Psoralen plus UVA vs. UVB-311 nm for the treatment of lichen planus

BACKGROUND: The purpose of this study was to evaluate and compare the short- and long-term therapeutic efficacy of psoralen plus UVA (PUVA) vs. UVB-311 nm in the treatment of patients with disseminated lichen planus. METHODS: A computerized data bank search and chart review revealed that data from a total of 28 patients, including 15 patients [11 women, four men; mean age 47 years (range, 16-65 years)] treated between 1998 and 2004 with PUVA and 13 patients [10 women, three men; mean age 51 years (range, 19-69 years)] treated with UVB-311 nm, were available at our institution for retrospective analysis. RESULTS: All 15 patients (100%) treated with oral PUVA had a complete [n=10 (67%)] or partial [n=5 (33%)] clinical response, whereas 10 of 13 patients (77%) treated with UVB-311 nm showed complete [n=4 (31%)] or partial [n=6 (46%)] clinical response. Statistical analysis revealed that the initial response to PUVA was superior to that of UVB-311 nm (P=0.0426; Wilcoxon's exact test). There were no statistically significant differences between the PUVA- and UVB-311 nm-treated patient groups with regard to mean therapy duration (10.5 vs. 8.2 weeks; P=0.1107; unpaired, two-tailed Student's t test) or mean number of treatment exposures (25.9 vs. 22.5; P=0.1775). After a mean follow-up period of 20.5 months (range, 2-49 months) and 35.7 months (range, 3-60 months), respectively, disease recurrence or deterioration was observed in seven of 15 PUVA-treated patients (47%) and three of 10 UVB-311 nm-treated patients (30%). Kaplan-Meier lifetime table analysis revealed no statistically significant difference between the 2 treatment groups in terms of sustained overall (i.e., partial and complete) clinical response rate (P=0.8593; log-rank test). CONCLUSIONS: Even though oral PUVA produces a better initial clinical response rate, both oral PUVA and UVB-311 nm are effective treatments for lichen planus that produce similar long-term outcomes.     

Psoralen–ultraviolet A vs. narrow-band ultraviolet B phototherapy for the treatment of vitiligo

BACKGROUND: Although many treatment modalities have been tried for the treatment of vitiligo, none is uniformly effective. Psoralen phototherapy (psoralen ultraviolet A (PUVA)) is established as efficacious treatment for vitiligo. Recently, narrow-band UVB (NBUVB) has been reported to be an effective and safe therapeutic option in patients with vitiligo. OBJECTIVE: To compare the efficacy of PUVA and NBUVB in the treatment of vitiligo. DESIGN AND SETTING: Retrospective analysis of 69 patients with vitiligo who were treated either with PUVA or NBUVB at the pigmentary clinic of the Dermatology Department of the Postgraduate Institute of Medical Education and Research, Chandigarh, India. OUTCOME MEASURES: The following variables were compared between the two groups of patients: repigmentation status, number of treatments for marked to complete repigmentation in existing lesions, appearance of new lesions or increase in size of existing lesions, adverse effect of therapy, stability of repigmentation and colour match. RESULTS: In PUVA-treated group, 9 patients showed marked to complete repigmentation (23.6%) and 14 patients showed moderate improvement (36.8%), whereas in NBUVB-treated group, 13 patients showed marked to complete repigmentation (41.9%) and 10 patients showed moderate improvement (32.2%). A statistically significantly better stability and colour match of repigmentation with surrounding skin was seen in NBUVB-treated patients. CONCLUSION: We showed that NBUVB is more effective than PUVA and repigmentation induced with NBUVB is statistically significantly more stable.     

Narrow band UVB (311 nm), psoralen UVB (311 nm) and PUVA therapy in the treatment of early-stage mycosis fungoides: a right-left comparative study

BACKGROUND: Psoralen ultraviolet A (PUVA) is a widely used first-line therapy for treatment of early cutaneous T-cell lymphoma. Narrow band UVB (UVB-NB) (311 nm) has been recently introduced as another effective line of treatment. It is postulated that the efficacy of UVB-NB could be enhanced by addition of psoralen. AIM: The aim of the present work was to compare the clinical and histopathologic efficacy of PUVA and UVB-NB in the treatment of early-stage MF (stages IA, IB and IIA), and to evaluate whether psoralen adds to the efficacy of UVB-NB or not. Patients and Methods: Twenty patients (stage IA, IB or IIA) were divided into two equal groups: group I received UVB-NB on the right body half vs. PUVA on the left side of the body for 48 sessions, and group II received PUVB-NB on the right side of the body vs. PUVA on the left side for 36 sessions. The sessions were administered three times weekly. RESULTS: In group I, almost equal results were obtained on both sides, i.e., UVB-NB and PUVA were equally effective in the treatment of early stages of MF, both clinically and histopathologically. In group II, PUVB-NB was found to be as effective as conventional PUVA in the treatment of early-stage mycosis fungoides, also on both clinical and histopathological grounds. CONCLUSION: UVB-NB phototherapy should be included among the initial therapeutic options of mycosis fungoides in view of its efficacy, convenience, and likelihood of fewer long-term adverse effects. Addition of psoralen does not seem to enhance its therapeutic efficacy.     

Clinical evaluation of interrupted versus continuous narrowband ultraviolet B phototherapy in nonsegmental vitiligo treatment: A prospective randomized comparative study

Phototherapy is the pillar of vitiligo treatment. One of its main obstacles is noncompliance. It was noticed that patients continue to repigment even after stopping sessions, so the idea of interrupted phototherapy emerged. To evaluate the effectiveness of interrupted versus continuous NB‐UVB in nonsegmental vitiligo treatment. A prospective randomized comparative study of 23 patients with bilateral, nonsegmental vitiligo with no age or sex limits. All patients were treated with NB‐UVB phototherapy for 1 month, after which one side of the body received continuous therapy (Side A) and the other received an interrupted course (Side B) for a total of 6 months. Two more groups of 10 patients were enrolled to exclude the systemic effect of NB‐UVB. One group received continuous NB‐UVB treatment, and the other received interrupted courses for 6 months. Evaluation of the results was performed clinically, by digital photography, planimetry and Vitiligo Area Scoring Index (VASI) prior to and 3 and 6 months after treatment. There was a significant clinical improvement in Group 1 compared to baseline (p < .05). However, there was no significant difference between the sides with regards to the clinical evaluation, point counting, and VASI scores (p > .05). When comparing the other two groups, there was a significant clinical improvement in each group after 6 months of treatment compared to baseline (p < .05), while there was no significant difference between them (p > .05). The current study suggests that interrupted NB‐UVB phototherapy is a good alternative to continuous treatment with improved patient compliance, fewer side effects, and a lower cost of treatment.     

Excimer laser treatment of vitiligo – critical retrospective assessment of own results and literature overview

Background: In numerous studies the 308‐nm excimer laser has been described as an effective therapy method for localized vitiligo. Our experience and critical evaluation of the relevant literature lead to a less enthusiastic endorsement. Patients and methods: A total of 9 patients with localized vitiligo were evaluated in our retrospective study. The sessions took place 2–3 times per week; the energy dose was increased depending on the occurring side effects. The rate of repigmentation was evaluated in 5 grades: grade 0 = 0 %, grade 1 = 1–25 %, grade 2 = 26–50 %, grade 3 = 51–75 %,grade 4 = 76–100 %. Subjective patient satisfaction was rated “satisfied”/“not satisfied”. Results: In face and neck areas we used a cumulative energy dose of 16.6 J/cm² and achieved repigmentation grade 4 in 33.3 %, grade 2 in 33.3 %, grade 1 in 11.1 % and no improvement in 22.2 % of the cases. On hands and knees we used a medium cumulative energy dose of 20.8 J/cm² and did not observe any tendency towards repigmentation. Four of the patients were satisfied, while 5 were not. Side effects (erythema, blisters, crusting and perilesional hyperpig‐mentation) were transient in all cases. Within a medium observation period of 19.1 months, one patient had a relapse. Conclusions: The excimer laser should be regarded as a treatment alternative in cases of localized vitiligo of the face. The treatment at other sites is clearly limited because of only partial repigmentation, considerable expense of time and money as well as the potentially higher risk of tumorigenesis.     

308nm准分子激光治疗白癜风概述

白癜风治疗方法较多,308 nm准分子激光凭借起效快、疗效高及副作用小等优势而迅速应用于临床。其治疗白癜风的作用机制不清,可能通过诱导皮损处浸润的淋巴细胞凋亡而取得疗效。联合外用他克莫司软膏或吡美莫司乳膏治疗白癜风效果比单独应用308 nm准分子激光更为显著。     

Topical calcipotriene and narrowband ultraviolet B in the treatment of vitiligo

BACKGROUND: Treatment of vitiligo, despite significant advances made in the past few years, remains to be a challenge. Narrowband ultraviolet (NB-UVB) has emerged as an important therapeutic option for this condition. OBJECTIVE: To evaluate whether the combination of calcipotriene ointment and NB-UVB could enhance the efficacy of NB-UVB alone. METHODS: An open, bilateral comparison study was performed in 20 patients with symmetrical vitiligo between August 2001 and October 2002. All patients received NB-UVB three times per week. Calcipotriene ointment was applied to lesions on the left side of the body. Response was graded visually as significant (66-100% repigmentation), moderate (26-65%), mild (10-25%), and minimal (< 10%). RESULTS: Seventeen patients (six females, 11 males) completed the study. Eight patients (8/17=47%) had significant repigmentation after 67-180 treatments, six patients (35%), one patient (6%), and two patients (12%) had moderate, mild, and minimal repigmentation after 40-160, 57, and 14-21 treatments, respectively. Nine of the 17 patients had an appreciably better improvement on the NB-UVB and calcipotriene side by 29-114 treatments. In six of these patients, differences were still observed at the end of the study period. No side effects were noted. CONCLUSION: Combination therapy of topical calcipotriene and NB-UVB is a therapeutic option that could be considered in the management of patients with vitiligo.     

308nm准分子光治疗白癜风疗效评价

目的：评价308nm准分子紫外光治疗白癜风的临床疗效。方法：31例进展期和34例稳定期白癜风患者皮损行308nm准分子紫外光治疗,共照射30次。结果：进展期和稳定期白癜风患者总有效率分别为62．14％、73．52％,无显著性差异（P〉0．05）。头面部及躯干部效果较好,肢端效果最差。结论：308nm准分子紫外光治疗白癜风安全有效,其疗效与皮损部位相关,与进展期或稳定期无关。     

Monochromatic excimer light 308 nm in the treatment of vitiligo: a pilot study

OBJECTIVE: To study the efficacy and safety of monochromatic excimer light (MEL) on 37 vitiligo patients referred to our clinic. METHODS: In a pilot study, 37 patients (17 males, 20 females) with acrofacial (n=21), focal (n=11), segmental (n=1), and generalized (n=4) vitiligo were treated twice weekly with MEL for a maximum period of 6 months. RESULTS: Thirty-five patients (95%) showed signs of repigmentation within the first eight treatments. The treatment resulted in good repigmentation in 16 patients, and excellent repigmentation in 18 patients. Adverse events were limited to transient erythema. In addition, some patients (n=3) not responding to prior narrow-band UVB (NB UVB) phototherapy showed good results with MEL in our series. CONCLUSIONS: Treatment with 308 nm MEL for vitiligo may be more effective in obtaining rapid repigmentation than phototherapy with NB UVB. The results in this study are similar to those recently reported with a 308 nm excimer laser, but 308 MEL could present some advantages: the possibility of treating larger areas compared to the 308 nm excimer laser, with shorter treatment times and better patient compliance. The overall good results and the early appearance of repigmentation contribute to reducing the cumulative exposure to UV radiation.     

窄谱中波紫外线治疗142例白癜风临床疗效观察

目的:观察窄谱中波紫外线(NB-UVB)治疗白癜风的临床疗效和安全性。方法:应用NB-UVB治疗仪对142例患者白癜风皮损进行照射,每周治疗3次,连续治疗30次。于治疗结束后3个月和6个月进行随访,评价疗效和安全性。结果:142例患者中痊愈26例(18.31%),显效78例(54.93%),有效30例(21.13%),无效8例(5.63%),有效率为73.24%。结论:NB-UVB治疗白癜风安全、有效,且操作简便。     

T helper 17 and Tregs: a novel proposed mechanism for NB‐UVB in vitiligo

Narrowband ultraviolet (NB‐UV)B is accepted as corner stone therapy for vitiligo. Its influence on the expression of IL‐17, IL‐ 22 and FoxP3 as markers for the Th17 and Tregs lineages has not been studied before in the context of non‐segmental vitiligo (NSV). The study included 20 active NSV patients who received 36 NB‐UVB sessions and 20 controls. Clinical evaluation Vitiligo Area Scoring Index (VASI) and determination of tissue expression of IL‐17, IL‐22 and FoxP3 by qRT‐PCR (lesional, perilesional) were carried out before and after therapy. Baseline levels of IL‐17 and IL‐22 were significantly higher in patients, whereas FoxP3 was significantly lower. After therapy, IL‐17 and IL‐22 significantly dropped, whereas FoxP3 significantly increased (lesional, perilesional). Baseline and post‐treatment VASI showed significant positive correlations with IL‐17 and IL‐22 and significant negative correlation with FoxP3 expression. Restoration of the balance between Th17 and Tregs might represent a novel pathway for the improvement that NB‐UVB exerts in vitiligo patients.     

他克莫司软膏联合308 nm准分子激光治疗白癜风临床疗效观察

目的：评价0．1％和0．03％他克莫司软膏联合308nm准分子激光治疗对紫外线治疗抵抗的白癜风皮损的疗效与安全性。方法：采用随机、自身对照的临床试验，每例患者选取紫外线治疗抵抗区域的皮损，随机选取躯体一侧皮损为治疗侧，采用他克莫司软膏联合308nm准分子激光治疗；另一侧为对照侧，仅用308nm准分子激光治疗。2个月后进行疗效判定。结果：联合治疗组有效率为89．0％，对照组为71．6％，两组间疗效比较差异有统计学意义（P〈0．05）。结论：他克莫司软膏联合308nm准分子激光治疗白癜风起效快，疗效好。     

中波高能紫外线治疗儿童白癜风疗效评价

目的:评价中波高能紫外线治疗儿童白癜风的临床疗效及安全性。方法:采用美国Dua LightTM型高能紫外线治疗仪UV120-2型治疗40例儿童白癜风患者50处皮损,以l~2倍MED值作为治疗起始量,根据治疗后皮损的反应,每次照射剂量不变或增加15%,每周治疗1~2次,6个月后评价疗效。结果:皮损的总有效率为62%,痊愈率为26%。头面部、躯干部、四肢及肢端有效率分别为81.8%,83.3%,37.5%及0。无严重不良反应。结论:中波高能紫外线治疗儿童白癜风安全有效,病变部位与疗效相关。     

Patterns of repigmentation in two cases of hypopigmented type of vitiligo

It has been observed that depigmentation in vitiligo passes through two stages; patches of light brown hypopigmentation which gradually changes into milky white patches. In this work, we studied two cases of hypopigmented vitiligo regarding the melanocytes and keratinocytes' changes before and after 7 months of psoralen plus ultraviolet A (PUVA) therapy. Skin biopsies were taken from the vitiliginous lesions before and after 7 months of PUVA therapy and were examined using haematoxylin and eosin and Masson Fontana stains, l -3,4-dihydroxyphenylalanine reaction, immuno-histochemical stains and ultrastructural examination. In the pretreated patients, the melanocytes present were inactive and degenerative changes were detected in both melanocytes and keratinocytes. After PUVA therapy, obvious histopathological improvement was detected. Clinically, the initial response to PUVA therapy was increased hypopigmentation indicating that degenerated cells in the vitiliginous patches might have continued the process of degeneration and did not recover. Meanwhile, the perifollicular and marginal pigmentation suggested that pigmentation occurred from those areas and not from activation of already degenerated melanocytes.