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Introduction: UVA therapy is used in treatment of wide range of skin diseases, which proceed with hardening of the skin or inflammation. First use of ultraviolet radiation can be tracked down to 1896. Wavelength vary among diseases against which it is used. In literature as results of therapy are mentioned improvement of skin elasticity, reduction of inflammation, and protection from relapse. In terms of sclerotic skin diseases most promising effect is seen in reducing skin hardness in the mechanism of stimulating collagen breakdown. The therapy itself has a good safety profile, but is time-consuming due to the high frequency of irradiation. Effectiveness of treatment are determined by factors such as advancement of skin lesions, pigmentation and the intensity of the therapy itself. Aim of study: The aim of the study is to summarize the available knowledge about the UVA therapy in skin diseases. The way of work, effectiveness of treatment, side effects and potential new methods of use were summarized and described. Materials and methods: The literature available in PubMed database was reviewed using following keywords: "UVA therapy", "UVA", "Scleroderma", "Buschke's Scleredema", "Systemic sclerosis", "Morphea" Conclusion: UVA1 therapy is one of the most effective therapeutic options in subtypes of morphea which affect only superficial tissues. Phototherapy accelerate healing of ulcerations on fingertips in patients with Systemic sclerosis. Patient suffering from Buschke Scleredema had good response to therapy. Observed side effects consist of hyperpigmentation, erythema, xerosis and pruritus in range from mild to severe. Carcinogenic effect has not yet been proven. [ABSTRACT FROM AUTHOR]

The review paper provides brief analysis of phototherapy methods used in various dermatoses. Phototherapy can be prescribed in combination with drugs or used solo. Phototherapy methods based on using the medium-wavelength (UVB) and long-wavelength (UVA) ultraviolet radiation are most commonly used in clinical practice: PUVA therapy and narrow-band UVB (311 nm) therapy, as well as treatment with excimer light with the wavelength of 308 nm. Photodynamic therapy combining photosensitizer, oxygen and visible light also gradually takes leading positions in aesthetic medicine and dermatology.

Introduction: UVA therapy is used in treatment of wide range of skin diseases, which proceed with hardening of the skin or inflammation. First use of ultraviolet radiation can be tracked down to 1896. Wavelength vary among diseases against which it is used. In literature as results of therapy are mentioned improvement of skin elasticity, reduction of inflammation, and protection from relapse. In terms of sclerotic skin diseases most promising effect is seen in reducing skin hardness in the mechanism of stimulating collagen breakdown. The therapy itself has a good safety profile, but is time-consuming due to the high frequency of irradiation. Effectiveness of treatment are determined by factors such as advancement of skin lesions, pigmentation and the intensity of the therapy itself. Aim of study: The aim of the study is to summarize the available knowledge about the UVA therapy in skin diseases. The way of work, effectiveness of treatment, side effects and potential new methods of use were summarized and described. Materials and methods: The literature available in PubMed database was reviewed using following keywords: “UVA therapy”, “UVA”, “Scleroderma”, “Buschke’s Scleredema”, “Systemic sclerosis”, “Morphea” Conclusion: UVA1 therapy is one of the most effective therapeutic options in subtypes of morphea which affect only superficial tissues. Phototherapy accelerate healing of ulcerations on fingertips in patients with Systemic sclerosis. Patient suffering from Buschke Sclerederma had good response to therapy. Observed side effects consist of hyperpigmentation, erythema, xerosis and pruritus in range from mild to severe. Carcinogenic effect has not yet been proven.

Abstract Of all the therapeutic options available in Dermatology, few of them have the history, effectiveness, and safety of phototherapy. Heliotherapy, NB-UVB, PUVA, and UVA1 are currently the most common types of phototherapy used. Although psoriasis is the most frequent indication, it is used for atopic dermatitis, vitiligo, cutaneous T-cell lymphoma, and cutaneous sclerosis, among others. Before indicating phototherapy, a complete patient assessment should be performed. Possible contraindications should be actively searched for and it is essential to assess whether the patient can come to the treatment center at least twice a week. One of the main method limitations is the difficulty that patients have to attend the sessions. This therapy usually occurs in association with other treatments: topical or systemic medications. Maintaining the regular monitoring of the patient is essential to identify and treat possible adverse effects. Phototherapy is recognized for its benefits and should be considered whenever possible.

Clinical reasoning. There is a need to optimize the use of UV-B-311 nm and PUVA-therapy in patients with mycosis fungoides to determine the duration of the treatment regimen, the number of sessions per week, and ultraviolet irradiation regimen. Goal of research. Evaluation of the effect of the type and duration phototherapy on efficacy in patients with mycosis fungoides. Principle. A comparative, non-randomized study of the effectiveness of phototherapy in patients with mycosis fungoides in the early stages. Evaluation of the effectiveness of UV-B-311 nm and PUVA therapy was performed using the BSA index (area of skin lesions) and Modified Severity-Weighted Assessment Tool (mSWAT), as well as according to the criteria proposed by the International Society for Skin Lymphomas (ISCL), the European Organization for the Study and Cancer Treatment (EORTC) and United States Cutaneous Lymphoma Consortium (USCLC). Results. The study included 14 patients with mycosis fungoides, 5 of whom received treatment with UV-B-311 nm, 9 PUVA therapy. A strong correlation was found between the duration of UV-B-311 nm therapy with mSWAT delta (R = 0.90; p = 0.038) and BSA delta (R = 0.90; p = 0.038), while similar correlation was not found in the PUVA-therapy group (mSWAT (R = 0.24; p = 0.527); BSA (R = 0.09; p = 0.823)). When comparing the effectiveness of therapy between the treatment group UV-B-311 nm and PUVA therapy, delta mSWAT and BSA at the 20th procedure, delta mSWAT and BSA after the end of therapy did not have a statistically significant difference between the UVB-311 nm and PUVA groups. Conclusion. Statistically significant correlation was found between the number of procedures and the effectiveness of therapy In the UV-B-311 nm group. An increase in the number of PUVA therapy procedures (after 20) does not lead to a statistically significant increase in the effectiveness of treatment. Additional research is needed to increase the level of evidence of the results and develop optimal phototherapy regimens.

Currently, phototherapy has been widely used in the treatment of various skin diseases, including mycosis fungoides. The article provides a literature review on the use of various spectra ultraviolet therapy in the treatment of patients with early stages of mycosis fungoides. The mechanisms of action of medium-wave ultraviolet therapy (UVB-311 nm) and PUVA therapy, causing the immunosuppressive, anti-inflammatory and anti-proliferative effect, are described. The results of retrospective studies of PUVA therapy and UVB-311 nm efficacy in patients with cutaneous T-cell lymphoma are presented, as well as modern literature evidence of the need for standardization of phototherapy methods for patients with mycosis fungoides.

The analysis of the literature data conducted incorporating modern views on psoriasis and the effectiveness of its complex therapy with the use of existing methods of physiotherapeutic treatment. The questions of the urgency of the problem of psoriasis, its etiology, and pathogenesis, the clinical picture of the disease, drug treatment are reflected. The review of physiotherapeutic methods in the complex treatment of psoriasis is presented. The modern scientific view of psoriasis is described as a systemic disease that manifests as a form of immune-dependence dermatosis. The question of application of physical factors considered in the complex therapy of psoriasis, the mechanism of their action, and describes the methods of physiotherapy due to the therapeutic treatment of psoriasis, in particular, ultraviolet radiation

Background: Mycosis fungoides is the most frequent form of cutaneous T-cell lymphoma. It is characterized by a chronic, slow, and progressive course, and is associated with mortality rates that depend on several factors, such as clinical staging. A median survival time of up to 13 months is found in patients with advanced stages that require more aggressive treatments, with greater toxicity and higher costs. In Latin America, few prognostic studies of the disease are available., Objective: To determine the rate of progression from early stages (IA, IB, IIA) to more advanced stages (> IIB) in patients older than 18 years with mycosis fungoides treated at two medical centers in Colombia between January 1, 2010, and December 31, 2019., Methods: Retrospective cohort study with a longitudinal design., Results: 112 patients diagnosed with early mycosis fungoides were included. 56.2% were male (n = 63), with a median age of 53 years (IQR 43‒67). The most frequent clinical variant was classic (67.9%; n = 76), followed by folliculotropic (16%; n = 18), and hypopigmented (10.7%; n = 12). The most common first-line treatment was NB-UVB phototherapy (27.7%; n = 31), followed by PUVA phototherapy (25.8%; n = 29%), and topical corticosteroids (25%; n = 28). The global rate of disease progression was 8% (n = 9), with an overall mortality of 12.5% (n = 14)., Study Limitations: Its retrospective design and the lack of molecular studies for case characterization., Conclusions: Early mycosis fungoides is a disease with a good prognosis in most patients, with a progression rate of 8% (n = 9)., (Copyright © 2024 Sociedade Brasileira de Dermatologia. Published by Elsevier España, S.L.U. All rights reserved.)

Abstract: Background: Topical agents used in combination with phototherapy or photochemotherapy may have both blocking or enhancing effects in ultraviolet rays. Objective: In this in vivo study, the effects of topical petrolatum, basis cream, glycerine, and olive oil on the transmission of ultraviolet A radiation were investigated. Methods: A test was performed to determine the minimal phototoxic dose on 29 volunteers with only psoralen plus ultraviolet A (PUVA) and then the same test was repeated with white petrolatum, basis cream, glycerine, olive oil, and sunscreen (0.3cc/25cm2). The effects of each agent on the minimal phototoxic dose were determined after 72 h. Results: When compared to pure PUVA, there was a statistically significant increase in the mean minimal phototoxic dose values by the application of white petrolatum (P = 0.011), but there was no significant increase or decrease in the mean minimal phototoxic dose values after the application of basis cream (P = 0.326), glycerine (P = 0.611) or olive oil (P = 0.799). Study limitations: Low number of patients Conclusion: The application of white petrolatum, which has a blocking effect, and also of basis cream immediately before PUVA therapy should not be recommended. Although we specify that glycerine and maybe olive oil can be used before photochemotherapy, there is a need for further research in larger series.

Goal. To assess the therapeutic efficacy of the rotation of mid-wavelength ultraviolet therapy (311 nm) and PUVA therapy in patients with moderate to severe forms of psoriasis, and to assess the efficacy of mid-wavelength ultraviolet therapy (311 nm) in a multiple-course therapy. Materials and methods. The study involved 66 patients with moderate to severe forms of psoriasis who received multiple courses of treatment by methods of the PUVA therapy and narrowband mid-wavelength phototherapy (311 nm). The patients were divided into three groups: Group 1 (n = 20) - patients who received treatment in the form of mid-wavelength ultraviolet therapy (311 nm) after multiple courses of PUVA therapy; Group 2 (n = 26) - patients who received only multiple courses of PUVA therapy; Group 3 (n = 20) - patients who received only multiple courses of mid-wavelength ultraviolet therapy (311 nm). Results. The authors determined high efficacy (82.8%) of mid-wavelength ultraviolet therapy (311 nm) in patients with moderate to severe forms of psoriasis vulgaris who had previously received multiple courses of PUVA therapy. After multiple courses of long-term treatment by mid-wavelength ultraviolet therapy (311 nm), patients with moderate to severe forms of psoriasis had high efficacy of such multiple courses of treatment (85.78%). Conclusion. Patients with moderate to severe forms of psoriasis who had previously received multiple courses of PUVA therapy can be switched to mid-wavelength ultraviolet therapy (311 nm) with the maintenance of high efficacy of such treatment. The authors observed the absence of any adaptation to the spectral range of mid-wavelength ultraviolet therapy (311 nm) in case of multiple courses of treatment.

The article presents published data on the assessment of the risk of cancerogenicity of multiple courses of phototherapy methods such as PUVA therapy and UVB-311 in psoriatic patients. The authors analyzed the incidence of malignant skin neoplasms (squamous cell carcinoma, basal cell carcinoma, malignant skin melanoma) among psoriatic patients from different population groups taking into account the cumulative radiation doses and number of procedures.

Goal. To study the dynamics of expression rates of growth factor proteins in psoriatic patients receiving the PUVA therapy. Materials and methods. The authors conducted a study of 30 patients with psoriasis vulgaris treated with the PUVA therapy. The psoriasis severity and extent of itching were assessed prior to and after the treatment by the PASI index and visual analogue scale, respectively. The expression of semaphorin 3A, amphiregulin, nerve growth factor and PGP 9.5 protein (a nerve fiber marker) in the skin was assessed by the indirect immunofluorescence method. The expression of PGP 9.5 protein was used to assess the quantity and mean length as well as average and total fluorescence intensity of nerve fibers. Results. An increased expression of amphiregulin and nerve growth factor as well as increase in the quantity, mean length and average and total fluorescence intensity of nerve fibers were revealed in the epidermis of psoriatic patients. Following a course of the PUVA therapy, a decrease in the PASI index and extent of itching, reduced expression of amphiregulin and nerve growth factor as well as reduced quantity, mean length and average and total fluorescence intensity of nerve fibers in the epidermis were observed. Direct correlation dependence between the extent of itching, amphiregulin and nerve growth factor expression level and quantity and length of nerve fibers in the epidermis was discovered. Direct correlation dependence between the amphiregulin and nerve growth factor expression level, and average length of nerve fibers in the epidermis was discovered. Conclusion. The itching intensity in psoriatic patients receiving the PUVA therapy is reduced due to the decreased skin expression of the nerve growth factor and amphiregulin.

The authors present a clinical case study of squamous cell carcinoma in a psoriasis patient after 24 courses of phototherapy (22 courses of PUVA therapy and two courses of mid-wavelength ultraviolet therapy (311 nm)). The malignant neoplasm developed against the background of signs of a chronic photodamage of the skin: lentigo, actinic elastosis, diffuse hyperpigmentation, spotty skin pigmentation.

Monitoring of disseminated superficial actinic porokeratosis (DSAP) in patient suffering from plaque psoriasis treated by PUVA therapy was presented. DSAP is a rare skin disease developing in the result of keratosis disorder caused by solar radiation and appearing as clearly localized ringed or line plates. As patients with DSAP are sensitive to solar radiation, phototherapy is contraindicated for them. In this regard, subcutaneous injections of Methotrexate 10 mg once a week were prescribed to a patient suffering from psoriasis. Psoriatic rashes were regressed after the second injection, instead of them DSAP rashes remained.

Introduction: Phototherapy, particularly psoralen plus ultraviolet A (PUVA) and narrowband ultraviolet B (nbUVB), is a mainstay in the treatment of Mycosis Fungoides (MF). Methods: We analyzed outcomes of MF patients treated for the first time with either PUVA or nbUVB at the Photodermatology Unit, in the Department of Dermatology of Centro Hospitalar Universitário do Porto, from 2007 to 2017. The primary outcome was response to treatment. The secondary outcome was disease relapse free survival. Results: From a total number of 34 patients with MF identified, nine (26.5%) patients were diagnosed at stage IA and 25 (73.5%) patients were diagnosed at stage IB. Of these patients, 30 (88.2%) were treated with PUVA and four (11.8%) with nbUVB. Overall, 24 (80%) patients treated with PUVA and two (50%) patients treated with nbUVB had complete responses (CR). Relapse was observed in 17 (70.8%) PUVA treated patients and two (100%) nbUVB treated patients. Median disease relapse free survival was 12 months for PUVA and 6 months for nbUVB. Conclusion: PUVA is an effective therapy in early MF. Narrowband UVB could be a valid therapeutic alternative for these patients. However, the small size of nbUVB group in our study limits the conclusions about its efficacy.

Introduction: Phototherapy, particularly psoralen plus ultraviolet A (PUVA) and narrowband ultraviolet B (nbUVB), is a mainstay in the treatment of Mycosis Fungoides (MF). Methods: We analyzed outcomes of MF patients treated for the first time with either PUVA or nbUVB at the Photodermatology Unit, in the Department of Dermatology of Centro Hospitalar Universitário do Porto, from 2007 to 2017. The primary outcome was response to treatment. The secondary outcome was disease relapse free survival. Results: From a total number of 34 patients with MF identified, nine (26.5%) patients were diagnosed at stage IA and 25 (73.5%) patients were diagnosed at stage IB. Of these patients, 30 (88.2%) were treated with PUVA and four (11.8%) with nbUVB. Overall, 24 (80%) patients treated with PUVA and two (50%) patients treated with nbUVB had complete responses (CR). Relapse was observed in 17 (70.8%) PUVA treated patients and two (100%) nbUVB treated patients. Median disease relapse free survival was 12 months for PUVA and 6 months for nbUVB. Conclusion: PUVA is an effective therapy in early MF. Narrowband UVB could be a valid therapeutic alternative for these patients. However, the small size of nbUVB group in our study limits the conclusions about its efficacy. [ABSTRACT FROM AUTHOR]

Narrowband UVB (NB-UVB) phototherapy and psoralen-UVA (PUVA) photochemotherapy are widely used phototherapeutic modalities for a range of skin diseases. The main indication for NB-UVB and PUVA therapies is psoriasis, and other key diagnoses include atopic eczema, vitiligo, cutaneous T-cell lymphoma (CTCL), and the photodermatoses. The decision on choice of phototherapy is important and NB-UVB is usually the primary choice. NB-UVB phototherapy is a safe and effective therapy which is usually considered when topical agents have failed. PUVA requires prior psoralen sensitization but remains a highly effective mainstay therapy, often used when NB-UVB fails, there is rapid relapse following NB-UVB or in specific indications, such as pustular or erythrodermic psoriasis. This review will provide a perspective on the main indications for use of NB-UVB and PUVA therapies and provide comparative information on these important dermatological treatments.

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AbstractBACKGROUND:For years, phototherapy has been used in a wide range of skin diseases, which is unsurprising as skin is the anatomical feature most directly exposed to light, especially in psoriasis. Although the role of light therapy has been replaced by different therapeutic modalities in recent years, this treatment is now an established option for many skin diseases.OBJECTIVES:The aim was to characterize the patient population thathad received the aforementioned treatment in the Virgen Macarena Health Area in Seville (Spain) between June 1985 and October 2011.METHODS:We have designed a descriptive study with a univariate analysis covering 443 treatments with light therapy, all administered to the same number of patients suffering from psoriasis.RESULTS:79.15% of patients were discharged due to improvement or healing, while the 20.85% were discharged due to other reasons. The average total accumulative dose was 131.53 J/cm2. We do not detected an increase in proportion in patients for develop NMSK after light therapy treatment.CONCLUSIONS:We consider that phototherapy is still an effective and efficient treatment that will have to be reconsidered in the current macroeconomic context.

Pigmented purpuric dermatoses are chronic and relapsing disorders characterized by a symmetrical rash of petechial and pigmentary macules, mainly confined to the lower limbs. Purpura annularis telangiectodes of Majocchi is a less common variant of Pigmented purpuric dermatoses characterized by punctate telangiectatic macules progressing to annular, hyperpigmented patches with central clearing and infrequent atrophy. A 12 year-old girl presented with asymptomatic round to oval reddish brown macules, present symmetrically over her lower and upper limbs for 3 years. Few lesions were annular in shape. Biopsy from the lesion was compatible with Pigmented purpuric dermatoses. On the basis of clinical and histopathological findings, a diagnosis of Purpura annularis telangiectodes of Majocchi was made. The patient began phototherapy thrice a week and showed excellent response.

Introduction: Biologic drug survival in psoriasis is mainly limited by a decrease of effectiveness over time. Strategies to improve retention rates are needed. Our purpose was to evaluate the efficacy and tolerability of concurrent narrowband ultraviolet- B (NB-UVB) or photochemotherapy (PUVA) to salvage the biologic drug in secondary non-response. Methods: Retrospective cohort study of 18 adults with moderate-to-severe plaque psoriasis treated with biologics who received concurrent phototherapy after a secondary efficacy loss. Results: Twelve patients underwent PUVA concurrently with etanercept and adalimumab in 13 and 5 cycles, respectively. Clinical response was observed in 72.2% of cycles (PASI75 55.5%). Median PASI decreased by 73%. Sustained response was observed for 25 months (median). A malignant melanoma was identified during follow-up. Six patients underwent NB-UVB concurrently with etanercept, adalimumab and ustekinumab in 7.3 and 2 cycles, respectively. Clinical response was observed in 75% of cycles (PASI75 41.7%). Median PASI decreased by 80%. Sustained responde was observed for 21 months (median). Conclusions: This study adds real-life evidence that PUVA and NB-UVB are effective options to salvage and improve the long-term performance of biologic drugs. Further efficacy and safety data, especially addressing the skin malignancy risk, should be sought to clarify the role of this interesting approach in the modern era of improved biologic therapies. [ABSTRACT FROM AUTHOR]