A comparative study of different treatment frequencies of psoralen and ultraviolet A in psoriatic patients with darker skin types (randomized-controlled study)

BACKGROUND: Photochemotherapy psoralen and ultraviolet A (PUVA) is a viable option for treatment of psoriasis. However, concerns about its side effects have raised the need to change current PUVA protocols. The aim of this study is to determine whether reducing the treatment frequency of PUVA to twice/week instead of three times/week would affect the efficacy of PUVA therapy. PATIENTS AND METHODS: The study included 20 psoriatic patients, randomized into two groups, 10 patients in each group. The first group received two weekly sessions, the second group received three. The study lasted until complete clearance or for 12 weeks (endpoint). Psoriasis area and severity index (PASI) score was done prior to therapy, at mid therapy and at end of therapy (PASI final). RESULTS: No significant different in PASI final and in the percentage of reduction of PASI score between both groups (P value >0.05) was found. However, a significant difference in the total number of sessions and the total cumulative UVA doses between both groups was found (P value <0.001). CONCLUSION: Our study suggests reducing PUVA frequency and the cumulative UVA dose does not compromise the efficacy of PUVA, but it may improve its benefit/risk ratio. RESTRICTIONS: Few number of cases.     

Efficacy and safety of hemoporfin in photodynamic therapy for port-wine stain: a multicenter and open-labeled phase IIa study

Background/purpose: This phase IIa study aimed to study the efficacy and safety of hemoporfin in photodynamic therapy (PDT) with a 532 nm continuous laser for port‐wine stain (PWS). Methods: In this 8‐week open‐labeled study in three centers, three different laser exposure times (532 nm continuous laser for 20, 30 and 40 min) were used in stage I, group A, stage II, group B and stage III, group C, respectively. Primary efficacy assessment was performed by an independent group of experts, who reviewed the standardized photos. Secondary efficacy assessment consisted of the subjective grading of the PWS fading by the investigators and the patients. Treatment reactions and adverse events (AE) were recorded separately. Results: Forty patients were initially enrolled in the study, but stage III had to be cancelled eventually for the safety of the patients. Patients in groups A and B showed similar satisfactory results in efficacy assessments, the total ‘response’ rate being 80.0% and 94.7% in groups A and B, respectively. The AE rates were also similar in the two groups. Self‐limiting photosensitive dermatitis and hyperpigmentation were the most frequently observed AE. Conclusion: Hemoporfin‐PDT is effective and safe for patients with PWS aged 16–50.     

体外光化学疗法防治移植物抗宿主病机制研究进展

体外光化学疗法(extracorporeal photochemotherapy),又称体外光分离置换疗法(extracorporeal photopheresis,ECP),现已成为一种防治移植物抗宿主病(GVHD)的手段。一般认为,ECP防治GVHD的机制为诱导免疫耐受;进一步的研究发现,其作用于GVHD发生的多个阶段,主要机制包括以下几方面:①作用于T淋巴细胞,包括诱导T淋巴细胞凋亡,抑制效应性T细胞分化增殖,促进调节性T细胞增殖,调整辅助T细胞数目及比例;②作用于抗原呈递细胞,诱导其凋亡,抑制其分化成熟,并影响其加工递呈抗原的能力;③调节细胞因子分泌,抑制炎症反应。本文将从上述几个方面对ECP防治GVHD的机制进行综述。     

新光敏剂PSD—007的光毒反应

本文报道新光敏剂PSD-007及美国和国产(北京制药工业研究所的血卟啉衍生物(HPD)在2·5mg/kg及其以上剂量静脉注射可致小鼠的光毒反应。光毒反应的强度随剂量增加而加重。在等重剂量条件下。PSD-007所致光毒反应较美国和国产HPD为轻;轻度光毒反应的恢复也以PSD-007为快。     

Separation and identification of the major components of Photocarcinorin and their tumor-photobiological activities

It has been shown by the results-of HPLC analysis in combination with spectrographicdeterminations that PsD-007 is composed of 7 different porphyrins,In order of the proportion inPsD-007,they are:3 (or 8)-(l-methoxyethyl)-8 (or 3)-(l-hydroxyethyl)-deuteroporphyrin Ⅸ(MHD);3,8-di-(l-methoxyethyl)-deuteroporphyrin Ⅸ(DMD);3(or 8)-(l-methoxyethyl)-8 (or3)-vinyl-deuteroporphyrin Ⅸ(MVD);3(or 8)-(l-hydroxyethyl)-8(or 3)-vinyl-deuteroporphyrin Ⅸ(HVD);hernatoporphyrin Ⅸ (Hp);protoporphyrin Ⅸ (Pp) and 3(or 8)-(O-aceylethyl)-8(or 3)-(l-hydroxyethyl)-deuteroporphrin Ⅸ (AHD),which presented only in crude PsD-007 and hasbeen transformed into MHD and Hp,respectively during the separation and preparing the clinicalpreparation of PsD-007.Structures of these porphyrins were further eonfirmed by the corre-sponding anthentic samples obtained by synthetic method.It was found on the basis of the experi-mental data of photosensitizing ability in cell-free systems and photoinactivation of human cancercells in vitro as well as efficacy of photodynamic therapy for sarcoma.S_(180) in mice of the ma-jor components MILD,DMD and MVD composed of which more over 85% of the totalamount of PsD-007,that they all exhibited comparatively high photosensitizing ability andphotodynamic effects on cancer cells and tram-planted animal tumor.     

再探高温效应在光敏疗法中的协同作用

本文对血卟啉光敏疗法中高温效应的协同作用作了进一步的研究,实验结果表明,光敏效应与温度效应两者的协同作用要明显大于光敏效应和温度效应单独作用之和。单独高温作用(42℃、30min)杀伤细胞数为7％,单独光敏效应(1J/cm~2)杀伤细胞数为30％(±5％),如果先加温后照光,杀伤细胞数可达80％(±5％),如果上述条件不变,先照光再加温处理,杀伤细胞数可达92％,由此可见,在肿瘤的光敏治疗中,高温的协同作用可增强对癌细胞的杀伤作用。     

Treatment of necrobiosis lipoidica with topical psoralen plus ultraviolet A

BACKGROUND: Necrobiosis lipoidica (NL) is a rare skin disease, mostly seen on the legs and often occurring in patients with diabetes mellitus. The disease belongs to the idiopathic cutaneous palisading granulomatous dermatitides associated with a degeneration of collagen, thus leading to skin atrophy. Application of topical corticosteroids is the most widely used treatment but the results are not always satisfactory and may worsen skin atrophy. Preliminary studies in patients with NL have shown a clinical response with psoralen plus ultraviolet (UV) A (PUVA). Objectives To study the effect of topical PUVA on NL in a multicentre prospective study. METHODS: Thirty patients (27 women and three men) including 13 with insulin-dependent diabetes mellitus, with a diagnosis of NL proven by histopathology, were included. All patients had been unsuccessfully treated with topical and/or intralesional corticosteroids. Patients were treated twice weekly with an aqueous gel containing 0.005% psoralen followed by irradiation with UVA. Clinical photographs were taken for evaluation. In addition, 20-MHz high-frequency ultrasound analysis was performed in 10 patients to evaluate the thickness and density of the dermis during topical PUVA therapy. RESULTS: Five patients (17%) showed complete clearing (healing of ulceration and disappearance of erythema) after a mean of 22 exposures (range 15-30). Eleven patients (37%) showed improvement, defined as healing of ulceration and/or reduction of erythema, after a mean of 23 exposures (range 11-42). Ten patients (33%) showed no effect and four patients (13%) worsened during topical PUVA therapy. The treatment results of the patients who suffered from diabetes mellitus were not different from those who did not have diabetes mellitus. No difference was seen in mean dermal thickness (1666 vs. 1706 micro m) and density (17 vs. 16 units) before and after topical PUVA therapy. Side-effects were seen in 10 patients: hyperpigmentation (n = 4), blistering (n = 4) and bacterial infection (n = 2). CONCLUSIONS: Topical PUVA may be a useful treatment modality for NL in patients not responding to topical or intralesional corticosteroids.     

Photopheresis affects the course of experimental allergic encephalomyelitis in Lewis rat

BACKGROUND/PURPOSE: The mechanism responsible for the beneficial effects of extracorporeal photochemotherapy (ECP) remains unknown. In the rat model of experimental allergic encephalomyelitis (EAE), the transfer of encephalitogenic cells (EAE cells) induces transient passive EAE, followed by resistance to subsequent disease induction through immunization with central nervous system antigens (active EAE). METHODS: We tested whether ECP exerts its therapeutic effect by inducing an immune response targeted on circulating pathogenic T-lymphocytes, which results from their increased immunogenicity. We compared the potential of untreated versus ECP-treated encephalitogenic cells to transfer passive EAE and protect against active induction of the disease. The UVA irradiation conditions were derived from intensive ECP protocols used in human clinical studies. RESULTS: Animals receiving untreated cells showed clinical symptoms following cell transfer but not after subsequent immunisation, whereas those receiving ECP-treated cells remained healthy following cell transfer but experienced clinical symptoms after subsequent immunisation. However, these symptoms were less marked than in control naive rats. CONCLUSION: Under these ECP protocol conditions, ECP-treated cells have no greater active stimulatory potential for the recipient immune system than untreated cells, since they are less effective at triggering the response that causes the resistant state to active EAE. We suggest that intensive ECP protocol may have deleterious effects with a risk of relapses after treatment discontinuation. The search for the irradiation threshold that would inhibit the T-cell pathogenic properties, but retain their ability to educate the immune system, remains a major research challenge.