Smitha S Prabhu; Sathish Ballambat Pai; Manasa Narayan Kayarkatte
Abstract
Phototherapy is an essential and useful therapeutic procedure wherein the properties of ultraviolet light are used to cure certain dermatological conditions like psoriasis, vitiligo, and atopic dermatitis. This is usually an office-based procedure dependent on the accurate use of sophisticated phototherapy ...
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Phototherapy is an essential and useful therapeutic procedure wherein the properties of ultraviolet light are used to cure certain dermatological conditions like psoriasis, vitiligo, and atopic dermatitis. This is usually an office-based procedure dependent on the accurate use of sophisticated phototherapy units. Since the advent of the COVID-19 pandemic, phototherapy practices were shut down as they were considered as non-essential services. Here, we attempt to analyze how COVID-19 has affected phototherapy and seek to formulate a working guideline for safe phototherapy operations in these taxing circumstances. We used search engines like PubMed, Google Scholar, and Embase to retrieve articles and guidelines regarding phototherapy in dermatology, using the pertinent search terms. There was a paucity of data with only a couple of research letters and guidelines by the British Association of Dermatology and the American Academy of Dermatology, as well as general guidelines issued by the Indian Association of Dermatologists, Venereologists and Leprologists. After a careful study of various modalities of phototherapy and viral inactivation, we collated a set of guiding instructions toward the appropriate utilization of phototherapy amidst the COVID-19 pandemic. Phototherapy is a viable option for selected patients even amidst the COVID-19 pandemic. However, local and national guidelines have to be followed while selecting the patient and operating the phototherapy machine with adequate protective measures for both the patient and the healthcare worker. Home phototherapy units and PUVASOL are good options for those patients who are unable to attend the phototherapy center due to various reasons.
Balighi Kamran; Ghodsi Zahra; Iravani Masoud; Damavandi Maede Rayati; Goodarzi Azadeh; Lajevardi Vahide; Saburi Sara; Kashani Alireza Faghihi
Volume 19, Issue 75 , 2016, , Pages 21-24
Abstract
Background: Chronic graft versus host disease (cGVHD) is a major cutaneous complication of bone marrow transplantation (BMT). Although milder forms of this process may be associated with a lower incidence of tumor recurrences, it is mandatory to develop a more efficient and less harmful therapeutic approach.Methods: ...
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Background: Chronic graft versus host disease (cGVHD) is a major cutaneous complication of bone marrow transplantation (BMT). Although milder forms of this process may be associated with a lower incidence of tumor recurrences, it is mandatory to develop a more efficient and less harmful therapeutic approach.Methods: This case-series study enrolled 7 patients diagnosed with chronic mucocutaneous GVHD. We divided the patients into three major categories based on the type of skin lesions: sclerodermoid, lichenoid, and mixed. Patients received several packs of narrow band UVB (NBUVB) phototherapy. Each pack contained ten sessions of NBUVB (311 nm) with a duration of at least ten seconds and a fixed radiation dosage (6 mj/cm2) during the treatment.Results: There were 3 patients diagnosed with lichenoid skin lesions, 2 with sclerodermoid lesions, and 2 had mixed cGVHD lesions. During the follow up period one patient was excluded due to a lower respiratory tract infection. The mean response ratio was 42% with a mean satisfaction level of 5.5 out of 10. The lichenoid group had the best, most rapid response. There were no serious adverse effects reported.Conclusion: Narrow band UVB phototherapy is useful as an adjuvant therapeutic modality in cutaneous lichenoid and intraoral cGVHD with no serious adverse effects.
Kamran Balighi; Zahra Ghodsi; Masoud Iravani; Maede Rayati Damavandi; Azadeh Goodarzi; Vahide Lajevardi; Sara Saburi; Alireza Faghihi Kashani
Volume 19, Issue 1 , 2016, , Pages 21-24
Abstract
Background: Chronic graft versus host disease (cGVHD) is a major cutaneous complication of bone marrow transplantation (BMT). Although milder forms of this process may be associated with a lower incidence of tumor recurrences, it is mandatory to develop a more efficient and less harmful therapeutic approach.Methods: ...
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Background: Chronic graft versus host disease (cGVHD) is a major cutaneous complication of bone marrow transplantation (BMT). Although milder forms of this process may be associated with a lower incidence of tumor recurrences, it is mandatory to develop a more efficient and less harmful therapeutic approach.Methods: This case-series study enrolled 7 patients diagnosed with chronic mucocutaneous GVHD. We divided the patients into three major categories based on the type of skin lesions: sclerodermoid, lichenoid, and mixed. Patients received several packs of narrow band UVB (NBUVB) phototherapy. Each pack contained ten sessions of NBUVB (311 nm) with a duration of at least ten seconds and a fixed radiation dosage (6 mj/cm2) during the treatment.Results: There were 3 patients diagnosed with lichenoid skin lesions, 2 with sclerodermoid lesions, and 2 had mixed cGVHD lesions. During the follow up period one patient was excluded due to a lower respiratory tract infection. The mean response ratio was 42% with a mean satisfaction level of 5.5 out of 10. The lichenoid group had the best, most rapid response. There were no serious adverse effects reported.Conclusion: Narrow band UVB phototherapy is useful as an adjuvant therapeutic modality in cutaneous lichenoid and intraoral cGVHD with no serious adverse effects.
Hassan Seirafi; Maryam Daneshpazhouh; Somayeh Khezri; Pardis Kiani; Sara Sabouri Rad; khadijeh Moghadam; Farzaneh Khezri
Volume 14, Issue 2 , 2011, , Pages 58-63
Abstract
Background: There is a large variety of therapeutic agents for the treatment of vitiligo, but it still remains a challenge. Narrow-band UVB phototherapy and 308-nm excimer laser have been shown to be safe and effective for the treatment of vitiligo. Topical calcipotriol has recently been reported to ...
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Background: There is a large variety of therapeutic agents for the treatment of vitiligo, but it still remains a challenge. Narrow-band UVB phototherapy and 308-nm excimer laser have been shown to be safe and effective for the treatment of vitiligo. Topical calcipotriol has recently been reported to enhance the efficacy of phototherapy, especially 8-methoxypsoralen plus UVA (PUVA). The goal of this study was to evaluate whether the addition of topical calcipotriol enhances the efficacy of 308-nm excimer laser in the treatment of vitiligo. Methods: The patients with symmetrical vitiliginous lesions received 308-nm excimer laser plus Calcipotriol ointment 0.005% (Daivonex®) as the intervention group and 308 nm excimer laser plus vaselin as the control group on the lesions of the right side. All patients in the two groups applied vaselin on the lesions of the left side. The evaluation of the patients was performed at baseline and at 12th week (the last laser session). SPSS version 15.0 package software was used for statistical analysis. P-values< 0.05 were accepted as statistically significant. Results: Seventy out of 83 patients completed the study. The diameter of the right side lesions (308nm excimer laser + calcipotriol) changed from 27.21 cm2 to 15.82 cm2 in the intervention group and from 27.86 cm2 to 16.02 cm2 in the control group; This difference was not statistically significant (p-value=0.74). Conclusion: Our findings showed that 308-nm excimer laser was effective and safe in the treatment of vitiligo, and that topical calcipotriol had no additive or synergistic effect.
Fariba Ghalamkarpour; Reza Robati; Ghadeh Ghasir; Mohammad Saeedi; Nahid Mohtasham
Volume 14, Issue 1 , 2011, , Pages 12-15
Abstract
Background: Treatment of vitiligo remains an attractive topic and several therapies with varying degrees of success have been used. The aim of this study was to find out whether the combination of topical calcipotriol and excimer laser increases the efficacy of therapy compared to excimer laser alone. ...
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Background: Treatment of vitiligo remains an attractive topic and several therapies with varying degrees of success have been used. The aim of this study was to find out whether the combination of topical calcipotriol and excimer laser increases the efficacy of therapy compared to excimer laser alone. Methods: Twenty eight patients in two groups were treated with 308nm excimer laser alone (14 patients) and the combination of excimer laser–calcipotriol (14 patients). After 16 sessions, response rate, side-effects and compliance were assessed. Results: Repigmentation rate more than 50% was significantly higher in the laser- calcipotriol group. No differences were seen in complication rate between the two groups. Conclusion: Combination of calcipotriol and 308nm excimer laser might enhance the response rate without increasing treatment complications.
Mohammad Ali Mapar; Sarah Hashemzade; Reza Yaghoobi
Volume 14, Issue 1 , 2011, , Pages 20-24
Abstract
Background: Topical corticosteroids and oral psoralen plus ultraviolet A radiation (PUVA therapy) are two common treatment methods for vitiligo. The aim of this study was to compare the efficacy, complications and patterns of repigmentation of these two methods. Methods: This prospective randomized clinical ...
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Background: Topical corticosteroids and oral psoralen plus ultraviolet A radiation (PUVA therapy) are two common treatment methods for vitiligo. The aim of this study was to compare the efficacy, complications and patterns of repigmentation of these two methods. Methods: This prospective randomized clinical trial was conducted from July 2007 to October 2008. Patients with disseminated vitiligo were divided into two groups. PUVA therapy was administered in one group and topical clobetasol was used in the other group. Results were recorded in 4 categories and therapeutic findings and complications were compared after 24 weeks. Results: Among 37 participants in the PUVA therapy group, 18 (48.6%) patients achieved marked and 14 (37.8%) patients showed good repigmentation. Similarly, among 35 participants in the clobetasol group, 6 (17.1%) patients showed marked and 8 (22.8%) patients showed good repigmentation. treatment complications were observed in 16.2% of the participants in PUVA group and 28.6% of the participants in clobetasol group. The patterns of repigmentation were different in the two groups. Conclusion: PUVA showed better therapeutic effects, and did not cause significant complications. Therefore, it could be used as one of the first line medications in the treatment of vitiligo.
Ghodsi Seyyede Zahra; Bahar Babak; Balighi Kamran; Ranjkesh Mohammad Reza; Toosi Siavash
Volume 11, Issue 4 , 2008, , Pages 137-142
Abstract
Background: Chronic graft versus host disease (ch.GVHD) is the most frequent late complication after allogenic stem-cell transplantation. Systemic immunosuppressive agents are usually required to control the disease. Psoralen plus UVA (PUVA) has been used for the treatment of ch.GVHD with variable beneficial ...
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Background: Chronic graft versus host disease (ch.GVHD) is the most frequent late complication after allogenic stem-cell transplantation. Systemic immunosuppressive agents are usually required to control the disease. Psoralen plus UVA (PUVA) has been used for the treatment of ch.GVHD with variable beneficial effects. The objective of this study was to assess the efficacy and safety of a relatively lower dose of oral psoralen compared with previous reports, for the treatment of ch.GVHD patients with PUVA.Methods: Eleven patients who received allogenic bone marrow transplantation and had severe progressive ch.GVHD that was unresponsive to conventional immunosuppressive treatments were treated with oral 8-methoxypsoralen (0.2 mg/kg, up to 10 mg) two hours before exposure to UVA.Results: The patients received a median of 43 treatments (range: 18 to 72). Mean cumulative dose of UVA was 200.5 J/cm2 (range, 116.5-306.5 J/cm2). In four of the 11 patients, there was a complete resolution of cutaneous ch.GVHD and the remaining seven patients achieved partial response with PUVA treatment. Complete and partial remission was observed in four and six patients with lichenoid lesions, respectively, but all of the four patients with sclerodermoid GVHD showed partial response to PUVA treatment. We observed no side effects like phototoxicity, nausea and vomiting, and exacerbation of GVHD. Liver enzymes raised in five patients, causing no significant morbidity for them.Conclusion: Low-dose psoralen plus UVA can be a safe and effective therapy for chronic cutaneous GVHD. Although the number of treatments and total cumulative exposure to UVA was rather high in our study, we observed no phototoxic reaction or severe irreversible liver damage due to phototherapy, which may be because of a relatively lower dose of methoxsalen used in our patients. Psoralen plus UVA is effective particularly in lichenoid GVHD lesions but sclerodermoid lesions may also benefit from this therapy.
C.Geilen Christoph
Volume 11, Issue 4 , 2008, , Pages 159-167
Abstract
Psoriasis is a chronic, genetically determined skin disease. A variety of biochemical and molecular biological alterations have been identified, but the pathogenesis of psoriasis is still not clear. For patients with mild to moderate psoriasis, topical therapies are generally used. However, approximately ...
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Psoriasis is a chronic, genetically determined skin disease. A variety of biochemical and molecular biological alterations have been identified, but the pathogenesis of psoriasis is still not clear. For patients with mild to moderate psoriasis, topical therapies are generally used. However, approximately one-third of the patients have a moderate to severe psoriasis and need a systemic therapy. Beside well known therapeutical approach
Ghaninejad Hayedeh; Esmaili Nafiseh; Ghiasi Maryam
Volume 10, Issue 2 , 2007, , Pages 105-110
Abstract
Background and aim: Psoriasis is a chronic inflammatory dermatosis that affects 0.6% to 4.8% of the population. Phototherapy is commonly used in the treatment of this disease. According to the results of previous studies that showed difference in minimal erythema dose between different body sites, it ...
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Background and aim: Psoriasis is a chronic inflammatory dermatosis that affects 0.6% to 4.8% of the population. Phototherapy is commonly used in the treatment of this disease. According to the results of previous studies that showed difference in minimal erythema dose between different body sites, it seems that the responses of psoriatic lesions are also different in various body sites. Our objective was to compare the response of psoriatic lesions to phototherapy in various body sites.Materials and methods: Forty patients with generalized chronic plaque-type psoriasis were enrolled in this study. All patients were examined prior and during phototherapy course every 10 sessions. In each patient time of clearance of psoriatic lesions at trunk, upper and lower extremities were recorded separately.Results: At the end of phototherapy course the lesions of the trunk were cleared completely in 32 patients, and remained partially in 8 patients. The lesions of the upper limbs were cleared completely in 37 patients, and remained partially in 3 patients. The lesions of the lower limbs were cleared completely in 22 patients, and remained partially in 16 patients. Incomplete responses were significantly higher on the lower limbs than the trunk and upper limbs.Conclusion: Therapeutic response of psoriatic lesions to phototherapy is lower on the lower limbsthan the trunk and upper limbs.
Z Halaji; K Balighi; E Abou Saeidi
Volume 8, Issue 2 , 2005, , Pages 101-103
Abstract
Background: Phototherapy is an important modality in dermatology and the number of skin diseases which can be controlled with it is increasing. In order to start treatment, the first dose of phototherapy is determined by measurement of minimal erythema dose (MED) in each patients individually or according ...
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Background: Phototherapy is an important modality in dermatology and the number of skin diseases which can be controlled with it is increasing. In order to start treatment, the first dose of phototherapy is determined by measurement of minimal erythema dose (MED) in each patients individually or according to patient’s skin type. Objective: To determine the relationship of skin type with MED in patients under UV phototherapy referred to Razi hospital in Tehran. Patients and Methods: In patients referred to Razi hospital in 1381 (2002-03) for UVB phototherapy, skin type was determined according to Fitzpatrick’s classification and MED was measured using a UV-meter. Age, sex and the disease of the patients were also recorded. The data were analyzed using one way ANOVA and Welch tests. Results: Eighty patients including 39 males and 41 females were studied. The mean age of the patients was 32 years (SD=15.8). Their diseases include psoriasis, vitiligo, parapsoriasis, pityriasis lichenoides chronica, perforating disorder and patch stage mycosis fungoides. The mean of MED in 17 patients with skin type II was 111.8±39.2, in 42 patients with skin type III was 105.9±43.1, and in 21 patients with skin type IV was 114.3±39.2 mJ/cm², with no significant statistical difference. Conclusion: The first dose of phototherapy could not be determined based on skin type and measurement of MED is necessary in each patient.
H Seyrafi; F Farnaghi; S Fathabadi
Volume 6, Issue 1 , 2002, , Pages 16-20
Abstract
Background: Due to the chronic nature of atopic dermatitis and dependence of most patients to steroids, finding a suitable alternative treatment is important. Objectives: To determine the efficacy of phototherapy in treatment of atopic dermatitis, also to evaluate possible influencing factors in response ...
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Background: Due to the chronic nature of atopic dermatitis and dependence of most patients to steroids, finding a suitable alternative treatment is important. Objectives: To determine the efficacy of phototherapy in treatment of atopic dermatitis, also to evaluate possible influencing factors in response of patients to psoralen+UVA (PUVA) therapy. Patients and Methods: 13 patients with resistant atopic dermatitis, older than 10 years, were treated with PUVA, 2 or 3 times a week until complete recovery or maximum of 30 sessions. Rate of recovery was determined according to reduction in 6 signs including itching, erythema, lichenification, xerosis, exfoliation and excoriation at the end of the treatment period and 2 months later. Results: 10 patients (77%) at the end of the treatment and 9 patients (69.2%) two months after that, showed more than 50% recovery. There was no significant relationship between the pretreatment serum IgE levels, site of the lesions, age, sex and phototherapy. The patients with family history of atopic dermatitis showed a better response to the treatment. Conclusion: PUVA is a suitable alternative treatment in resistant cases of atopic dermatitis.
