Epidermal Langerhans' cells in chronic eczematous dermatitis of the palms treated with PUVA and UVB

Epidermal Langerhans' cells (LC) were studied in patients with chronic eczematous dermatitis of the palms. The monoclonal antibodies anti-Leu 6 and anti-HLA-DR were used, and the cells visualized with an immunoperoxidase technique. Increased numbers of LC were found in allergic contact dermatitis as well as in irritant contact dermatitis and hyperkeratotic dermatitis of the palms. The increased number of epidermal LC in lesional skin may facilitate presentation of exogenous or endogenous antigens to activated T-cells. One hand was treated with PUVA or UVB and the other hand served as a non-exposed control. PUVA treatment cleared the dermatitis and the LC number decreased markedly. With UVB treatment clinical improvement was achieved, and a less pronounced decrease in epidermal LC was noticed. There seems to be a crude relationship between the extent of clinical improvement and the reduction in epidermal LC numbers. The change in LC might be a primary event or secondary to a reduction of the inflammatory process.     

Chronic eczematous dermatitis of the hands: a comparison of PUVA and UVB treatment

The efficacy of PUVA and UVB treatment in chronic eczematous dermatitis of the hands was compared in a randomised controlled study including 35 patients who were randomly allocated to PUVA or UVB treatment. One hand was exposed to light and the other served as an untreated control. The dermatitis cleared on the treated hand in all PUVA patients, but in 9 out of 14 there was a relapse within three months. In the UVB group clearing of the skin lesions was not achieved, but compared with the "untreated" hands a statistically significant improvement was found at 12 weeks of treatment. A statistically significant improvement of "untreated" hands was found in both groups. PUVA and UVB treatments are alternative treatment modalities in patients with recalcitrant chronic eczematous dermatitis of the hands. PUVA is superior to UVB.     

Local and systemic effect of ultraviolet irradiation (UVB and UVA) on human allergic contact dermatitis

In subjects hypersensitive to nickel we have investigated local and systemic effect of whole body exposure of cumulative suberythema UVB doses as well as solarium-UVA exposure. UVB possesses both locally and systemically a suppressive effect on human allergic contact dermatitis, but UVA has no such effect. The systemic suppressive effect of UVB might be of therapeutic importance in patients with severe chronic dermatitis of the hands when adding this effect to a local suppressive effect. Also, patch testing should not be performed during UVB and/or overt sun exposure.     

Contact allergy to Compositae plants in patients with summer-exacerbated dermatitis

16 patients with summer-exacerbated dermatitis were examined by patch testing and photopatch testing with a battery of Compositae and standard allergens. IgE and RAST, and the thresholds to UVA and UVB, were determined. 6 female and 2 male patients showed allergic contact reactions to one or more Compositae extracts from flowers common in Sweden, also used in skin care products. The study points to the importance of including testing with Compositae allergens in patients with summer-exacerbated dermatitis. This group comprises patients with multiple contact reactions, photosensitivity and flares of atopic dermatitis.     

Contact sensitivity in patients with recalcitrant atopic dermatitis

Patients with atopic dermatitis are usually responsive to conventional treatment such as topical steroids; however, they are sometimes refractory to the treatment. The influence of contact sensitivities on the course of patients with recalcitrant atopic dermatitis is not known. The aim of this study was to investigate whether contact sensitivities affect the course of patients with recalcitrant atopic dermatitis. We evaluated 45 patients with atopic dermatitis who had failed conventional therapy. Patch testing was performed with the Japanese standard series, metal series and/or suspected items. A total of 15 patients had a positive patch test reaction to at least one allergen. The most common allergens were nickel, topical drugs and rubber accelerators. Avoidance of products or food containing allergic substances greatly or partially improved skin symptoms in nine patients. These results suggest that contact allergens and metals may be critical factors causing eczematous lesions in patients with recalcitrant atopic dermatitis.     

Contact and photocontact sensitization in chronic actinic dermatitis: sesquiterpene lactone mix is an important allergen

Summary Eighty-nine patients with chronic actinic dermatitis (CAD) were retrospectively studied: 69 (78%) male and 20 (22%) female, with mean ages of 66 and 64 years, respectively; nine (10%) were dark skinned. Eight (9%) were abnormally sensitive to UVB wavelengths alone, 74 (83%) to UVB and UVA, and seven (8%) to UVB, UVA and visible radiation. Eighty-six patients were patch tested to an extended standard European series of contact allergens, including in 80 cases a 0.1% mix of three sesquiterpene lactones, and photopatch tested to a standard photopatch series. Sixty-four of these 86 patients (74%) had positive patch or photopatch tests; 36% (29 of 80) were sensitive to the sesquiterpene lactone mix, 21% (18 of 86) to fragrance compounds, 20% (17 of 86) to colophony, and 14% (12 of 86) to rubber chemicals. Ten (12%) had positive photopatch tests; five (6%) to musk ambrette, six (7%) to sunscreens and one to both. Fourteen of the eighty-nine patients with CAD (16%) had preceding endogenous eczema. In 18 of 86 patients (21%), CAD occurred alone, with neither detectable contact nor photocontact allergy, nor a preceding history of endogenous eczema. This study confirms the association between Compositae (sesquiterpene lactone) dermatitis and CAD.     

Narrow-band (TL-01) UVB air-conditioned phototherapy for chronic severe adult atopic dermatitis

In an open study of 21 severely affected adult atopic dermatitis patients, air-conditioned narrow-band UVB phototherapy using the Philips TL-01 lamp three times weekly for 12 weeks resulted in a 68% reduction in atopic dermatitis severity scores, with a concomitant 88% reduction in potent topical steroid use.
Follow-up at 24 weeks revealed that six patients had relapsed to >70% of pre-phototherapy severity scores; the remaining 15 continued to derive long-term benefit. The mean value of potent topical steroid use remained 50% below pre-phototherapy needs.
Narrow-band UVB (TL-01) phototherapy appears an effective, steroid-sparing treatment for chronic severe atopic dermatitis, offering long-term benefits in the majority of those treated.     

Topical mechlorethamine for psoriasis. An attempt to avoid the development of sensitization by the use of a topical tolerogenic schedule.

The topical application of mechlorethamine is associated with a high incidence of irritant contact dermatitis. An attempt was made to avoid this complication by the use of a topical tolerogenic schedule. Seven of ten patients developed contact dermatitis to the medication after they had completed the schedule, The use of this medication in its present form is unlikely to be practical value in the treatment of psoriasis.     

Papular dermatitis (subacute prurigo, “itchy red bump” disease): Pilot study of phototherapy

Background: Some patients with a subacute or chronic pruritic erythematous papular eruption are refractory to treatment. We previously described a number of these patients with papular dermatitis or subacute prurigo. Objective: The purpose of this study was to examine the effectiveness of different types of phototherapy for treatment of papular dermatitis. Methods: We reviewed the medical records of 11 patients who were diagnosed with papular dermatitis and who underwent phototherapy within the last 5 years. Results: Eleven patients had a total of 17 phototherapy courses: psoralen–UVA (PUVA; 9), UVA/UVB light (3), and UVB alone (5). Within the PUVA treatment group, three of nine patients experienced total clearing, and six of nine patients experienced partial improvement. Although patients in all groups relapsed with time, overall the PUVA-treated patients had the best response rate and the best chance of the condition remaining clear after treatment was stopped. Conclusion: PUVA may be an effective treatment for papular dermatitis. The frequency of relapse indicates that maintenance treatments may be necessary for long-term control of the disease. (J Am Acad Dermatol 1998;38:929-33.)     

The successful use of topical tacrolimus treatment for a chronic actinic dermatitis patient with complications of idiopathic leukopenia

Chronic actinic dermatitis (CAD) is a photosensitivity disorder marked by severe eczematous lesions on exposed areas. Although associations with contact dermatitis, atopic dermatitis, and human immunodeficiency virus (HIV) have been suggested, its pathogenesis remains unknown. CAD is often refractory, and systemic administration of cyclosporin A has been the treatment of choice. Recently, topical tacrolimus therapy has been reported to be effective. We report the efficacy of topical tacrolimus treatment in a CAD patient who also had the complication of idiopathic leukopenia. A phototest showed marked suppression of erythema formation in the skin pre-treated with tacrolimus before UVB radiation but not in the skin treated after the irradiation. Therefore, it is suggested that tacrolimus may prevent UV-B induced erythema by suppressing a very early phase of the inflammatory process in CAD.     

The validity of the Mathias criteria for establishing occupational causation and aggravation of contact dermatitis

Mathias proposed 7 criteria for establishing occupational causation and aggravation of contact dermatitis (Mathias, J Am Acad Dermatol 1989, 20, 842-848). 4 of the 7 criteria must be positive to conclude occupational dermatitis. In order to evaluate the validity of these criteria, we re-examined 19 patients (17 male and 2 female) with contact dermatitis, who had given a positive answer to at least 4 of the criteria and had either exchanged their workplace or stopped working. We re-evaluated them, 2-5 years later, for the presence of contact dermatitis. 14 of 19 patients (74%) reported that their dermatitis had cleared after they had left their previous workplace. Only 5 patients still suffered from dermatitis, 2-5 years later. 3 of these 5 patients could have been exposed to the causative allergens in their new workplace. We conclude that the Mathias criteria are useful to assess occupational contact dermatitis.     

A UVB phototherapy protocol with very low dose increments as a treatment of atopic dermatitis

From 1991 to 1992, 15 patients with atopic dermatitis were treated with a new UVB treatment regimen guided by skin reflectance measurements. The new treatment was characterized by very low dose increments from start to end of therapy. The median cumulative dose increment during therapy was only 20%. The severity of the disease, the efficacy of the treatment, the occurence of adverse effects and the cumulative UVB dose were obtained from the case records. This data were compared in an open study with the data obtained from 17 patients with atopic dermatitis who were treated from 1988 to 1991 at the department with a standard UVB treatment regimen with stepwise dose increments. There was no difference in the severity of the disease at the beginning of the therapy between the two groups. The skin reflectance-guided low-dose UVB therapy was not significantly faster (3.5 weeks) than the regimen with stepwise dose increments (4.5 weeks). The cumulative UV exposure was four times lower with the new treatment regimen (34 standard erythema doses) compared with the old regimen (161 standard erythema doses), P <0.001. The healing score was significantly higher with the new treatment regimen compared with the old, P <0.05. This study indicates that skin reflectance-guided UVB phototherapy may enable the dermatologist to lower the cumulative UVB exposure significantly without losing effect.     

A left–right comparison of UVB phototherapy and topical photochemotherapy in bilateral chronic hand dermatitis after 6 weeks' treatment

We have compared the efficacy of local UVB phototherapy with topical (bath) photochemotherapy in 13 patients with bilateral chronic hand dermatitis. In each patient, one hand was treated with UVB phototherapy and the other hand with topical (bath) photochemotherapy. Both treatments moderately improved the chronic hand dermatitis after 6 weeks' treatment. We observed no significant differences in improvement between the modalities, but side-effects occurred more often on the photochemotherapy-treated side. Considering the similar responses and relative incidence of side-effects, we would advise starting treatment with UVB phototherapy and only using topical photochemotherapy if this fails.     

Tacrolimus enhances irritation in a 5-day human irritancy in vivo model

Tacrolimus (FK 506) is a macrolide discovered in 1984 as a metabolic product of Streptomyces tsukabaensis. It has been used successfully in treating atopic dermatitis, allergic contact dermatitis, lichen planus mucosae and pyoderma gangrenosum. In the present study, we evaluated the anti-inflammatory activity of FK 506 in 2 human skin inflammation models. FK 506 as Protopic(R) cream was tested (i) in a 4-day repetitive irritation test with 2 x daily application of sodium lauryl sulphate (SLS), and (ii) in a UVB erythema model. The effect was evaluated visually and quantified by non-invasive bioengineering methods, namely chromametry and tewametry (TEWL). When FK 506 was applied 30 min after SLS irritation, an increased inflammation in comparison to controls was observed with all 3 methods, with only the TEWL data reaching statistical significance. 1 x daily application of FK 506 for 5 days, starting at the end of the 4-day irritation period, was without any effect. Similarly, no effect of FK 506 was seen in the UVB model. In conclusion, FK 506 was shown to enhance experimentally induced irritant contact dermatitis and not to accelerate healing of irritant contact dermatitis and UVB erythema.     

UVB-308-nm- (NUVB-)Therapie mittels Excimer-Laser bei atopischer Dermatitis und weiteren inflammatorischen Dermatosen

UVB 311 nm phototherapy (NUVB) is used successfully in the treatment of psoriasis or atopic dermatitis and is often choosen as “first-line” therapy. In a prospective study we investigated the efficacy of the targeted UVB 308 phototherapy by excimer laser in the treatment of 57 patients with localized, mild therapy-resistant atopic dermatitis. We achieved a complete remission (CR) in nearly 85% and a partial remission (PR) in 15% after 10 treatments during 6–8 weeks in all patients. A mean reduction in patient-reported pruritus was one hallmark after 3–4 treatments. 48 other patients with lichen simplex chronicus Vidal, nodular prurigo, granuloma anulare, alopezia areata (AA) and lichen ruber planus were also treated by targeted NUVB. We found higher rates of CR and PR only in patients with AA and in patients with oral Lichen ruber mucosae. These results and the systematically reviewing of the current medical literature shows that targeted NUVB by excimer laser cannot be successfully transfered for all inflammatory skin diseases. In particular, Excimer UVB treatment expands the therapeutic options in patients with localized and therapy-resistant atopic dermatitis enormously.     

Ultraviolet-B phototherapy is successful in Japanese patients with early-stage mycosis fungoides

UVB phototherapy is widely used for the treatment of psoriasis and atopic dermatitis, however, only limited reports evaluate its usefulness in the treatment of mycosis fungoides. We introduced UVB phototherapy to five patients with early-stage mycosis fungoides. All of them were classified as stage IB (erythematous stage), and none had obtained a satisfactory response to other therapies. After initial treatment with UVB phototherapy, all the patients obtained significant improvement in their skin lesions leaving pigmentary changes. After this satisfactory response was achieved, the same dose of UVB was administrated as a maintenance therapy with longer intervals between exposures. Histopathological examination of three patients revealed decreased numbers of inflammatory cells in both the epidermis and the dermis after the treatment. Immunohistochemical study showed that CD1a+/HLA-DR+ dendritic cells were present throughout the lesional epidermis before the treatment. In contrast, after the treatment, the dendritic cells in the epidermis were CD1a+/HLA-DR-. Although it remains unclear why only the expression of HLA-DR antigen was eliminated after treatment, we presume that this loss of HLA-DR antigen expression by epidermal Langerhans cells was, in part, responsible for the improvement of skin lesions. This preliminary study suggests that UVB phototherapy is an effective treatment for patients with early-stage mycosis fungoides.     

Ultraviolet light is an environmental factor aggravating facial lesions of adult atopic dermatitis

An increasing number of adult patients with atopic dermatitis (AD) in Japan are distressed by persistent eczematous lesions of the face (so-called atopic red face). Phototests were carried out in 28 patients with the atopic red face to test a possibility that ultraviolet (UV) light could be an aggravating factor. Contact and photocontact dermatitis had been ruled out by repeated patch and photopatch tests. All of the patients had a normal response to a screening dose of UVA (10 J/sq cm) and a normal minimal erythema dose (MED) of UVB. Ten of these patients, however, showed an abnormal papular response to a single or 3-times consecutive UVB radiation above the MED (90 mJ/sq cm).     

Evaluation of narrow band ultraviolet B phototherapy in the treatment of chronic actinic dermatitis in Chinese patients

Few studies have been conducted in chronic actinic dermatitis (CAD) treated with narrowband ultraviolet B (NB UVB) phototherapy, especially in Asian patients. We aim to evaluate the efficacy and safety of NB UVB phototherapy in Chinese patients with CAD. 19 CAD patients of Fitzpatrick skin phototype IV received NB UVB phototherapy in spring and treatments were given 3 times weekly with incremental dose and maintenance therapy was given twice weekly for 3–4 weeks. The mean initial, endpoint, and cumulative dose of NB UVB was 0.08, 0.33, and 6.0 J/cm², respectively. Patients totally received 27 times of treatments in average. 87.5% of previously ultraviolet B（UVB） sensitive patients and 75% of previously ultraviolet A（UVA） sensitive patients had normal or improved MED after phototherapy. The percentage of patients returned to normal UVB phototesting was higher than that of patients returned to normal UVA phototesting (68.8% vs. 37.5%). The mean 1‐week DLQI and the need for using immunosuppressive agents and antihistamines were significantly reduced after treatment (p < .01 or p < .05). In conclusion, prophylactic NB UVB phototherapy is effective and safe in treatment of CAD in Chinese patients with Fitzpatrick skin phototype IV.     

Sun exposure is an aggravating factor responsible for the recalcitrant facial erythema in adult patients with atopic dermatitis

BACKGROUND: In Japan, a considerable number of adult patients with atopic dermatitis suffer from recalcitrant facial erythema that resists common treatment with topical corticosteroids and antihistamines. OBJECTIVE: Our purpose was to investigate the potential role of sun exposure in the aggravation of these facial lesions. METHODS: The history of photoaggravation was taken from 74 adult patients with atopic dermatitis who suffered from recalcitrant facial erythema. Repeated UVB and UVA phototests were performed in 36 patients. Surface markers of infiltrating cells in UVB-provoked lesions were characterized immunohistochemically. RESULTS: Forty-one of 74 patients experienced an exacerbation of the facial lesions after sun exposure. UVB testing revealed an abnormal, papular response in 14 of 36 patients. All of the 14 patients complained of clinical aggravation after sun exposure. No abnormal reactions were observed at UVA testing. In UVB-provoked lesions, CD4+ cells were predominant to CD8+ cells. CONCLUSION: Exposure to UVB radiation may be responsible for the recalcitrant facial erythema in at least some of the patients with atopic dermatitis.     

UVA solarium versus UVB phototherapy of atopic dermatitis: a paired-comparison study

In a paired-comparison study, 21 patients suffering from atopic dermatitis were treated with fluorescent tubes radiating mainly ultraviolet A (UVA) on one half of the body and with tubes radiating mainly UVB on the other. Treatment was given three times a week for up to 8 weeks. Eight variables reflecting disease status were recorded and the sum of these comprised the total score. The total score and the overall evaluation score were better with UVA therapy (P less than 0.02 and P = 0.01, respectively). No statistically significant difference for the pruritus score was found. The reduction in extent of dermatitis, seen with both therapies, was more pronounced with UVA (P less than 0.05). Differences in the healing score were not statistically significant. Treatment with UVA resulted in healing or considerable improvement in 15 patients and 13 patients showed improvement when treated with UVB. A better result was found with UVA in 10 subjects and with UVB in two subjects. Equal results occurred with both UVA and UVB in nine of the patients although most preferred UVA treatment.