[Personal experience with photochemotherapy and phototherapy of dermatoses].
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Special fluorescent lamps as well as filtered high pressure lamps are used for photo- and photochemotherapy of psoriasis. The spectra of the lamps offered for phototherapy are compared with the antipsoriatic range of action (lambda ca.295-315 nm) and judged by their therapeutic effect. The spectra offered for photochemotherapy should be free of UVB-radiation. Visible and infrared rays are not effective with psoriasis. The production of heat may stress the patient and require heat removal. On the skin surface the distribution of irradiation should be as even as possible. PUVA treatments of longer duration are preferably performed in a lying position. Closed irradiation units may produce claustrophobia . Open irradiation units require remote control. The most decisive economic factors are the duration of a single exposure as well as space requirements.
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Absolute and relative indications for phototherapy have to be distinguished. Absolute indications, where no better treatment is available, are psoriasis, mycosis fungoides and - according to newer observations - atopic dermatitis. Relative indications, where phototherapy is an additional therapeutical possibility, are acne, certain types of dermatitis and of urticaria. Acute and chronical side effects are discussed and an outlook on the possibilities of phototherapy is given.
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About two per cent of the Scandinavian population have manifest psoriasis, which may vary in distribution and duration. With a chronic progressive disease such as psoriasis, it is especially important to weigh the effect of treatment against its tolerance by the patient and the risk of side effects. Recent advances in pharmacology have markedly increased the range of treatment available in severe cases of psoriasis, and the recent introduction of local treatment with vitamin D has resulted in a broader range of treatment for patients with mild or moderate psoriasis. However, no curative treatment is yet within sight.
Some of the more common features of psoriasis are reviewed here as an introduction to therapeutic modalities that can be employed in the management of this disorder in the New Zealand situation. An approximate indication of costs for the various therapies is included. This article is sponsored by the therapeutics section of the Department of Health, however, the views of the contributors do not necessarily reflect departmental policies.
BACKGROUND: Calcipotriol/calcipotriene (Dovonex/Daivonex) ointment plus phototherapy has been used in the treatment of psoriasis. OBJECTIVE: We will attempt to clarify two issues: First, is there any benefit to combining the above treatment modalities? Second, is there any increased risk associated with the use of the combination? METHODS: A complete review of the literature revealed four studies dealing with the combination of calcipotriol with UVB phototherapy and three studies dealing with the combination of calcipotriol with PUVA phototherapy. RESULTS: These studies showed an advantage to the use of the combination compared with the use of either treatment alone. CONCLUSION: Topical calcipotriol enhances the effect of UVB and PUVA phototherapy.
The paper deals with the problem of adequacy of electromagnetic exposure of biological systems, indicates principal directions of optimization of physiotherapeutic actions including necessary hard and software, methodology of registration of the body response to these effects.
Multiple and eruptive dermatofibromas are, on the contrary, unusual. Often the patients who show this peculiar cutaneous pattern are referred for immunosuppressive therapy or they have an immunosuppressive disease. We report the case of a woman affected by mycosis fungoides, who developed, in 2 months, 14 dermatofibromas on her legs. The personal history of the patient revealed a previous immunosuppressive treatment with systemic corticosteroids for interstitial pneumonia. Different etiological hypothesis have been proposed to explain the eruptive presence of multiple dermatofibromas and the alteration of the immune response, but the real mechanism is still unclear. Dermatofibromas are benign tumours usually encountered in dermatology.
Studies of a relationship between the severity of the developing secondary tissue hypoxia and reduction of the neutrophil phagocytic activity in patients with combined maxillofacial and craniocerebral injuries of varying severity have prompted the authors to include ultraviolet irradiation of the blood and essential therapy in the complex of therapeutic measures aimed at prevention of pyoinflammatory complications with due consideration for the severity of secondary tissue hypoxia detected in the patients on admission to hospital.
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Cutaneous 7-dehydrocholesterol, exposed to ultraviolet radiation, converts to previtamin D3, which in turn converts in skin to vitamin D3 and is carried into the circulation. We investigated the feasibility of the photochemical conversion in skin of hydroxylated derivatives of 7-dehydrocholesterol - such as 1 alpha, 25-dihydroxy-7-dehydrocholesterol (1 alpha, 25-(OH)2-7-DHC) - to the corresponding hydroxylated previtamin as an alternative method of delivery of 1 alpha, 25-dihydroxyvitamin D3 (1 alpha, 25-(OH)2-D3) to subjects who are deficient in the endogenous metabolite. In human volunteers and in vitamin-D-deficient rats [24-3H] 1 alpha, 25-(OH)2-D3 appeared in blood after [24-3H] 1 alpha, 25-(OH)2-7-DHC was applied to the skin and exposed to ultraviolet radiation. In anephric rats, intestinal calcium absorption and serum calcium levels were elevated after a topical dose of 1 alpha, 25-(OH)2-7-DHC combined with ultraviolet phototherapy. Delivery of equivalent doses of 1 alpha, 25-(OH)2-D3 through the skin and orally showed that there was more prolonged stimulation in intestinal calcium absorption and serum calcium elevation after cutaneous administration. The photochemical conversion of precursors may be useful in the treatment of patients with impaired vitamin-D metabolism.
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Although light therapy is a recognized effective treatment for seasonal affective disorder (SAD), there has been little research into the critical wavelengths of light that produce the antidepressant effect. Previous studies found conflicting results for the importance of the ultraviolet (UV) spectrum in the therapeutic effect of light therapy. To assess the clinical effects of UV-A wavelengths (315-400 nm), we studied 33 depressed SAD patients diagnosed with structured interviews by DSM-IIIR criteria. Following a baseline week, patients underwent 2 weeks of 2500 lux light therapy for 2 h daily (06:00-08:00). Light therapy consisted of cool-white fluorescent light with the addition of a special UV-A fluorescent tube. Patients were randomized to wear glasses during light therapy that either blocked (UV-blocked condition) or passed (UV-A condition) wavelengths below 400 nm. Both treatments significantly reduced all depression ratings, but no differences were found between the UV-A and UV-blocked conditions. We conclude that the UV-A spectrum does not increase the antidepressant response of light therapy. Given the potential side effects of chronic UV exposure, clinical application of light therapy should use light sources that have the UV spectrum filtered.
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In order to further elucidate the mechanisms by which high-dose ultraviolet A1 (UVA1) therapy leads to improvement in patients with atopic eczema, we assessed skin sections from patients before and after high-dose UVA1 therapy (n = 5) or conventional UVA/UVB therapy (n = 4) for changes in Langerhans cells and mast cells expressing the high-affinity IgE receptor Fc epsilon RI and in surface-bound IgE by histochemical and immunohistochemical techniques. The two treatment groups exhibited different patterns of changes in the number of Fc epsilon RI+, CD1a+, and mast cells within the dermis: The density of both Langerhans cells and mast cells was decreased after high-dose UVA1 therapy, but not after UVA/UVB therapy. High-dose UVA1 and UVA/UVB therapy significantly increased the number of CD1a+ cells within the epidermis, but only high-dose UVA1 reduced the relative number of IgE+ intraepidermal Langerhans cells typically found in atopic eczema. Reduction of numbers of dermal Langerhans cells and mast cells, as well as relative numbers of intraepidermal IgE+ Langerhans cells, was closely linked to significant clinical improvement by high-dose UVA1, but not UVA/UVB therapy. These studies support the notion that IgE-binding cutaneous cells are involved in the pathogenesis of atopic eczema. We propose that UVA1 radiation exerts its effects in atopic eczema, at least in part, by inhibiting Langerhans cell migration out of the epidermis and, in particular, by reducing the number of IgE-bearing Langerhans cells and mast cells in the dermis.