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At the end of 2019, an innovative coronavirus caused an outbreak of pneumonia cases in Wuhan, a city Hubei Province of China. Despite the direct effect on the routine of all life aspects, there are no clinical guidelines regarding phototherapy treatment during COVID-19 pandemic and as a result, phototherapies units continued to deliver this therapy for patients worldwide. We wish to explore the phototherapy utilization among dermatologic patients. We marked all patients that continue to arrive and being treated during COVID-19 pandemic. From March more than 50% of patients stopped arriving to treatments due to the fear of COVID-19 infection. COVID-19 has a major implication on chronic dermatology treatments such as phototherapy. [ABSTRACT FROM AUTHOR]

Background: Phototherapy has been a mainstay in the treatment of mycosis fungoides (MF). However, the recent findings of UV-induced p53 mutations in advanced MF suggest that phototherapy may contribute to disease progression. Objective: The objective of this study was to evaluate the effect of phototherapy on the time to tumor progression and overall survival in MF. Materials and methods: Retrospective analysis of patients seen at the University of Pittsburgh Cutaneous Lymphoma Clinic from 1979 to 2016. Results: A total of 345 patients with MF were identified. 258 (74.8%) were diagnosed at stage IA or IB. 43 out of the 258 (16.6%) progressed to tumor stage. Before tumor development, 30 out of the 43 (69.8%) patients received phototherapy, and 13 (30.2%) did not. Patients who received phototherapy had a longer median time to tumor progression than those who did not: 3.5 years (interquartile range = 1.9-5.7) versus 1.2 years (0.2-2.3) (p = .001). Patients who received phototherapy also survived longer: 6.9 years (interquartile range = 4.3-9.5) versus 3.8 years (3.0-4.5) (p = .014). Limitations: Limited information on specific phototherapy start dates, durations, and treatment protocols. Conclusions: The therapeutic effects of phototherapy, with longer times to tumor progression and increased overall survival, appear to outweigh its potential adverse effects. [ABSTRACT FROM AUTHOR]

Generalised granuloma annulare (GGA) is a significant cosmetic issue for patients but evidence is lacking to guide optimum treatment. We reviewed our patients with GGA treated with PUVA and narrowband UVB (NBUVB). A telephone questionnaire obtained the patients’ perspective in terms of treatment response, remission and overall satisfaction. Twenty patients, all female, were treated. Twelve patients had 15 courses of PUVA therapy (10 oral, 5 bath PUVA) and 10 had 12 courses of NB UVB (two patients had both). There was clearance or minimal residual disease (MRD) on clinical examination in eight of 12 patients after PUVA. Remission was for six months in seven patients extending to one year or more in five patients. Nine patients were contactable after PUVA therapy. They reported their satisfaction as excellent (n = 1), very good (n = 2) or good (n = 4), and two were disappointed. There was clearance or MRD in seven patients treated with NBUVB. Remission was for six months in at least three patients and greater than 1 year in at least 2 patients. Eight patients were contactable and reported satisfaction as excellent (n = 1) or good (n = 5) and two were disappointed. PUVA and NBUVB were effective in at least half of patients and they achieved satisfactory remission. Patients’ perceptions of the improvement after phototherapy were lower compared with their dermatologists’ assessment. [ABSTRACT FROM PUBLISHER]

Pityriasis lichenoides is a benign disease that includes a continuous spectrum with two polar ends: pityriasis lichenoides et varioliformis acuta (PLEVA) and pityriasis lichenoides chronica (PLC). Although its benign and self-limited character, treatment is required, both for itch relief and for cosmetic issues. The present study is a retrospective analysis of 13 patients (11 PLC and 2 PLEVA) treated in our institution with psoralen plus ultraviolet A (PUVA) or ultraviolet A combined with ultraviolet B (UVA/UVB) during the period 1998-2011. In the PUVA group, complete response was achieved in five patients and partial response in two. Total cumulative UVA dose was 84.4 J/cm2. One patient quit therapy without therapeutic response. In the UVA/UVB group, complete response was achieved in two patients and partial response in an equal number of patients. One patient did not reach a significant improvement. Total cumulative doses were: 26.1 J/cm2 for UVA and 3.62 J/cm2 for UVB. There were no acute side effects in either therapeutic group. In the present study, PUVA phototherapy was preferred for patients with more widespread or long-evolving disease, while UVA/UVB was selected for patients who presented more recent disease or contraindications for PUVA therapy. Regardless of the absence of clinical guidelines, both therapeutic options proved to be successful, ascertaining phototherapy as an effective and safe option for pityriasis lichenoides patients. [ABSTRACT FROM AUTHOR]

Some of the traditional psoriasis therapies, such as PUVA therapy and ciclosporin, have been linked to an increased incidence of non-melanoma skin cancer. More recently, an increased risk of cancer has also been a concern with newly introduced biologic agents. The authors report a case of multiple cutaneous squamous cell carcinomas arising on the lower limbs of a patient receiving efalizumab first and subsequently infliximab following many years of treatment with conventional therapies including PUVA and ciclosporin. Both these previous therapies likely contributed to the development of the skin tumors of this patient. Several case reports have documented that the use of tumor necrosis factor (TNF)-αα inhibitors may be associated with non-melanoma skin cancer, in particular squamous cell carcinoma. However, case reports, although numerous and well documented, do not fulfil the requirements for testing a cause--effect hypothesis. Since data from animal models indicate that TNF inhibition does not increase the incidence of malignancies, additional longer-term studies are necessary to ascertain whether a link exists between anti-TNF-αα and non-melanoma skin cancer above that normally observed in psoriasis patients. [ABSTRACT FROM AUTHOR]

Nail psoriasis is common in psoriatic patients, particularly in patients with joint involvement. It has a significant impact on their quality of life, affecting physical activities as well as causing emotional and social impairement. The disease is often refractory to treatment, and available therapeutic agents affect the matrix or the nail-bed features with variable success. The recent design of the Nail Psoriasis Severity Index allows a more standarized approach regarding outcome assessment. In this review, we assess treatment options of nail psoriasis and empahsize the importance of selecting modalities according to the particular psoriatic nail features. [ABSTRACT FROM AUTHOR]

Over the last few years, one of the major highlights in phototherapy is demonstrating the effects of UV-induced immunosuppression, which have led to greater understanding of the mechanisms and principles of photoimmunology and its therapeutic relevance. Various types of phototherapy have been used in the treatment of different dermatologic conditions. The aim of this review is to provide an update on the immunology of narrowband UVB phototherapy, high-dose UVA1 therapy, photochemotherapy, which includes psoralen plus UVA and extracorporeal photopheresis, and photodynamic therapy. [ABSTRACT FROM AUTHOR]

8-Methoxypsoralen (8-MOP) is a natural plant biosynthetic metabolite found in produce. Its synthetic form is also widely used in combination with ultraviolet A irradiation in skin photochemotherapy, a procedure called psoralen ultraviolet A (PUVA). This compound has been implicated in a number of adverse reproductive effects in the Wistar rat, including decreased birth rate as a result of decreased ovulations, reduction in levels of circulating 17-β estradiol, and reduction in the granulosa cell population in antral ovarian follicles. The present study examines the potential for decreased production of aromatase (cytochrome P450 19) proteins in the ovaries as a mechanism of 8-MOP-mediated toxicity. Aromatase proteins were measured by Western blotting as a possible origin of decreased estradiol, and estradiol production was measured by radioimmunoassay. Significant decreases in both aromatase proteins and estradiol levels were observed. These results, which are also supported by a decrease in pituitary weight and, possibly, pituitary function, show the potential for 8-MOP-mediated infertility and may explain, in part, adverse reproductive effects reported in humans undergoing PUVA. The findings are consistent with previous observations and with the hypothesis that 8-MOP may affect reproductive function by adversely impacting organs in the hypothalamic-pituitary-gonadal axis. [ABSTRACT FROM AUTHOR]

Background: Psoralen photochemotherapy (PUVA), the combined use of psoralen and long wave ultraviolet (UVA) irradiation, was introduced around 1974 and its beneficial effects were rapidly confirmed worldwide. In an attempt to minimize its recognized long-term photocarcinogenic risk after some 150–200 exposures while also maintaining efficacy, however, the narrowband (311–312 nm) ultraviolet B (UVB) lamp (TL-01) was introduced in 1984, and has moved towards replacing PUVA except for severe or resistant disease. Aims: To discover whether our use of these therapies complied with established British Photodermatology Group guidelines for PUVA and guidelines formulated within our unit for narrowband UVB. Methods: The study was retrospective over 6 months from November 2001 to April 2002, all relevant information being obtained from the patients' hospital notes. Results: Thirty-one patients received PUVA (18 oral, 11 bath and two uncertain because of missing notes) and 20 narrowband UVB during this period. Conclusions: Our PUVA and narrowband UVB phototherapy guidelines were shown to have been followed relatively closely with the following exceptions: one PUVA patient received a high cumulative exposure by mutual agreement because there was no other suitable therapy; a failure to measure minimal phototoxic doses (MPDs) in some PUVA patients; and slightly prolonged referral delays, but generally by patient choice. [ABSTRACT FROM AUTHOR]

BACKGROUND: The addition of calcipotriol ointment to PUVA therapy for psoriasis vulgaris results in a lower total UVA dose and a faster onset of response. The addition of calcipotriol cream to PUVA, however, has not been studied. OBJECTIVE: To investigate whether combining calcipotriol cream with PUVA therapy has a UVA sparing effect. METHODS: We performed a randomized, multicentre, vehicle-controlled, double-blind, 12-week comparative study including 120 patients with psoriasis covering 20-50% body surface area. The study consisted of a washout phase followed by a 10-week treatment phase. PUVA therapy three times weekly was added within 1 week after randomization. Efficacy was assessed by the Psoriasis Area and Severity Index (PASI). RESULTS: At baseline the mean PASI scores were 17.5 and 19.2 in the calcipotriol and vehicle (placebo) groups, respectively. At the end of treatment, the mean PASI scores were 2.65 and 7.03 ( p <0.01), respectively. A reduction in PASI score >90% was observed in 69% of the patients in the calcipotriol-treated group and in 36.4% of the patients in the vehicle group ( p <0.01). CONCLUSION: Calcipotriol cream plus PUVA clearly reduces the cumulative dose of UVA and improves the response of psoriasis vulgaris to PUVA. [ABSTRACT FROM AUTHOR]

Retinoids have been used for the treatment and suppression of cutaneous malignancies in patients with basal cell nevus syndrome, xeroderma pigmento-sum, and in patients with recurrent skin cancers as a result of immunosuppression for renal transplantation. We report a 40-year-old male who began to develop multiple squamous cell carcinomas of the skin after treatment with PUVA for severe psoriasis. The numbers of squamous cell carcinomas increased when acitretin was discontinued and decreased when he was taking the drug at a dose of 25 mg daily. Acitretin should be considered as a maintenance therapy for psoriasis patients developing squamous cell carcinomas as a result of PUVA therapy. [ABSTRACT FROM AUTHOR]

Vitiligo, particularly in darker skinned individuals, is a psychosocial disaster. With patient education, proper therapeutic selection and persistence, favorable repigmentation can be achieved in the majority of individuals with vitiligo. Attention to the activity state of the disease, the type, location and extent of the vitiligo must be carefully balanced against the patient's expectations, time commitment and assumption of risks. In this review, Dr Taneja succinctly summarizes the wide range of therapeutic options available today for the vitiligo patient. [ABSTRACT FROM AUTHOR]

PUVA and UVB phototherapy are very effective and popular treatments for a variety of dermatological problems. This article gives an overview of the possible acute and chronic adverse effects of these therapies. [ABSTRACT FROM AUTHOR]

This review examines the available options for the treatment of polymorphic light eruption (PLE). Many patients do not present to dermatologists, but for those who do, usually with moderate to severe disease, appropriate treatment allows most of them to lead normal or near-normal lives during the summer months or on vacation in sunny climates. (J Dermatol Treat (2000) 11: 195-199). [ABSTRACT FROM AUTHOR]

AIM: To compare the therapeutic efficacy of calcipotriol-PUVA therapy and PUVA in Korean patients with psoriasis. METHODS: A total of 38 patients were treated with conventional PUVA and 37 with calcipotriol PUVA. A comparison was made between the total number of PUVA treatments and the total UVA dose required to reach clearance in the two groups. Thereafter, categorization into clearing, improvement and failure was undertaken, with measurement of the psoriasis area and severity index made at each visit. RESULTS: Cumulative UVA dose as well as the number and duration of treatments in the calcipotriol-PUVA group were significantly lower than in the PUVA-treated group. Some 86% of patients treated with calcipotriol-PUVA showed clearing compared with 66% of those treated by PUVA. In the calcipotriol-PUVA group, the patients with only moderate extent required fewer irradiation treatments, shorter durations of treatment, and a lower final and cumulative UVA dose to reach clearance than the severely affected group. CONCLUSION: Combining PUVA with calcipotriol in the treatment of psoriasis may reduce the risks of long-term UV radiation and improve the clinical response. (J Dermatol Treat (2000) 11:125-130). [ABSTRACT FROM AUTHOR]

Background: Psoriasis is a common chronic disease. It is estimated that between US$$1.6 billion and US$$3.2 billion is spent per year to treat psoriasis. Objective: To compare psoralen plus UV-A (PUVA) therapy with topical steroids in moderate plaque psoriasis. Methods: In this randomized, clinical trial with cost analysis, 88 patients with moderate plaque psoriasis were recruited in two equal groups to receive either PUVA therapy or topical steroids. The induction phase was applied for 4 months and the patients were followed-up for another 3 months, while the maintenance therapy continued. Outcome, direct cost (related to medications, phototherapy, laboratory tests, and medical consultation), indirect cost (related to transportation and other extra expenditures) and total cost (direct plus indirect costs) were compared between the two groups. Results: The outcome was equally satisfactory in both groups. The indirect cost was significantly higher in the PUVA group, while the direct and total costs as well as the patients' satisfaction rate were comparable. Recurrence was significantly more frequent in the topical group. Conclusion: Although both PUVA therapy and topical steroids are equally efficient and cost-effective in moderate plaque psoriasis, the recurrence rate is higher in the latter group. [ABSTRACT FROM AUTHOR]

Palmoplantar dermatoses have a tendency to be chronic and are frequently recalcitrant to treatment. We summarize our experience with paint PUVA in the treatment of 125 patients with palmoplantar dermatoses between the years 1996 and 2000. The dominant clinical picture of the lesions was hyperkeratosis in 84, pustulosis in 11 and exudative dermatitis in the remaining 30 patients. The treatment was applied thrice weekly on alternate days. The affected skin was painted with methoxsalen 0.1% solution, and exposed 30 minutes later to UVA radiation, starting at 0.25 J/cm2, with increments of 0.25–0.50 J/cm2 every third treatment. Complete response was considered if all signs disappeared, and partial response if improvement occurred in more than 75% of each of the clinical findings of scaling erythema, fissuring, pustule formation and infiltration. Sixty‐nine percent of the patients had a good response (i.e. a complete or partial response), which was achieved in 78.5% of the exudative dermatitis lesions, but in only 46.7% of the pustular lesions. The average time to achieve good response was 13 weeks (range 1–42), with an average total dose of 50 J/cm2 (range 0.50–366). Maintenance therapy every 1–4 weeks was recommended for all responding patients, but only 58 consented and were treated for an average period of 10 additional weeks. Side effects were minor and transient, mainly mild first‐degree superficial skin burns in 10 patients, and patchy hyperpigmentation in three patients, which resolved after a few weeks. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Combination UVA irradiation (PUVA) and photophoresis as an option for the treatment of cutaneous T-cell lymphoma (CTCL). METHODS: Two patients with CTCL, who had demonstrated clinical response to therapy with a variety of agents (including photochemotherapy and photophoresis) followed by relapses, were placed on a treatment regimen combining photophoresis every 4 to 8 weeks with PUVA four times per week. RESULTS: There was a decrease in the size of existing lesions, arrest of new tumor development, and resolution of lymphadenopathy. These patients who had become unresponsive to both PUVA and photophoresis, individually, were successfully treated with combination therapy and have not relapsed over an 8-month period. CONCLUSION: The combination of PUVA and photophoresis may act synergistically resulting in clinical improvement in patients with CTCL. (J Dermatol Treat (2000) 11:105-107). [ABSTRACT FROM AUTHOR]

Background : Immunosuppressive agents are used widely in the treatment of vitiligo. Corticosteroids are used either alone or as adjuvant therapy by many practitioners. Cyclophosphamide and cycloporine‐A have also been used with variable success. Azathioprine may have the potential for the treatment of vitiligo alone or in combination with other modalities. Objective : To compare the efficacy of combined low‐dose azathioprine and oral PUVA therapy versus oral PUVA therapy alone for the treatment of vitiligo. Patients and methods : A total of 60 vitiligo patients were randomized to receive either azathioprine (0.6–0.75 mg/kg) and oral PUVA therapy (group 1) or oral PUVA therapy alone (group 2). Patients were followed for 4 months. A graph transparency with squares of 2.5×2.5 mm was used to measure the rate of repigmentatiopn after 4 months of therapy. Results : Perifollicular repigmentation started after a mean of five sessions in group 1, and eight sessions in group 2. The mean total repigmentation rate after 4 months was 58.4% for group 1 and 24.8% for group 2. No serious side effects were seen during or after treatment. Conclusion : Azathioprine may potentiate the repigmentary effects of PUVA therapy in vitiligo patients. A limitation of the study is the lack of validated measures for vitiligo assessment. [ABSTRACT FROM AUTHOR]