In vitro evaluation of a novel topical cream for vitiligo and psoriasis that selectively delivers NB‐UVB therapy when exposed to sunlight

Ultraviolet‐B (UVB) phototherapy is a well‐established mode of treatment for several types of dermatological disease. For psoriasis and vitiligo, narrow band UVB (NB‐UVB) phototherapy is an effective therapy, demonstrating greater efficacy and safety compared to broadband UVB or psoralen plus UVA treatments. While the treatment efficacy of NB‐UVB artificial light sources is well documented, the long term time and cost commitment of the therapy remains a barrier to treatment adherence. Natural sunlight is an ideal source of accessible UVB radiation; however, exposure to natural sunlight generally results in erythema prior to the accumulation of sufficient dosage of therapeutic wavelengths of UVB. This communication describes a novel topical cream designed to selectively deliver NB‐UVB therapy when exposed to sunlight. The topical cream when combined with natural sunlight could offer patients a more convenient phototherapy option for psoriasis and vitiligo, potentially increasing patient compliance.     

Narrow‐band ultraviolet B as a potential alternative treatment for resistant psychogenic excoriation: an open‐label study

Narrow‐band ultraviolet therapy has been used successfully for the treatment of inflammatory skin disorders and generalized pruritus. We have prospectively evaluated seven consecutive patients with resistant psychogenic excoriation (PE) treated with narrow‐band ultraviolet B (NB‐UVB). Approximately 70% of all patients showed improvement in their condition. NB‐UVB therapy was well tolerated, with no serious side effects. We may conclude that, when treating a patient with PE, NB‐UVB in combination with other approaches may provide extra benefit in resistant cases.     

Bath psoralen+ultraviolet A photochemotherapy vs. narrow band‐ultraviolet B in psoriasis: a comparison of clinical outcome and effect on circulating T‐helper and T‐suppressor/cytotoxic cells

Background: Comparative success rates of bath psoralen+ultraviolet A (PUVA) and narrow band‐ultraviolet B (NB‐UVB) in psoriasis treatment are variably reported with no previous studies on the possible effect of bath PUVA on circulating CD4+ and CD8+ T cells. Objective: We aimed to compare the effect of bath PUVA and NB‐UVB clinically and on circulating T‐helper and T‐suppressor/cytotoxic cells in psoriasis. Patients and methods: Thirty‐four psoriatic patients divided into a bath PUVA‐treated group (18 patients) and a NB‐UVB‐treated group (16 patients) were compared regarding the disease severity by psoriasis area and severity index (PASI) score and percentage of circulating CD4+ and CD8+ T cells by flowcytometry before and after treatment. Results: After treatment, the bath PUVA group showed a significantly higher reduction of PASI score (85.44%) than the NB‐UVB group (58.72%). Mean peripheral CD4+ T‐cell percentage was significantly lower after [36.8; 95% confidence interval (CI) 33.80, 39.97] compared with before treatment (42.06; 95% CI 38.29, 45.83) (P<0.05) in the bath PUVA group while this difference was insignificant in the NB‐UVB group (P>0.05). Conclusion: Bath PUVA therapy is superior to NB‐UVB in the treatment of moderate and severe psoriasis with mild reversible side effects. Both modalities have a systemic effect decreasing peripheral CD4+ T cells, which is more with bath PUVA.     

NB‐UVB (311–312 nm)‐induced lentigines in patients with mycosis fungoides: a new adverse effect of phototherapy

Background Lentigines are a common pigmentary disorder in adults and in patients treated by psoralen and ultraviolet A (PUVA) radiation. Their appearance following treatment with narrow‐band ultraviolet B (NB‐UVB) radiation has been reported in only two patients. Objective To describe the clinical and histological features of NB‐UVB‐induced lentigines their relation to dosimetry and the course of the eruption in patients with mycosis fungoides (MF). Methods The files of all patients with MF treated in our department in 2003–2010 were searched to identify those in whom lentigines appeared following monotherapy with NB‐UVB radiation. Results Of the 73 patients with early stage MF identified, 10 met the study criteria. Lentigines were detected in skin previously involved by MF in seven patients, and in both involved and uninvolved skin in three patients. They appeared during therapy in three patients, after a mean of 56 exposures (range 50–61), and several months (mean 7.8) following completion of treatment in seven patients, after a mean of 69 exposures (range 32–157). Histopathological study of lesions from five patients revealed basal hyperpigmentation relative to adjacent normal‐looking skin. Two lesions had a slight increased number of normal‐looking melanocytes on immunohistochemical staining with melanoma cocktail. One lesion had elongated rete ridges. The lesions persisted throughout follow‐up (mean 26.7 months) in 8 patients. Conclusions Patients with MF treated with NB‐UVB may acquire lentigines. As opposed to PUVA‐induced lentigines which are a known common side‐effect of long‐term treatment, NB‐UVB‐induced lentigines are uncommon but appear earlier, even after a few months of treatment.     

NB‐UVB irradiation attenuates inflammatory response in psoriasis

Psoriasis is a chronic inflammatory disease characterized by immunological imbalance and vasodilation. Many triggering factors for psoriasis initiate inflammation via the activation of NF‐κB. Narrow‐band ultraviolet B (NB‐UVB) irradiation can be used as a general treatment for psoriasis, although the molecular mechanism has not yet been determined. The aim of this study was to elucidate the potential molecular mechanism of NB‐UVB irradiation therapy on psoriasis. We collected serum samples from patients with psoriasis and healthy control, and detected the expression of inflammatory factors by ELISA. In addition, we established mouse model of psoriasis. After different doses of NB‐UVB irradiation, the proportion of CD4⁺, CD8⁺, and CD11c⁺ cells in mouse spleen was detected by flow cytometry. Meanwhile, the expression of inflammatory factors in the damaged skin of mice was detected by RT‐PCR and Western blot analysis, and mouse serum levels of inflammatory factors were detected by ELISA. Our results showed that NB‐UVB irradiation regulated the expression of inflammatory factors in psoriasis patients. In mice, high‐dose NB‐UVB irradiation effectively eliminated IMQ‐induced psoriasis‐like dermatitis and inhibited the expression of pro‐inflammatory factors. In conclusion, our results indicate that NB‐UVB irradiation could regulate the expression of inflammatory factors and attenuate psoriasis plaques.     

Serum 5-S-cysteinyldopa levels in patients with psoriasis undergoing narrowband ultraviolet B phototherapy

Background. Ultraviolet (UV) B radiation from sunlight can result in tanning or burning of the skin. Narrowband UVB (NB‐UVB), a relatively new light source that is not yet widely available, is effective for treating generalized psoriasis without the use of psoralens. Aims. The melanin‐related metabolite 5‐S‐cysteinyldopa (5‐S‐CD), which reflects pheomelanin production, has been used as a biological marker of melanoma progression, but there are no studies available on therapeutic UVB effects on serum 5‐S‐CD of human subjects. In the present study, we measured the time course of changes in serum levels of 5‐S‐CD in patients with psoriasis undergoing NB‐UVB phototherapy. Methods. In total, 11 Japanese patients with generalized psoriasis vulgaris received NB‐UVB treatment five times per week, at an initial dose of 0.1 J/cm². The dose was increased by 10–20% per treatment for > 20 treatments. Serum samples were taken before and 3, 7, 10, 14 and 28 days after phototherapy. Results. After 4 weeks of NB‐UVB treatment, 9 of 11 patients were in remission, confirming the effectiveness of NB‐UVB for treating Japanese patients with psoriasis. Two patients withdrew before day 28 because of other complications. Mean level of 5‐S‐CD in serum was significantly increased on day 7, 10 14 and 28 compared with the level before phototherapy and it peaked on day 10. Conclusions. Serum 5‐S‐CD levels were significantly increased by therapeutic UVB exposure. Sustained levels of 5‐S‐CD in serum appear to reflect the degree of skin injury during NB‐UVB phototherapy.     

Treatment of pigmented purpuric dermatoses with Narrow‐band UVB: a report of six cases

Background Pigmented purpuric dermatoses (PPD) are a group of chronic disorders that pose a therapeutic challenge. Objective In this study, we evaluated the effectiveness of narrow band ultraviolet B (NB UVB) in the treatment of PPD. Patients and methods Six patients of PPD were treated with NB UVB: one patient had Majocchi's purpura and five had Schamberg's disease. NB UVB was given on three weekly basis till clearance, then maintenance treatments were scheduled as twice weekly for 3 weeks and once weekly for another 3 weeks. The patients were followed up to 1 year. Results Successful treatment was achieved in all treatment patients after 24–28 NB UVB treatments and maintenance of nine treatments. Only two patients showed flare of their lesions after stoppage of NB UVB and efficiently controlled with further 14 NB UVB treatments. Conclusion NB UVB is effective in the treatment of PPD and should be considered as a treatment option for PPD.     

A large scale analytical study on efficacy of different photo(chemo)therapeutic modalities in the treatment of psoriasis,vitiligo and mycosis fungoides

Psoriasis, vitiligo, and mycosis fungoides (MF) are among the most frequently treated dermatological diseases by photo(chemo)therapy. The objectives are to determine which photo (chemo) therapeutic modality could achieve the best response in the treatment of psoriasis, vitiligo, and MF. The design used in this study is retrospective analytical study. The study included 745 patients' records; 293 with psoriasis, 309 with vitiligo, and 143 with early MF, treated in the Phototherapy Unit, Dermatology Department, Kasr El‐Aini Hospital, Cairo University by either psoralen and ultraviolet A (PUVA), narrow band ultraviolet B (NB‐UVB), psoralen and narrow band UVB (P‐NBUVB), broad band UVB (BB‐UVB), or broad band UVA (ΒΒ‐UVA). Data were retrieved from the computer database of the unit and statistically analyzed. In psoriasis, oral and topical PUVA and NB‐UVB were found to be equally effective, whereas oral PUVA had significantly better results than both UVA and BB‐UVB at the end of therapy. In generalized vitiligo, PUVA and P‐NBUVB had significantly better results than NB‐UVB alone. In early MF, there was no statistically significant difference between the response to oral PUVA and NB‐UVB. PUVA and NB‐UVB are good choices in patients with psoriasis and early stage MF, whereas PUVA appears the best choice in the treatment of vitiligo.     

Influence of narrowband ultraviolet B phototherapy on serum tumour necrosis factor‐like weak inducer of apoptosis (TWEAK) in patients with psoriasis

Psoriasis is characterized by keratinocyte resistance to apoptosis. We recently demonstrated an increase in serum tumour necrosis factor‐like weak inducer of apoptosis (TWEAK) in patients after topical treatment for psoriasis. We decided to verify whether narrowband ultraviolet B (NB‐UVB) has a similar effect. Serum concentration of TWEAK was estimated in patients with exacerbated plaque psoriasis treated with NB‐UVB. Baseline TWEAK levels were similar in patients with psoriasis and healthy controls, and Psoriasis Area and Severity Index (PASI) correlated inversely with TWEAK levels. Treatment with NB‐UVB caused a significant reduction in PASI and concurrent increase in serum TWEAK. This finding may be due to increased expression of TWEAK receptor in psoriatic skin, which has been reported previously, with consequent binding of excess soluble TWEAK during treatment and subsequent release after treatment. Severity of plaque psoriasis and its improvement after NB‐UVB treatment may be associated with TWEAK concentrations. The importance of our findings remains to be established.     

Notalgia paresthesica successfully treated with narrow‐band UVB: report of five cases

Background Notalgia paresthesica is a disorder of unknown origin characterized by pruritus localized to the patients’ back. Local pain, burning or paresthesias have also been described. No definite treatments have been found for this disorder and most of those reported to date are anecdotal. Topical capsaicin is the option most widely used among dermatologists. Transcutaneous electrical nerve stimulation, gabapentin, oxcarbazepine and botulinum toxin have recently shown promising effects. UVB has been used for decades to treat different pruritic skin diseases, but its benefits in the management of NP have not been stated to date. Objectives To test the effects of UVB in notalgia paresthesica. Methods We used a course of UVB narrow band to treat five patients with notalgia paresthesica. The treatment was administered following a phototype protocol in a UV 7002 cabinet. Results We provide the results of a course of UVB narrow‐band phototherapy in five patients. Phototherapy contributed substantially to improve pruritus in all of them. Conclusion Given the benefits achieved, we stress the interest of UVB narrow‐band as a safe and well tolerated alternative treatment for notalgia paresthetica.     

Abstract No. 3Is there a skin cancer risk with narrowband ultraviolet B phototherapy? Preliminary data from the second phase of the Dundee follow‐up study

We do not know whether narrowband ultraviolet B (NB‐UVB, TL‐01) phototherapy carries any increased risk of skin cancers. Follow‐up of 126 patients treated with NB‐UVB in Germany (Weischer M, Blum A, Eberhard F et al. No evidence for increased skin cancer risk in psoriasis patients treated with broadband or narrowband UVB phototherapy: a first retrospective study. Acta Derm Venereol (Stockh) 2004; 84 : 370–4) did not detect any increased skin cancer risk. Our follow‐up study (with linkage to Scottish Cancer Registry data complete to 1998) showed greater than expected (compared with age‐ and sex‐matched Scottish population) numbers of basal cell carcinomas (BCCs) in those treated with NB‐UVB (Man I, Crombie IK, Dawe RS et al. The photocarcinogenic risk of narrowband UVB (TL‐01) phototherapy: early follow‐up data. Br J Dermatol 2005; 152 : 755–7). Whether the modestly increased standardized incidence rate (SIR) of 213 (95% confidence interval, CI 102–391) was due to treatment or factors such as ascertainment bias was not clear. Analysis of data from the next phase of this follow‐up study, with linkage to the Scottish Cancer Registry complete to December 2002, is ongoing. The summary phototherapy records of 4050 patients treated with NB‐UVB between 1985 and 2002 were examined. The median duration of follow‐up was 5·8 years (up to 16·7) from end of first NB‐UVB course. We now have 26 633 person‐years of follow‐up data. The most frequent primary diagnoses were: psoriasis (55%), atopic dermatitis (15·4%), polymorphic light eruption (7·7%) and chronic urticaria (3·9%). Indirect standardization, adjusting for age and sex, was used to compare numbers of skin tumours identified with numbers expected in the general Scottish population. We did not find significantly more melanomas [SIR 164 (95% CI 60–357), P = 0·16] nor squamous cell carcinomas [SIR 173 (95% CI 79–329), P = 0·08] than expected. More BCCs than expected were registered in patients who had received NB‐UVB and psoralen plus ultraviolet A [SIR 184 (95% CI 128–255), P = 0·0007] and who had received only NB‐UVB [SIR 211 (95% CI 135–314), P = 0·0007, n = 3082]. So far, these findings are reassuring. A possible explanation for the excess BCCs is a causative association between NB‐UVB exposure and BCC development. Alternatively, more BCCs may have been registered in our treated patients because of careful surveillance leading to more BCCs being detected earlier and treated with modalities leading to a histopathological diagnosis (and, therefore, registration). However, only with more prolonged follow‐up of patients who have received high cumulative numbers of treatments might a definite skin cancer risk become detectable. Therefore, we should remain cautious as we cannot dismiss the possibility that NB‐UVB is carcinogenic in humans.     

A randomized, ‘head‐to‐head’ pilot study comparing the effects of etanercept monotherapy vs. etanercept and narrowband ultraviolet B (NB‐UVB) phototherapy in obese psoriasis patients

Background Etanercept is a tumour necrosis factor‐alpha antagonist used for the treatment of moderate‐to‐severe psoriasis. Current opinion suggests that etanercept may have reduced efficacy in obese patients. Narrowband ultraviolet B (NB‐UVB) phototherapy is unaffected by body weight and the addition of NB‐UVB to etanercept therapy may supplement the efficacy of etanercept in these patients. Objective To evaluate the efficacy and safety of NB‐UVB phototherapy when administered in conjunction with 50 mg of etanercept once weekly in the treatment of obese patients with moderate‐to‐severe plaque psoriasis. Methods Thirty psoriasis patients with a body mass index (BMI) greater than 30 were enrolled into this randomized, ‘head‐to‐head’ comparison study. All subjects received 50 mg of etanercept twice weekly for 12 weeks and then randomized to receive either etanercept monotherapy or combination etanercept and NB‐UVB three times weekly for an additional 12 weeks. Treatment response was evaluated using Psoriasis Area and Severity Index (PASI), body surface area (BSA) and Physician’s Global Assessment (PGA) scores. Results Twenty‐five subjects completed the study. At 12 weeks, 48% of all patients achieved PASI 75. By Week 24, 62.5% of all patients achieved PASI 75. Patients in the etanercept monotherapy and combination etanercept and NB‐UVB phototherapy arms had similar rates of achieving PASI 75 (46.7% vs. 53.3% of each group, respectively). Conclusion Combination etanercept and NB‐UVB has similar efficacy to etanercept monotherapy in obese patients. This result indicates that even in the setting of obesity, the majority of patients respond well to etanercept, with or without NB‐UVB.     

Serum YKL‐40 and IL 17 in Psoriasis: Reliability as prognostic markers for disease severity and responsiveness to treatment

YKL‐40, a mammalian chitinase 3‐ like protein that was associated with multiple inflammatory and immune diseases. Previous studies have suggested a role for YKL‐40 in psoriasis based on its significantly higher levels in the serum of psoriatic patient compared with healthy controls. The aim of this study was to determine the correlation between serum YKL‐40, psoriasis severity using PASI score and serum levels of IL‐17 before and after narrow‐band UVB therapy. 28 patients with moderate to severe plaque psoriasis, as defined by PASI scores, were enrolled in this prospective cohort study. All cases received NB‐UVB phototherapy twice weekly for 3 months. Serum YKL‐40 and IL‐17 levels were evaluated before and after 3 months of treatment. Clinical photographs were taken both at baseline and after 3 months. There was a statistical positive correlation between serum levels of YKL‐40 and serum IL‐17 levels as well as PASI score in patients with moderate to severe psoriasis before and after treatment. YKL‐40 represents a reliable marker for psoriasis severity estimated by PASI and positively correlated with IL 17 as an inflammatory marker in psoriasis.     

Narrowband ultraviolet B treatment improves vitamin D balance and alters antimicrobial peptide expression in skin lesions of psoriasis and atopic dermatitis

Background Narrowband ultraviolet B (NB‐UVB) is a routine treatment for psoriasis and atopic dermatitis (AD) but its effect on vitamin D balance is not well studied. Objectives To examine whether NB‐UVB treatment in winter improves vitamin D balance in psoriasis and AD, and to study the effects of NB‐UVB on antimicrobial peptide and cytokine expression in the skin. Methods Eighteen adult patients with psoriasis, 18 with AD and 15 healthy subjects received a total of 15 NB‐UVB exposures on the whole body, given three times a week. Serum calcidiol (25‐hydroxyvitamin D) was measured by radioimmunoassay. Antimicrobial peptide and cytokine expression in skin lesions was examined by real‐time quantitative polymerase chain reaction. Results At onset 16 (89%) patients with psoriasis, 17 (94%) patients with AD and eight (53%) healthy subjects had vitamin D insufficiency (calcidiol < 50 nmol L^?1). NB‐UVB treatment significantly increased (P < 0·001) serum calcidiol. The increase was 59·9 nmol L^?1 (95% confidence interval, CI 53·5–66·9) in psoriasis, 68·2 nmol L^?1 (95% CI 55·4–80·1) in AD and 90·7 nmol L^?1 (95% CI 63·8–123·4) in healthy subjects. Psoriasis Area and Severity Index and SCORAD improved significantly (P < 0·001) but no correlation to the increase of serum calcidiol was found. Cathelicidin and human β‐defensin 2 (HBD2) expression was high in skin lesions of psoriasis. After six NB‐UVB treatments cathelicidin increased further while HBD2 expression decreased. A similar trend was observed in AD lesions. NB‐UVB caused a marked but nonsignificant decrease of interleukin (IL)‐1β and IL‐17 in psoriasis lesions. Conclusions The present study shows that in addition to a significant improvement of psoriasis and AD, NB‐UVB treatment effectively corrects vitamin D insufficiency. It also increases cathelicidin and decreases HBD2 levels in healing skin lesions of psoriasis and AD. This effect might be mediated by improved vitamin D balance and the local cytokine network.     

Neue und etablierte Indikationen der UV‐B‐311‐nm‐Phototherapie

Phototherapy with ultraviolet (UV) irradiation of wavelengths between 280 and 320 nm (UV‐B) is a safe and effective treatment for a variety of inflammatory skin diseases. In addition to standard broad band UVB, narrow band phototherapy with fluorescent bulbs emitting near monochromatic UV between 310 – 315 nm has become an important treatment for diseases such as psoriasis, atopic dermatitis or vitiligo. Other diseases respond favorably to narrow band UV‐B phototherapy, the number of potential indications for such phototherapy is continuously growing. The differential effects of narrow band UV‐B phototherapy in comparison to other UV phototherapies, as well as new and established indications for this treatment modality are reviewed.     

Treatment of moderate and severe adult chronic atopic dermatitis with narrow‐band UVB and the combination of narrow‐band UVB/UVA phototherapy

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.     

Incidence of skin cancers in 3867 patients treated with narrow-band ultraviolet B phototherapy

Background  Narrow‐band ultraviolet B (NB‐UVB) phototherapy is a widely used treatment. Psoralen‐UVA photochemotherapy (PUVA) increases skin cancer risk and some animal studies have raised the possibility of an increased risk with NB‐UVB. The risk of skin cancer in humans following treatment with NB‐UVB is unknown. Objectives  This current analysis forms part of an ongoing study ultimately aiming to define the long‐term carcinogenic risk of NB‐UVB treatment in humans. Methods  Details of all patients receiving NB‐UVB treatment until 31/12/2002 in Tayside, Scotland, were accessed from a treatment database and linked to the Scottish Cancer Registry. Indirect standardization was used to compare skin cancer incidence in the study population with age and sex matched cancer registry data for the Tayside population. We also assessed the effect of NB‐UVB exposure treatment numbers on the risk of developing skin cancer. Results  Of 4690 records reviewed, 4665 were suitable for analysis with 3886 records linked with the cancer registry and 3867 followed‐up for at least 6 months before 31/12/02 (the date at which cancer registration was deemed to be complete). The median number of NB‐UVB treatments was 29 with 352 patients receiving ≥ 100 treatments. The study gave 24 753 person‐years of follow up. First skin cancers recorded in study patients were 27 basal cell carcinomas (BCC), seven squamous cell carcinomas (SCC) and six melanomas. No association was found between NB‐UVB exposure alone (without PUVA) and any skin cancer. For NB‐UVB and PUVA treated patients there was an association with BCC, with 27 BCCs found compared with 14·1 expected in the matched population. Conclusion  We found no significant association between NB‐UVB treatment and BCC, SCC or melanoma. There was a small increase in BCCs amongst those also treated with PUVA. These reassuring results do not demonstrate the early increase in skin cancers that was found associated with PUVA treatment. However, cautious interpretation is required as the cohort contained relatively few patients who had a high treatment number and because the slow evolution of skin cancers may result in a delayed incidence peak. Ongoing risk assessment is therefore essential.     

窄谱UVB治疗寻常性银屑病的临床研究

目的　评价窄谱UVB治疗寻常性银屑病的疗效及安全性,并与改良PUVA(PUVA+UVB)疗法比较方法　108例患者,其中50例单纯照射窄谱UVB; 58例口服8 甲氧补骨脂素片, 0. 6mg/kg/次, 2h后照射UVA和UVB;每周3次,疗程8周,观察疗效与安全性。结果　经过8周治疗,窄谱UVB组基愈率为70. 0%,显效率为20. 0%。改良PUVA组基愈率为96. 6%,显效率为3. 4%;不良反应:窄谱UVB组仅个别患者出现轻度红斑、色素沉着及皮肤瘙痒。改良PUVA组发生率为40. 3%,多为轻中度消化道反应及皮肤瘙痒、色素沉着等。照射时间窄谱UVB组最长不超过7min,改良PUVA组最长需30min以上。结论　窄谱UVB治疗寻常性斑块型银屑病具有良好疗效,与改良PUVA疗法相比,虽然疗效略逊,但方法简便,患者无需服药,照光时间短,不良反应发生率亦低。     

Narrowband ultraviolet B (311 nm, TL01) phototherapy in chronic ordinary urticaria

Background Chronic ordinary urticaria (COU) can severely reduce quality of life and be difficult to control. Ultraviolet (UV) A and UVB phototherapy has been reported to decrease the release of histamine from either mast cells and/or basophils. Previous small studies have suggested that UVB phototherapy is a good alternative treatment for COU. Objectives The purpose of this study was to assess the efficacy of narrow‐band UVB (NB‐UVB) phototherapy for COU. Materials and methods Twenty‐two patients (three male, 19 female) received NB‐UVB phototherapy. These patients had not responded to at least two H1 antihistamines, and most had been treated with a variety of antihistamine combinations. Clinical responses were assessed according to an outcome scoring scale. During both visits, patients were administered the following: the visual analogue scale (VAS) on present pruritus and/or whealing; chronic urticaria impact on patients’ quality of life according to the interference with daily activities, quality of sleep, and flare‐up rates. Results The median number of treatments was 31.4 (9–44), and the mean top dose was 9.46 J/cm² (1.1–16.4 J/cm²). NB‐UVB treatment led to clearance in 10 patients (45%), marked improvement in five (22%), and moderate improvement in seven (31%) patients according to an outcome scoring scale. Mild side effects were observed in two patients. Six patients who cleared or observed marked improvement remained clear at follow‐up for a period of six months to one year, and other patients had a few recurrent lesions that did not need retreatment. For VAS scores and total chronic urticaria impact on patients’ quality of life scores, the differences between baseline and after treatment scores were significantly lower (P < 0.001, P < 0.001, respectively). Conclusion Narrow‐band UVB (NB‐UVB) therapy is an effective, well‐tolerated treatment option in second‐line therapy for COU. This therapy can lead to subjective relief of pruritus and whealing and objective reduction of whealing. Further larger studies with longer follow‐up periods are necessary to determine the proper clinical response and long‐term complications of this therapy in COU.