[The current status of therapy for psoriasis].
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A study was made of the influence of UV-irradiation (254 nm) of blood in vitro, of the autotransfusion of UV-irradiated blood (AUVIB), and of the mixture of UV-irradiated and intact blood in vitro on the content of bactericidal cation proteins (CP) in blood neutrophil of calves suffered from dyspepsia and broncho-pneumonia. Age differences were noticed in CP contents and their decrease in neutrophils following AUVIB in vivo and administration of the mixture of blood in vitro. The decrease in cell CP contents is presumably due to neutrophil degranulation and CP release into the blood plasma. Since the initial mechanisms of neutrophil degranulation are located on the cell surface, the CP release is supposed to result from a membranotropic effect of UV-irradiated blood on the intact autologous blood. This effect may explain the increase in nonspecific resistance of organism after the AUVIB, being one of the main therapeutic phenomena of the AUVIB-therapy.
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A descriptive dose-response model is presented to evaluate the long-term risk with respect to non-melanoma skin cancer associated with UVB therapy. The model is based on the results of animal dose-response studies and epidemiological data. A number of factors that influence the risk associated with therapy are evaluated: annual dose applied, solar exposure, therapeutic period, age at start of therapy. Shielding from therapeutic exposures of the skin areas that normally receive the most sun exposure could effectively reduce the risk. The model calculations were compared with observational data, as far as available. The calculated risk corresponded within the limits of statistical error with observed long-term risk of UVB therapy in Sweden; as far as there was a deviation, the model calculations tended to over-estimate the risk. A comparison of the model prognoses for UVB therapy with the observed risk among PUVA-treated patients in the USA shows a much higher observed risk for squamous cell carcinoma among the PUVA-treated patients.
Intensive treatment of cutaneous T-cell lymphoma with modalities directed only at skin manifestations appears to cure up to 40 per cent of patients with early, limited skin involvement. For patients with widely disseminated skin lesions, the dermatologist often must choose a treatment regimen with both cutaneous and systemic effects in order to provide effective long-term control. Although vigorous combined-modality therapy results in improved disease-free survival intervals, it also has significant associated morbidity. When compared with less intensive treatment regimens, it is not clear at this time whether such combined-modality therapy improves either the cure rate or overall survival intervals of patients with early disease. For this reason, the authors recommend a conservative treatment program initially for most patients unless there is clinical evidence that the patient has biologically aggressive disease.
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Five patients with a histopathologically confirmed diagnosis of pityriasis lichenoides were treated with PUVA or irradiated with a light source emitting UVB and UVA, without prior intake of psoralens. All patients showed a good response to treatment. Long-term follow up showed that patients remained free of lesions during a period of 20 to 36 months; 3 patients had a recurrence of the disease, though less extensive than before, after 25, 23, and 23 months, respectively.
The increase in fluorescent chromophores within the human ocular lens is age related, leading to an increasingly yellow core (nucleus) that presumably results from UV radiation exposure. In approximately 10% of our population this process progresses more rapidly, resulting in the formation of the brown (nuclear) cataract. Some lenticular discoloration may be beneficial, since it enables the mature lens to filter UV and short-wavelength visible radiation, thus protecting the retina from potential photodamage. Aphakic primate retinas can be irreversibly damaged by exposure to approximately 5 mW.cm-2 long-wavelength UV (greater than 325 nm) radiation. Photosensitized damage to the lens and retina with psoralen plus UV radiation (320-400 nm) (PUVA) has been demonstrated in experimental animals, and cataracts have recently been reported in patients given PUVA therapy. A new method to screen patients for lens damage is by enhanced fluorescence measurements. This method, UV slit-lamp densitography, permits detection of lenticular photodamage at a molecular level, years before visible opacities become manifest by conventional slit-lamp examination. This procedure has also demonstrated a significantly lower level of lens fluorescence (hence decreased filtering capacity) in patients with retinal degenerative diseases, suggesting UV photodamage as a factor in the progression and perhaps pathogenesis of these conditions.