weekly. The clinical response to therapy and adverse effects were recorded. Results: Patients with psoriasis vulgaris (n=30) showed a 74.6% improvement in the mean psoriasis area and severity index score after a total of 16 MEL treatments (2 ×/week) with 36.7% of the patients (n=11) achieving clearance. Patients with palmoplantar psoriasis (n=15) showed a 52.5% improvement in the mean severity index score after a total of 25 MEL treatments (1 ×/week) with only one patient (6.7%) achieving clearance. The MEL therapy was well tolerated with a low incidence of side effects, which included pruritus, erythema and blister formation. Conclusion: The 308‐nm MEL can be utilized as an effective and safe treatment modality for patients with mild‐to‐moderate psoriasis vulgaris and palmoplantar psoriasis.     

单频准分子光治疗白癜风的临床研究

目的 研究观察单频准分子光308nm局部照射治疗白癜风的临床疗效,评估其安全性.方法 对77例不同临床类型的白癜风患者的201处皮损进行局部照射,每周1次,随访3-6个月.结果 经过准分子光局部照射平均18次,86.6%皮损有不同程度色素恢复,色素恢复随疗程延长而增加,照射24次总有效率为71.0%,显效率为51.6%.躯干、颈部和头面部疗效优于四肢及手足;泛发型和节段型白癜风疗效尤佳.主要不良反应为局部水疱和疼痛,患者能耐受.结论 准分子光局部照射治疗白癜风疗效显著,且不良反应少.     

Efficacy of 308-nm excimer light for Japanese patients with psoriasis

Ultraviolet irradiation therapy, including psoralen and ultraviolet A therapy and narrow-band ultraviolet B (310–312 nm) therapy, is a widely used and highly efficient treatment modality for psoriasis. Therapy with 308-nm excimer light has been reported to be effective for the treatment of psoriasis vulgaris. To evaluate the efficacy of 308-nm excimer light therapy for Japanese psoriasis patients, seven patients (six men and one woman) with plaque-type psoriasis were treated with 308-nm excimer light at 7–14-day intervals. The Psoriasis Severity Index (PSI) was calculated for individual plaques in order to assess the effectiveness of the therapy. A 74.9% mean improvement in the PSI was observed after 10 treatment sessions. These results suggested that targeted irradiation with 308-nm excimer light leads to rapid and selective improvement in plaque-type psoriatic lesions without unnecessary radiation exposure to the surrounding unaffected skin.     

308 nm准分子光治疗皲裂性湿疹21例

308 nm准分子光是目前治疗白癜风和银屑病的有效治疗方法之一,而其对于皲裂性湿疹的疗效报道较少.我科使用308 nm准分子光治疗掌跖部皲裂性湿疹21例,观察其临床疗效及安全性,现将结果报道如下. 一、资料和方法 1.临床资料:2009年11月至2011年1月在我科就诊的皲裂性湿疹患者41例,根据确诊顺序采取逐一分配原则分为两组,治疗组21例,男11例,女10例;年龄29～43岁,平均年龄32.3岁;病程＜1年3例,1～5年4例,＞5年14例;对照组20例,男7例,女13例,年龄29 ～ 57岁,平均年龄31.05岁,病程1～5年7例,＞5年13例.     

308-nm Excimer laser treatment of palmoplantar psoriasis

Abstract

Psoriasis is a chronic inflammatory condition affecting 1–3% of the population. The incidence of palmoplantar involvement has been estimated to be between 2.8% and 40.9%. Significant psychosocial distress and difficulty performing activities of daily living can result. Treatment is often challenging. Traditional treatments include topical steroids, anthralin, calcipotriene, PUVA, methotrexate, cyclosporine, retinoids and biologics. In this case series, we report our success with the 308-nm excimer laser in the treatment of palmoplantar psoriasis.     

308单频准分子紫外光治疗无色素痣的临床疗效观察

目的 探讨308单频准分子紫外光对无色素痣的疗效及其不良反应。方法 308单频准分子紫外光对18例躯干部无色素痣的患者进行连续10次治疗,治疗前后检测皮损平均黑素值,随访3个月。结果 同初次治疗前基线值相比,治疗后皮损平均黑素值以次数依赖方式逐渐上升;约6次治疗后,皮损平均黑素值与周围正常皮肤平均黑素值百分率接近100%,随着随访时间的延长,皮损平均黑素值有下降趋势,约1个月后,皮损平均黑素值接近周围正常皮肤,3个月后皮损平均黑素值是正常皮肤的90%。治疗期间未发现水疱和瘢痕形成等不良反应。结论 308准分子紫外光治疗无色素痣安全有效,为稳定疗效可间隔3个月巩固治疗1次。     

308nm准分子激光治疗面部银屑病42例

摘要】 目的 探讨308nm准分子激光面部银屑病的疗效及不良反应。 方法 48例病人采用巅峰308nm准分子激光治疗,每周3次,10次一个疗程,最多20次治疗,初始剂量2倍MED,观察临床疗效和不良反应,以PASI评分为依据。结果 42例病人完成了治疗,一个疗程治疗后显效率73.8%,两个疗程显效率85.7%,不良反应发生率47.6%,主要为色素沉着、瘙痒等。结论 308nm准分子激光治疗面部银屑病具有起效较快、疗效较高、无严重不良反应、治疗方便的特点。     

Comparison of the 308-nm excimer laser and a 308-nm excimer lamp with 311-nm narrowband ultraviolet B in the treatment of psoriasis

BACKGROUND: Psoriasis is a chronic, genetically determined inflammatory disease, characterized by an immunomediated pathogenesis, which affects approximately 1-3% of the population. Various modalities have been used for psoriasis treatment, including ultraviolet (UV) radiation. Narrowband UVB (311 nm) phototherapy is a well-established, widely used and highly efficient treatment for psoriasis, but a big disadvantage is that large areas of unaffected skin are irradiated along with the psoriatic lesions. OBJECTIVES: This investigation evaluates a 308-nm excimer laser and a 308-nm excimer lamp in comparison with 311-nm narrowband UVB in the treatment of patch psoriasis by using two different dose-increase schemes. MATERIALS AND METHODS: Fifteen patients with plaque psoriasis were enrolled in the study (first regime). Three different psoriatic lesions were treated with the 308-nm excimer laser, the 308-nm excimer lamp or 311-nm narrowband UVB three times per week. UVB doses were increased slowly and stepwise (1, 1, 2, 2, 3, 3, ...multiple MEDs). Sixteen patients were enrolled in the second regime. Two plaques were treated with the 308-nm excimer laser or with the 308-nm lamp with an accelerated scheme (2, 2, 4, 4, 6, 6, ...multiple MEDs) three times per week. We increased the UVB doses every second treatment (first and second regime) during the whole treatment. If blistering occurred, the blistered plaque was not treated on the next scheduled treatment. At every third visit and 1, 2 and 4 months after the last treatment a Psoriasis Severity Index (PSI) score was assigned in both regimes. RESULTS: Using Friedman analysis, the PSI scores did not show a statistically significant difference (P > 0.05) comparing 308-nm laser therapy, 308-nm lamp therapy and 311-nm narrowband therapy after 10 weeks in the first regime. The mean number of treatments to achieve clearance was 24. With the accelerated scheme, clearance could be achieved with fewer treatments and with half the cumulative dose of the first regime. Nevertheless, the side-effects such as blistering and crusting were also increased. CONCLUSIONS: Both 308-nm light sources can clear patch psoriasis in a similar manner to standard phototherapy, with the advantage of the ability to treat exclusively the affected skin and with a reduced cumulative dose, thus perhaps reducing the long-term risk of carcinogenicity.     

Treatment of alopecia areata with 308-nm excimer lamp

Alopecia areata is considered to be a T-cell mediated autoimmune disorder. The 308-nm excimer lamp is thought to be capable of inducing T-cell apoptosis in vitro, suggesting that the lamp might be effective for the treatment of alopecia areata. We examined the effectiveness of the 308-nm excimer lamp for the treatment of alopecia areata. We recruited three patients with single alopecia areata lesions that were resistant to conventional treatment. The lesions were exposed to a 308-nm excimer lamp at 2-weekly intervals. Hair regrowth was observed in all three patients after approximately 10 treatment sessions. Our study showed that exposure to the 308-nm excimer lamp effectively induced hair regrowth in solitary alopecia areata lesions. Apart from erythema, there were no significant adverse effects. Therefore, we suggest that it may be considered as a treatment modality for recalcitrant alopecia areata.     

High-dose 308-nm excimer laser for the treatment of psoriasis

BACKGROUND: The excimer laser can deliver high-intensity ultraviolet B (UVB) energy at 308 nm, a wavelength similar to that used in narrow-band UVB phototherapy. OBJECTIVE: The goal of this investigation was to evaluate the role of high-dose single treatments with the excimer 308-nm laser in stable plaque-type psoriasis. METHODS: Eighteen volunteers were enrolled in the study. Two plaques were selected and half of each plaque was held as a control while the other half was treated with a single dose of either 8 or 16 times the minimal erythema dose. RESULTS: Sixteen subjects completed the study. Two patients signed up but never actually participated because of scheduling problems. Eleven showed significant improvement within 1 month, and 5 still demonstrated persistent areas of clearing at 4 months. CONCLUSION: As little as one high-dose excimer laser treatment can be effective for localized plaque-type psoriasis. Multiple treatments or other irradiation schedules with this innovative device may prove even more efficacious.     

Medium-dose 308-nm excimer laser for the treatment of psoriasis

BACKGROUND: The excimer laser delivers targeted ultraviolet B 308-nm radiation. OBJECTIVE: This investigation evaluated the efficacy of multiple, medium-dose excimer 308-nm laser treatments for psoriasis. METHODS: Twenty volunteers with plaque psoriasis were enrolled. Six plaques received treatment 3 times per week for up to 8 weeks; another plaque served as a control. As in standard phototherapy, a flexible dose escalation scheme was implemented during the course of treatment. Modified Psoriasis Area and Severity Index scores were rendered throughout the study with follow-ups at 1, 2, 4, and 6 months. RESULTS: Fifteen subjects completed the study without complications. The mean number of treatments to achieve >95% clearance was 10.6. The mean cumulative UV radiation dose was 6.1 J/cm(2), and the mean remission time was 3.5 months. CONCLUSION: A thrice-weekly, medium-dose irradiation schedule with the 308-nm laser can effectively clear localized plaque-type psoriasis in fewer treatments with an overall lower cumulative dose, compared with standard phototherapy. This innovative UV device allows specific targeting of affected sites without needless exposure of unaffected skin.     

Topical tacalcitol and 308-nm monochromatic excimer light: a synergistic combination for the treatment of vitiligo

BACKGROUND/PURPOSE: To study and compare the efficacy of combined 308-nm monochromatic excimer light (MEL) therapy with tacalcitol vs. that of MEL 308-nm therapy alone in treatment of vitiligo. METHODS: Thirty-eight patients with vitiligo were enrolled in a single-blind, within patient controlled clinical trial. Symmetrical or nearby lesions were randomly applied with either topical tacalcitol cream or vehicle. Each lesion was treated weekly with the 308-nm MEL, for a total of 12 sessions. Patients were examined at monthly intervals. The mean number of sessions and the cumulative dosage for initial repigmentation were calculated. RESULT: Thirty-five patients were evaluated. Treatment with tacalcitol and MEL resulted in higher percentages for excellent repigmentation (25.7%) compared with vehicle and MEL (5.7%) (P<0.05). Percentages for total response were 71.4% and 60%, respectively (P>0.05). The mean+/-SEM cumulative dose and number of excimer light exposures for initial repigmentation were, respectively, 3.93+/-0.59 J/cm2 and 4.52+/-0.49 at the tacalcitol side, and, respectively, 4.99+/-0.68 J/cm2 and 5.3+/-0.52 at the vehicle side (P<0.05). CONCLUSION: Our results have shown that concurrent topical tacalcitol potentiates the efficacy of the 308-nm MEL in the treatment of vitiligo, and that this combination achieves earlier pigmentation with a lower total dosage.     

The effectiveness of PUVA treatment in severe psoriasis is significantly increased by additional UV 308-nm excimer laser sessions

In most cases, patients with moderate to severe psoriasis are treated with narrow-band UVB phototherapy or with psoralen UVA (PUVA-) photochemotherapy. This UV-radiation is given to the whole skin, including unaffected skin. Normally, these two PUVA- and UVB-radiation procedures cannot be combined on account of the phototherapeutic side-effects on unaffected skin. The 308-nm excimer laser has been shown to be safe and effective in the treatment of localized mild-to-moderate plaque-type psoriasis whilst sparing healthy skin. Our aim was to compare the therapeutic response to PUVA plus up to 4 UVB308-nm radiations and PUVA monotherapy in patients with moderate-severe plaque-type psoriasis. 272 hospitalized adult patients were enrolled on this prospective random study. 256 patients completed the full course of treatment. PUVA treatment was given 4 times weekly to all patients. 123 patients received PUVA as a monotherapy. During the first two weeks, 149 patients were additionally treated up to four times with 308-nm excimer-derived UVB on the affected skin and treatment was evaluated for its efficacy, duration, number of times necessary for complete (CR) or partial remission (PASI reduction > 90 or > 50%, respectively), cumulative light dose, side effects of therapy and duration of remission after therapy. Statistically, there is no significant difference when comparing the efficacy of PUVA (CR 67.3%) and PUVA plus excimer (CR 63.6%). On average, patients treated by the combination method went into remission in half the treatment time (15 +/- 6 versus 27 +/- 7 days) and with half the cumulative UVA dose (22.9 +/- 5.8 versus 53.2 +/- 26.3), p < 0.05. In conclusion, skin heals considerably quicker when treated with a combination of photochemotherapy and a short course of UVB 308 nm laser treatment applied directly to the affected skin, resulting in a shorter hospital stay and quicker rehabilitation of patients with moderate-severe psoriasis.     

Use of the 308-nm excimer laser for psoriasis and vitiligo

The 308-nm excimer laser represents the latest advance in the concept of selective phototherapy. It emits a wavelength in the UV-B spectrum and thus shares the same indications as conventional phototherapy. Like other laser devices, the 308-nm excimer laser emits a monochromatic and coherent beam of light, can selectively treat a lesion while sparing surrounding healthy skin, and can deliver high fluencies. Clinicians have taken advantage of these properties to treat dermatologic disorders since 1997, with psoriasis and vitiligo attracting most attention. Initially, high fluencies (minimal erythemal dose, 8-16) were used, with excellent clinical results, to treat psoriasis vulgaris. The significance of side effects and the potential long-term carcinogenic risk associated with such fluencies have resulted in medium doses (about 3 minimal erythemal dose) being recommended, however. Interestingly, taking advantage of the selectivity of the laser, newer treatment protocols adapt the dose to the lesion and not to the minimal erythemal dose, as is the case for conventional phototherapies. Many prospective study series have also shown the efficacy and the good tolerance of the 308-nm excimer laser in the treatment of localized vitiligo. Induced rates of repigmentation seem to be higher than with narrowband UV-B. Moreover, the selectivity of the treatment prevents irradiation of healthy skin and limits unsightly tanning of surrounding skin. Aesthetically pleasing results are usually not achieved in extremities and bony prominences, which are not good indications for this technique. Combining the 308-nm excimer laser with 0.1% tacrolimus ointment has provided very interesting results, which need to be confirmed in larger series. The absence of actual data concerning the long-term risk for skin cancer after this treatment means that it should be considered with caution. Combination with topical steroids appears to be synergistic and potentially reduces long-term side effects; again, prospective data are lacking.