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Results for “Photochemotherapy”

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PubMed1999

[Balneologic photochemotherapy of prurigo simplex subacuta].

Seventeen patients with extensive subacute prurigo, often resistant to different regimens of prior external and internal therapy, were treated with PUVA bath photochemotherapy (psoralen bath followed by UVA irradiation) using bath water containing 0.5 mg/l of 8-methoxypsoralen (8-MOP). In 15 of 17 patients treated, the skin lesions showed a significant improvement or even complete clearance within 8 weeks of therapy. In two patients, only limited clinical improvement was achieved. Follow-up after 6 weeks revealed sustained improvement in the successfully treated patients. The mean cumulative UVA dose given until clearance was 30.3 (SD +/- 12.6) J/cm2. Therefore, a mean of 24.1 (SD +/- 5.3) PUVA bath treatments was necessary. No side effects were seen except phototoxic reactions in two patients manifested as slight erythema. The results of this trial show that PUVA bath photochemotherapy with 8-MOP is an effective therapeutic alternative to other known therapies in subacute prurigo. Compared to oral PUVA therapy or other topical and systemic treatments, PUVA bath photochemotherapy with 8-MOP shows an excellent efficiency-side effect ratio. The clearance of chronic skin lesions refractive to other topical or systemic treatments by PUVA bath photochemotherapy with 8-MOP demonstrates that this therapy can be even superior to other common therapeutic modalities used for subacute prurigo.

Adult↗

PubMed2000

[Therapy of lymphomatoid papulosis with balneo-PUVA-photochemotherapy]].

Lymphomatoid papulosis is a rare lymphoproliferative disorder of the skin. The standard therapeutic regimen is systemic (oral) photochemotherapy (PUVA). We examined the efficacy of PUVA-bath photochemotherapy in a patient requiring heart transplantation because of idiopathic dilatated cardiomyopathy and a relative contraindication against systemic 8-methoxypsoralen. The 42-years old male patient had suffered for 15 years with itching papules and plaques which clinically, immunohistochemically and molecular biologically were diagnosed as lymphomatoid papulosis. PUVA-bath photochemotherapy with 8-MOP was initiated. After 29 treatments the plaques disappeared completely. After 44 sessions (cumulative UV-A dose 206 J/cm2) the patient's skin almost was clear. PUVA-bath photochemotherapy proved to be a therapeutic alternative to systemic PUVA-treatment in this case of lymphomatoid papulosis.

Adult↗

PubMed1997

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.

Chronic Disease↗

PubMed2001

Laser resurfacing-induced hypopigmentation: histologic alterations and repigmentation with topical photochemotherapy.

BACKGROUND: Hypopigmentation is a relatively common side effect of CO2 laser resurfacing. Little is known regarding the histologic features of the areas of pigmentation loss. To date, hypopigmentation is considered a permanent complication of this procedure. OBJECTIVE: To assess the histologic features of hypopigmentation caused by laser resurfacing and to evaluate the efficacy and safety of topical psoralen photochemotherapy. METHODS: Ten patients were included in this pilot study. Four had baseline biopsies performed. Histologic parameters assessed included epidermal melanin, dermal melanophages, perivascular inflammation, Mel-5 immunostaining for melanocytes, and dermal fibrosis. Seven patients were treated twice a week with topical photochemotherapy utilizing 0.001% 8-methoxypsoralen. RESULTS: All of the biopsy specimens demonstrated varying quantities of epidermal melanin and residual epidermal melanocytes. Mild perivascular inflammation was evident in two specimens. Superficial dermal fibrosis was noted in all biopsy specimens. Topical photochemotherapy induced moderate to excellent repigmentation in 71% of the treated patients. Adverse effects were minimal. CONCLUSION: The results of this investigation suggest that hypopigmentation induced by laser resurfacing may result from a suppression of melanogenesis rather than destruction of area melanocytes. The preliminary data further suggest that hypopigmentation caused by laser resurfacing can be effectively treated by topical photochemotherapy.

Acne Vulgaris↗

PubMed2006

Modulation of ultraviolet (UV) transmission by emollients: relevance to narrowband UVB phototherapy and psoralen plus UVA photochemotherapy.

BACKGROUND: Patients with psoriasis undergoing or about to undergo ultraviolet (UV) phototherapy and photochemotherapy often have thick scale on their plaques which can prevent the penetration of UV radiation. Emollients are used to moisturize the skin and to prevent or reduce some of the milder side-effects ('dryness', itching) sometimes experienced during UV therapy. However, emollients can alter the UV transmission of skin and thus may alter the clinical effects of phototherapy and photochemotherapy. OBJECTIVES: We tested 30 of the topical emollients in the British National Formulary (BNF) using a standard in vitro technique used to test sunscreens. We also surveyed U.K. phototherapy units to establish routine practice for emollient use in phototherapy and photochemotherapy. METHODS: We used a standard in vitro technique to measure the monochromatic protection factors (MPFs) of 30 non-bath emollients from the BNF. An application rate of 2 mg cm-2 was used. For the assessment of effects during narrowband UVB (TL-01) phototherapy, the mean of the protection factors at 310 and 315 nm was calculated; for psoralen plus UVA photochemotherapy the mean UVA protection factor was used. A questionnaire survey was used to assess routine practice concerning emollient use prior to phototherapies in phototherapy units throughout the U.K. RESULTS: In the UVA range, 17 of the 30 emollients gave protection factors of 1.2 or above. In the UVB range, 23 of 30 had an MPF of 1.2 or above. Yellow soft paraffin had the highest protection factor in the UVB range. Of 78 centres surveyed, 57 returned completed questionnaires (73%). Seventeen of 57 (30%) centres routinely used emollients immediately prior to administering phototherapy treatments. The remaining 40 of 57 (70%) did not. Forty-five (79%) responding centres recommended the use of emollients after phototherapy. CONCLUSIONS: This study has revealed considerable variability in the practice of emollient use before phototherapy treatments. Although the majority of centres included in this study did not routinely use emollients, almost one third did. Our in vitro measurement of 30 emollients revealed marked variation in UV transmission, with many emollients blocking sufficient UV to affect the response to therapy.

Drug Utilization↗

PubMed1990

Mechanisms of lymphocytotoxicity induced by extracorporeal photochemotherapy for cutaneous T cell lymphoma.

Extracorporeal photochemotherapy is an effective treatment for cutaneous T cell lymphoma but its mode of action is uncertain. The reduction in viability of patients' photoirradiated buffy coat lymphocytes was correlated with a 35% increase in DNA single-strand breaks and marked decreases in cellular ATP and NAD levels (to 58 and 34% of control, respectively) immediately after photoirradiation. Complementary in vitro studies were conducted with normal human peripheral blood lymphocytes using a Therakos ultraviolet A (UVA) light box. UVA light was cytotoxic on its own but was potentiated by 8-methoxysporalen. 3-aminobenzamide, a poly (ADP-ribose) synthetase inhibitor, mitigated the cytotoxic effect of ultraviolet A light in the presence of 8-methoxypsoralen in lymphocytes and reduced the amount of nucleotide depletion they caused. 10 J/cm2 of UVA light in the presence of 300 ng/ml 8-methoxypsoralen increased the poly (ADP-ribose) synthetase activity of peripheral blood lymphocytes. Exposing lymphocytes to deoxycoformycin and deoxyadenosine was found to induce biochemical and physical effects similar to those of photochemotherapy. In summary, we have shown that the lymphocytotoxic effect of extracorporeal photochemotherapy for cutaneous T cell lymphoma is apparently mediated by DNA damage, subsequent poly (ADP-ribosyl)ation and adenine nucleotide depletion. It is not known how the DNA damage and resultant biochemical effects relate to the possible immunological mechanism of extracorporeal photochemotherapy; however, it is possible that its effects can be mimicked by other DNA-damaging agents.

Adenine Nucleotides↗

PubMedDate not supplied

Extracorporeal photochemotherapy treatment for acute lung rejection episode.

BACKGROUND AND METHODS: We investigated extracorporeal photochemotherapy--which consists of the collection of blood mononuclear cells by means of a cell separator, their exposure to ultraviolet A light in the presence of a photoactivatable molecule such as 8-methoxypsoralen, and their intravenous reinjection into the patient--for the treatment of an acute lung rejection episode in a severely infected patient, assuming that its mechanism of action is an immunomodulation rather than an actual immunosuppression. RESULTS: Three weeks after the simultaneous beginning of antiinfectious and extracorporeal photochemotherapy treatments, the patient improved clinically. Acute lung rejection was no longer detectable histologically 4 weeks after the beginning of extracorporeal photochemotherapy. Twenty-two months after the beginning of extracorporeal photochemotherapy (47 months after transplantation), the patient was living a normal life. CONCLUSIONS: We believe this treatment may be considered for further studies not only in acute lung rejection therapy when intensive immunosuppression is contraindicated but also as a means of rejection prevention.

Cell Separation↗

PubMed1985

Hematoporphyrin derivative photochemotherapy of experimental bladder tumors.

Recent studies have shown that disruption of tumor blood flow is a major consequence of hematoporphyrin derivative photochemotherapy. A series of experiments was undertaken on the transplantable N-(4-(5-nitro-2-furyl)-2-thiazolyl)-formamide induced urothelial tumor in Fischer 344 rats to determine a dose response for both hematoporphyrin derivative and light. Tumor blood flow was used as the biologic criteria of response. Hematoporphyrin derivative doses of 10 micrograms./gm. body weight or above were necessary to cause a significant decrease in tumor blood flow when the tumors were illuminated with 360 joules/cm.2 of noncoherent red light (greater than 590 nm.). With a constant hematoporphyrin derivative dose of 20 micrograms./gm. body weight, significantly lower tumor blood flows were observed with fluences of 240 joules/cm.2 and above. In order to correlate dose response to tumor regression, experiments were done in which tumor dry weights were determined 3 weeks after completion of photochemotherapy (360 joules/cm.2). Hematoporphyrin derivative doses of 10 micrograms./gm. body weight or above were necessary to induce tumor regression. These studies support the hypothesis that disruption of tumor blood flow is a tumoricidal mechanism of hematoporphyrin derivative photochemotherapy.

Animals↗

PubMed1980

Photochemotherapy in mycosis fungoides. A study of 73 patients.

Seventy-three patients with mycosis fungoides were treated with photochemotherapy and followed up for 2 to 39 months. Photochemotherapy produced clinical and histological clearing in a very high proportion of patients with stage 0 to II disease. The response in patients with tumours was less satisfactory, and a high proportion of these patients required local radiotherapy to resistant lesions. Maintenance treatment with photochemotherapy may keep many patients with stage 0 to II disease in remission for up to 3 years, but patients with advanced disease may relapse despite maintenance treatment. Patients with all stages of mycosis fungoides may relapse when maintenance treatment is withdrawn.

Adolescent↗

PubMed1978

Psoriasis treated with clobetasol propionate and photochemotherapy.

Comparable lesions in 16 patients with chronic plaque psoriasis were treated with clobetasol propionate or placebo ointments for 1 week before beginning photochemotherapy. The greater improvement of the steroid treated lesions was maintained after the ointment was withdrawn and there was a mean period of 31 days before those treated with placebo showed a comparable response to photochemotherapy. By the end of the study 8 patients were completely free of psoriasis, healing being achieved after a mean of 7.2 photochemotherapy treatments on the steroid treated lesions compared with 13.5 where a placebo ointment was used. No patient had any adverse reaction to treatment.

Adult↗

PubMed1994

Control of polycythaemia vera with photochemotherapy in a patient with cutaneous T-cell lymphoma.

We report the use of photochemotherapy in a patient with polycythaemia vera (PV) and cutaneous T-cell lymphoma (CTCL). The patient was diagnosed with PV and required monthly phlebotomy. Subsequently he was diagnosed with CTCL and was started on photochemotherapy. A clinical improvement in both conditions, with haematocrit stabilizing at a level of 50%, eliminated the need for further phlebotomy. It is conceiveable that photochemotherapy induced the clinical and laboratory improvement in PV by targeting the aberrant clonal haemopoietic cell, similar to the mechanism thought to be operative in CTCL, a clonal helper T cell malignancy.

Aged↗

PubMed2000

Canine carotid allograft changes after photochemotherapy and external polyester sheathing.

BACKGROUND: The purpose of this study is to define and refine the changes in canine carotid allografts after photochemotherapy and polyester sheathing. Photochemotherapy with 8-methoxy psoralen (8MOP) and UVA (PUVA) was given alone or combined with intraluminal visible light (VL) 450 nm in proper dosages to speed the depopulation of endothelial (EC) and smooth muscle cells (SMC) and to modulate the immune response. METHODS: Novel apparati were made for photochemotherapy of 19 right canine carotid arterial allografts with 19 paired untreated controls in the left carotid. External UVA and internal visible light (VL 450 nm) were used with 8-methoxy psoralen (8-MOP) as a sensitizer. RESULTS: With moderate dosage of 8-MOP (1 microg/cc) and 2-4 J/cm2 of external UVA (PUVA), smooth muscle cells (SMC) disappeared faster from the media and fibroblasts (FB) appeared earlier in the adventitia of the treated right allografts, reducing but not eliminating the immune response. Intraluminal VL did not enhance the PUVA effect. At 68 days, treated and control allografts showed similar dimensions with subsided immune reactions. The media thickness was reduced from 0.38 mm to 0.18 mm and the host adventitia increased from 0.22 to 0.60 mm. Variable reactions peaked between two and three weeks and subsided after one month. All allografts remained open with canine carotid i.d.s of 2-3 mm and 80 to 100 cc/ minute arterial flows. Although the UVA dosage was moderate) similar doses sterilized log 7 of staph aureus cultures in saline. The allografts without smooth muscle showed moderate but stable cylindrical dilatation without spasm or stenosis and with an adequate adventitial buttress for a small vessel. A polyester sleeve around four treated grafts was inseparable from the allograft in less than 3 weeks and tolerated well over a 70-day period. CONCLUSIONS: Biodegradable graft sheaths with bioerodible hydrogels with growth factors (FGF) for local delivery may provide a faster and more complete matrix remodeling for a superior conduit in the future.

Animals↗

PubMed1991

Combined therapy for Sézary syndrome with extracorporeal photochemotherapy and low-dose interferon alfa therapy. Clinical, molecular, and immunologic observations.

Extracorporeal photochemotherapy is a well-tolerated treatment of palliative benefit for patients with the Sézary syndrome, but up to 25% of patients do not respond to this form of therapy. Interferon alfa is a glycoprotein with immunomodulatory properties that is also an active agent in the treatment of Sézary syndrome; however, dose-related toxic effects often limit its long-term use. A patient with rapidly advancing Sézary syndrome was treated with a combination of extracorporeal photochemotherapy and low doses of subcutaneous interferon alfa-2b. In addition to the almost complete clearing of his skin lesions and the marked diminution of his extensive lymphadenopathy after 16 weeks of combined therapy, disappearance of the malignant T-cell clone from the peripheral blood was documented by Southern blot analysis. Normalization of the peripheral blood lymphocyte phenotypic profile and an increase in natural killer cell activity were also observed. The excellent clinical response to combined therapy has been sustained, without adverse effects, during 18 months of treatment and 22 months of continued follow-up. The long-term disappearance of the malignant clone from the blood of a patient with Sézary syndrome in response to therapy has not been previously described and thus represents a novel observation. Extracorporeal photochemotherapy and low-dose interferon alfa are well-tolerated therapies that, when combined, may have additive efficacy in the treatment of Sézary syndrome. These results suggest that further exploration of this therapeutic combination is warranted.

Combined Modality Therapy↗

PubMed1990

[Late results of photochemotherapy of patients with psoriasis].

Results on photochemotherapy of 140 patients with psoriasis are reported. It is shown that the immediate and long-term results in patients receiving photochemotherapy in combination with theonicol were higher. In 11 patients showing stable remission, examination of the functional state of the urinary system by means of the gamma-chamber revealed no renal disorders. Photochemotherapy proved highly efficient in the treatment of psoriasis.

Adolescent↗

PubMed1979

Photochemotherapy for mycosis fungoides: a clinical and histological study.

Nine patients with stages 2 or 3 mycosis fungoides (MF) and one with Sézary's syndrome were treated with oral methoxsalen and long-wave ultraviolet light. Previous therapy had either failed or achieved only partial control. Satisfactory clinical control was achieved in all but one case. Histological improvement was seen in all cases, but complete clearance of lymphoid infiltrate was noted mainly in epidermal and papillary dermal infiltrates. Lower dermal infiltrate remained largely unchanged. The case of Sézary's syndrome was inadequately controlled with systemic prednisone and cyclophosphamide, but addition of photochemotherapy improved the erythema and pruritus. This shows that photochemotherapy may have a place in MF treatment both alone and perhaps in conjunction with other treatments. An early relapse occurred on stopping photochemotherapy in four cases, but one patient has had three months' full remission.

Adult↗

PubMed1995

Combination therapy of cutaneous T cell lymphoma with interferon alpha-2a and photochemotherapy.

The efficacy of a combination treatment with interferon alpha-2a and photochemotherapy was investigated in 16 patients with cutaneous T cell lymphoma. During the initial treatment, interferon alpha-2a was given subcutaneously at maximum dose of 9 million IU. Simultaneously, photo-chemotherapy with a maximum single dose of 3.0 J/cm2 was applied. After a complete or partial remission had been achieved, the dose of interferon was continued as permanent treatment at 3-9 million IU a week. Photochemotherapy was maintained twice a week for a minimum of 2 months and then stopped depending on the course of the disease. The combination treatment was well tolerated and all patients responded to the initial therapy. Three patients were withdrawn at an early stage of therapy, as they developed erythrodermia after photochemotherapy. The permanent treatment led to a complete remission in ten out of 13 patients and to a partial remission in three patients. During the follow-up period (now 10-40 months), therapy was stopped in four patients because of progression and in one patient because of newly diagnosed Hodgkin's disease. In another three patients, who developed local recurrences, a repetition of the initial treatment schedule was necessary to keep them in remission.

Adult↗

PubMed2005

Quantitative echographic analysis of photochemotherapy on systemic sclerosis skin.

Systemic sclerosis (SSc) is a connective tissue disease of unknown etiology, in which development of fibrosis, vascular insufficiency and inflammatory processes are prominent in the skin as well as in other organs. We studied the effect of photochemotherapy with quantitative echography in SSc. Dermal echo intensity and dermal thickness was measured using high-frequency dermal echography before and after therapy. The dermal echo intensity after photochemotherapy (33.51+/-9.34) significantly increased than that before therapy (21.23+/-6.00) (P < 0.01), while dermal thickness (1.20+/-0.20) significantly decreased than that before therapy (1.38+/-0.18) (P < 0.05). Photochemotherapy was more likely to improve dermal edema, not fibrosis, because echo intensity after treatment was significantly elevated with that before treatment in patients with edema. Quantitative echographic analysis was concluded to be a reliable method in evaluating the change of skin edema in SSc.

Adult↗

PubMed2004

[Photochemotherapy for pityriasis lichenoides: 3 cases].

BACKGROUND: Pityriasis lichenoides is a rare cutaneous disorder of unknown origin that mainly affects children and young people. The disease consists of two variants: pityriasis lichenoides et varioliformis acuta, characterized by papular lesions evolving into necrosis and pityriasis lichenoides chronica characterized by scaly papules that may last from several months to several years. Various types of therapy have been proposed for pityriasis lichenoides, to our knockledge, photochemotherapy has never been used. We report the first 3 cases of pityriasis lichenoides treated by photochemotherapy. CASE REPORTS: Three patients, 6, 15 and 18 years old, presented respectively with a 1 month, 2 years and 3 months history of numerous, papular and necrotic lesions or squally papular lesions. Clinical appearance and histopathologic examination of biopsy were consistent with pityriasis lichenoides et varioliformis acuta (patients 1 and 3) and with pityriasis lichenoides chronica (patient 2). They had received different treatments without significant effect: topical corticosteroids, antibiotic, UVB therapy and dapsone. Acitretin associated with PUVA were dramatically effective within few weeks. DISCUSSION: Pityriasis lichenoides can be a severe scarring disease with significant social, psychological and physical consequences. In our opinion, photochemotherapy, which has never been used in pityriasis lichenoides, is effective. Therapeutic modalities have to be define.

Acitretin↗