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PubMed1984

Different biologic effectiveness of blacklight fluorescent lamps available for therapy with psoralens plus ultraviolet A.

In 1976 we reported a change in spectral distribution of "blacklight" fluorescent lamps. It was not possible to determine the spectral composition of these lamps by any codes or packaging materials. Phototherapy booths utilizing standard BL-HO lamps will accept lamps of at least two spectral distributions; both types are commercially available. This study was conducted to determine the biologic efficacy of these two lamp types that we refer to as BL-O and BL-N. The BL-O spectrum had a peak emission at approximately 350 nm with 98% of the energy between 320 and 400 nm. The BL-N spectrum had its peak emission at 365 nm with a range from 340 to 400 nm. The BL-O spectrum was at least 2.5 to 4 times as effective as BL-N in causing minimally perceptible phototoxicity in albino hairless mice given oral doses of 8 mg/kg of 8-methoxypsoralen. Food and Drug Administration (FDA)-approved specifications imply that the BL-O spectrum is to be used for psoralens and ultraviolet A (PUVA) phototherapy. If lamps with the BL-N spectrum are replaced by lamps with the BL-O spectrum, the metered dose must be reduced to no more than one-fourth of the previous dose or the patient may suffer serious phototoxic reactions.

Animals↗
PubMed1996

Ultraviolet-A1 (340-400 nm) irradiation therapy in systemic lupus erythematosus.

Ultraviolet-A1 (UV-A1) wavelengths have been found effective in mitigating signs and symptoms of disease activity in systemic lupus erythematosus (SLE) but studies have been uncontrolled. To rigorously assess the effectiveness and safety of daily low-dose UV-A1 irradiation as a therapeutic agent in this disorder we enrolled 26 women with SLE in an 18-week two-phase study. During the initial six-week prospective, double-blind, placebo-controlled phase, the patients were divided into two groups; Group A was exposed to 60kJ/m2 of UV-A1 (340-400 nm) irradiation within a sunbed five days a week for three weeks and Group B was exposed for an equal amount of time to visible light of greater than > 430 nm (placebo). Each group was then crossed over for exposure to the other source for three weeks. During the second phase-2 weeks-patients and physicians were unblinded and patients were irradiated with progressively decreasing levels of UV-A1 only. Twenty-five patients completed the six-week placebo-controlled phase of the study and eighteen patients participated for the entire 18 weeks. In Group A the systemic lupus activity measure (SLAM) score improved significantly after three weeks of five-day-a-week UV-A1 irradiation (P < 0.05), regressing to baseline during the three weeks of placebo irradiation. Improvement recurred and progressed with six weeks of three-day-a-week UV-A1 irradiation (P < 0.05). Group B patients responded negligibly to the three weeks of visible light, more sharply to UV-A1, and as with Group A, maximally to the six weeks of three-day-a-week UV-A1 (P < 0.01). With twice- and then once-weekly UV-A1 irradiation the SLAM scores worsened slightly. All patients decreased their drug use. Anti-double-stranded DNA antibodies (anti-dsDNA) decreased significantly (P < 0.05) and anti-nuclear antibodies non-significantly. Side effects were negligible. Visible light had no significant effect. In conclusion, low-dose UV-A1 irradiation effectively, comfortably, and without apparent toxicity diminished signs and symptoms of disease activity in SLE.

Adult↗
PubMed2005

Therapeutic options in the treatment of psoriasis and atopic dermatitis.

A variety of therapeutic options are available to treat psoriasis and atopic dermatitis (AD). Local agents typically are used to treat localized and milder forms of disease, whereas phototherapy and systemic agents are used for more generalized and severe disease. Various combinations and sequences of topical or systemic therapies, or both, have been utilized in the treatment of psoriasis and, less frequently, of AD. Conventional systemic therapies for psoriasis, such as corticosteroids, oral calcineurin inhibitors, antimetabolites, and retinoids, are limited by their propensity to cause serious side effects. More recently, a number of immunobiologic agents, such as monoclonal antibodies, recombinant cytokines, and fusion proteins, have been approved by the Food and Drug Administration or are undergoing development as systemic antipsoriatic treatments. In many of these categories, a number of exciting new therapies are in development that may augment the existing armamentarium available to clinicians for the treatment of inflammatory skin diseases.

Administration, Oral↗
PubMed1999

A randomized comparison of narrow-band TL-01 phototherapy and PUVA photochemotherapy for psoriasis.

BACKGROUND: Although PUVA treatment of psoriasis is more effective than conventional or broad-band UVB phototherapy, two small studies have suggested that narrow-band or TL-01 phototherapy may have a therapeutic effect equal to PUVA. If confirmed, this would be of considerable importance as TL-01 therapy is likely to be considerably safer in the long term than PUVA. OBJECTIVE: The purpose of this study was to compare PUVA with narrow-band (TL-01) phototherapy in psoriasis. METHODS: We studied 100 patients with plaque-type psoriasis who were randomly allocated to twice-weekly treatment with PUVA or narrow-band UVB. RESULTS: Clearance of psoriasis was achieved in a significantly greater proportion of patients treated with PUVA (84%) than with TL-01 (63%) (P =.018), and with significantly fewer treatments (median number of treatments for clearance with PUVA, 16.7; with TL-01, 25.3; P =.001). Only 12% of those treated with TL-01 were clear of psoriasis 6 months after finishing treatment compared with 35% for PUVA (P =.002). CONCLUSION: When given twice weekly, PUVA is more effective for psoriasis than narrow-band UVB phototherapy.

Adult↗
PubMed1999

Acitretin combination therapy.

Systemic therapies used in psoriasis such as methotrexate, PUVA, cyclosporine, and acitretin often have side effects that limit their usefulness. Combination therapy, an effective strategy for treating psoriasis, allows use of lower doses of medications to achieve superior therapeutic results with fewer side effects. Acitretin is one of the most popular drugs used in combination with other systemic therapies for psoriasis. Details of the regimens used and results obtained from combining acitretin with PUVA, cyclosporine, and methotrexate are discussed.

Acitretin↗
PubMed1994

Multiple lentigines confined to psoriatic plaques.

The development of naevus spilus-like hyperpigmentation at sites of resolving plaques of psoriasis has been reported previously. Although the mechanism is not understood, PUVA therapy has been implicated in most cases. We report an additional case in which lentigines, confined to sites of resolving psoriasis, occurred following oral PUVA. We also describe similar clinical features in two patients who had not received PUVA, which strengthens the observation that this treatment is not a prerequisite for development of this unusual pattern of pigmentation.

Adult↗
PubMed1992

A reappraisal of the use of 5-methoxypsoralen in the therapy of psoriasis.

5-methoxypsoralen (5-MOP) is considered an alternative to 8-methoxypsoralen (8-MOP) for photochemotherapy of psoriasis. We have compared the clinical efficacy and tolerability of 5-MOP (1.2 mg/kg)-UVA versus 8-MOP (0.6 mg/kg)-UVA therapy in 25 patients of skin type III and IV, affected by relapsing plaque-type psoriasis of similar body involvement; indeed, the same patients were given 8-MOP during 1 year and 5-MOP during the subsequent year after relapsing. Both treatments cleared psoriatic lesions with a comparable number of exposures, but 5-MOP required significantly higher cumulative UVA doses. The difference was due to the lower phototoxicity of 5-MOP, as assessed by the determination of the minimal phototoxic dose, and to its higher tanning activity, as assessed by the weekly grading of pigmentation. Nevertheless, therapy by 5-MOP-UVA seemed particularly interesting in that it showed a higher tolerability since only 1 patient experienced nausea, whereas during therapy with 8-MOP-UVA nausea and/or vomiting occurred in 7 patients, sunburn in 6 and itching in 3. Since we have treated the same patients with the two drugs, our results were not influenced by interindividual variations of phototoxic responses, tanning ability and susceptibility to develop psoralen-induced short-term side-effects. It was concluded that, although long-term side-effects of the 5-MOP-UVA treatment have still to be determined, such treatment of psoriasis should be reappraised due to its higher tolerability in comparison to 8-MOP-UVA treatment.

5-Methoxypsoralen↗