DOCSLIB.ORG

Phototherapy in Pediatric Patients: Choosing the Appropriate Treatment Option Rupa Pugashetti, BA* and John Koo, MD†

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Phototherapy in Pediatric Patients: Choosing the Appropriate Treatment Option Rupa Pugashetti, BA* and John Koo, MD† Phototherapy in Pediatric Patients: Choosing the Appropriate Treatment Option Rupa Pugashetti, BA* and John Koo, MD† Phototherapeutic modalities, including narrowband-UVB, broadband-UVB, PUVA photo- chemotherapy, and excimer laser therapy are valuable tools that can be used for photore- sponsive dermatoses in children. As a systematically safer alternative compared with internal agents, including the prebiologic and biological therapies, phototherapy should be considered a possible treatment option for children with diseases including psoriasis, atopic dermatitis, pityriasis lichenoides chronica, and vitiligo. Semin Cutan Med Surg 29:115-120 © 2010 Published by Elsevier Inc. hen choosing appropriate therapies for dermatologic adults. NBUVB represents a notable advance in phototherapy Wconditions in the pediatric population, clinicians and is considered more efficacious than BBUVB in the treat- must not only consider disease severity and morphology but ment of psoriasis, mycosis fungoides (MF), and vitiligo. also the general systemic safety profile of the treatment. For- NBUVB also has been increasingly tested in the pediatric tunately, many diseases, including psoriasis, atopic dermati- population as a therapy for diseases, including psoriasis, viti- tis, vitiligo, and pityriasis lichenoides, are photoresponsive ligo, pityriasis lichenoides, MF, and atopic dermatitis. dermatoses for which phototherapy represents an especially valuable treatment option. The pediatric population is a spe- Psoriasis cial population for whom it is important to avoid systemic agents and their associated potential risks whenever possible. Psoriasis is a chronic inflammatory skin disease that can be- Phototherapy represents a safe alternative for appropriately gin at any age and accounts for approximately 2% of visits to selected cases. There are 4 phototherapeutic options: nar- pediatric dermatologists. Most cases of childhood psoriasis rowband-UVB (NBUVB), broadband-UVB (BBUVB), psor- can be controlled with topical regimens, including emol- alen-UVA photochemotherapy (PUVA), and excimer laser lients, corticosteroids, coal tar, and vitamin D agents. How- therapy. This article aims to review which therapeutic mo- ever, some patients with a larger percentage of body surface dalities may be preferred for which light-responsive condi- area (BSA) involvement or more severe disease will require tions in the pediatric population. Phototherapeutic modali- other therapeutic options, including phototherapy. Further- ties will be discussed in the following order: NBUVB, BBUVB, more, children with extensive BSA involvement may not be PUVA, and monochromatic excimer laser. good candidates for topical therapy because of the associated potential systemic risks of applying topical steroids and other agents to such extensive surfaces. In general, UVB photother- NBUVB apy in combination with topical agents is the recommended NBUVB, ranging from 311 to 313 nm, is a safe and efficacious treatment option before systemic therapy, including retin- treatment option for several photoresponsive conditions in oids, methotrexate, cyclosporine, and biological agents. The optimal wavelength for the treatment of psoriasis has been found to be approximately 313 nm, leading to the de- *University of California, Irvine, School of Medicine, Irvine, CA. velopment of NBUVB phototherapy that emits a distinct †University of California, San Francisco, Department of Dermatology, Pso- 1 riasis and Skin Treatment Center. band of high-intensity UVB light at 311 to 313 nm. Al- Disclosure of competing interests Dr John Koo has been a clinical researcher, though PUVA still appears to be more efficacious than consultant, and speaker for Abbott, Allergan, Amgen, Astellas, Gal- NBUVB for psoriasis in head-to-head large comparison stud- derma, Genentech, JSJ, Photomedex, Roche, Warner-Chilcott, and ies, especially with respect to duration of treatment effect, Teikoku. NBUVB is much simpler to apply and perhaps more practical Address reprint requests to John Koo, MD, University of California, San 2 Francisco, Department of Dermatology, Psoriasis and Skin Treatment for use in the pediatric population. In general, NBUVB has Center, 515 Spruce Street, San Francisco, CA 94118. E-mail: proved to be more efficacious than BBUVB phototherapy, [email protected] leading to faster clearance of psoriatic plaques and inducing 1085-5629/10/$-see front matter © 2010 Published by Elsevier Inc. 115 doi:10.1016/j.sder.2010.03.006 116 R. Pugashetti and J. Koo longer remission periods.3 The mechanism of action of UVB cantly greater improvement (P Ͻ 0.05) in scaling, indura- light is multifaceted, including the ability to induce T-lym- tion, and clearance on the side of the body that was pretreated phocyte apoptosis, increase secretion of interleukin-10, and with mineral oil. Furthermore, the cumulative dosage needed diminish antigen presentation.4 for clearance of psoriatic plaques was significantly lower on The authors of one study5 treated 20 children who had the side pretreated with emollients. No adverse effects were psoriasis unresponsive to topical therapy with NBUVB 3 noted with respect to mineral oil or NBUVB phototherapy; times per week. The NBUVB dose was increased by 10% to however, it should be noted that this study was conducted in 20% per session; the dose was maintained and not increased India and all patients treated were Fitzpatrick skin type IV. if any erythema was detected. In this population, the median Thus, there may be potential risk of mineral oil-associated age was 13 years, with 80% of patients having plaque psori- burns in patients with fairer skin types. asis and 20% guttate psoriasis. Altogether, 69% of patients The long-term risk of NBUVB light in children has yet to be reached PASI 75 response (75% improvement in Psoriasis determined. Although it is clear that NBUVB can be an effi- Area and Severity Index) and 52% of patients achieved PASI cacious and safe short-term treatment option in children with 90 response after an average of 32 phototherapy treatment severe psoriasis, further prospective studies must be per- sessions. In most patients studied (70%), the remission pe- formed to evaluate the long-term risks of this therapy in riod was approximately 8 months. The major adverse event children. observed was erythema, which did not lead to discontinua- tion of therapy. Thus, most children had at least 75% im- Vitiligo provement in their psoriasis after 32 treatments; this number Vitiligo can be a challenging condition to treat in children would represent approximately 11 weeks of treatment at a because of a lack of markedly efficacious treatments and lim- phototherapy center. ited available data in pediatric patients. NBUVB may be a safe Pasic et al6 and Jury et al7 also studied the efficacy and and preferred treatment option for children with vitiligo be- safety of NBUVB in pediatric psoriasis patients with similarly cause it is generally well-tolerated with minimal side effects. small sample sizes of 20 and 35 patients, respectively. Pasic et As discussed below in the PUVA section, PUVA is also a al reported a PASI 70 response rate of 65% and a PASI 90 treatment option for vitiligo but may be considered second- response rate of 45%, after a mean number of 19 photother- line to NBUVB because of the concern regarding potential apy treatments; the PASI 75 response was not assessed.6 Jury increased skin cancer risks, especially in fair-skinned pa- et al reported a PASI 90 response rate of 63%.7 In another tients. small study, Kumar et al8 treated 20 pediatric psoriasis pa- In 20 children treated with NBUVB for vitiligo, 75% of tients with NBUVB. Approximately 60% of patients obtained patients achieved marked or complete repigmentation after a PASI 90 response, and no improvement was seen in 10% of an average 34 phototherapy treatments.12 In another study, patients after a median number of 24 sessions.8 In another NBUVB was used to treat 9 pediatric patients with either group of children with median age 12 years, NBUVB was localized or generalized vitiligo.9 Response, which was de- used to treat 28 pediatric patients with generalized guttate- fined as greater than 50% repigmentation, was achieved in type psoriasis.9 Response was defined as a greater than 75% 44% of those patients. The median number of treatments improvement in psoriasis (although PASI was not used to required for response was 14 but ranged widely among pa- measure response). Patients were treated 3 times per week, tients from 9 to 107 treatments. Thus, NBUVB can represent which was reduced to twice or once weekly once response a preferred treatment option for children with vitiligo. was reached. Altogether, 93% of patients responded. In gen- eral, plaque-type psoriasis required more treatment sessions compared with guttate psoriasis; the mean number of treat- Pityriasis lichenoides ments required for response was 36 in plaque-type psoriasis Pityriasis lichenoides is an acquired disorder affecting both compared with 16 treatments in guttate psoriasis. It is not children and young adults. Classification of this disease may clear, but perhaps the more indurated psoriatic plaques re- be controversial, and it may be considered on a spectrum quired more UVB irradiation compared with thinner, less ranging from pityriasis lichenoides chronica to pityriasis scaly guttate plaques. lichenoides et varioliformis acuta.13 In general, children with As an adjunct to treatment with NBUVB for psoriasis, min- pityriasis lichenoides may have
Load more

Recommended publications
  • Mutagenesis by 8-Methoxypsoralen and 5-Methylangelicin Photoadducts in Mouse Fibroblasts: Mutations at Cross-Linkable Sites Indu
    [CANCER RESEARCH 55, 1283-1288, March 15, 1995] Mutagenesis by 8-Methoxypsoralen and 5-Methylangelicin Photoadducts in Mouse Fibroblasts: Mutations at Cross-Linkable Sites Induced by Monoadducts as well as Cross-Links1 Edward J. Günther,Toni M. Yeasky, Francis P. Gasparro, and Peter M. Glazer2 Departments of Therapeutic Radiology ¡E.J. G., T. M. Y.. P. M. G.] and Dermatology ¡F.P. G.I, Yale University School of Medicine, New Haven, Connecticut 06520-8040 ABSTRACT center PUVA trial, Stem et al. (4) showed a statistically significant increase in the incidence of squamous cell carcinoma in PUVA Psoralens are used clinically in the treatment of several skin diseases, patients. A comparative analysis of the incidence of squamous cell including psoriasis, vitíligo,and cutaneous T cell lymphoma. However, psoralen treatment has been associated with an increased risk of squa- carcinoma in the U.S. and European trials was recently reported (5). nious cell carcinoma of the skin. To elucidate molecular events that may While in earlier comparisons there appeared to be differences between play a role in the psoralen-related carcinogenesis, we examined psoralen- the European and American experience with PUVA-induced inci induced mutagenesis in a mouse fibroblast cell line carrying a recoverable, dence of squamous cell carcinoma, the ongoing periodic reanalysis of chromosomally integrated A phage shuttle vector. Using the stipi- gene as each set of data with a longer follow-up period now indicates com a mutation reporter gene, we determined the spectrum of mutations parable findings. induced by photoactivation of 8-methoxypsoralen and of 5-methylangeli- It is likely that these cancers arise from the mutagenic psoralen cin.
    [Show full text]
  • Comparative Study of Therapeutic Efficacy of Puva, Nbuvb and Puvasol in the Treatment of Chronic Plaque Type Psoriasis
    COMPARATIVE STUDY OF THERAPEUTIC EFFICACY OF PUVA, NBUVB AND PUVASOL IN THE TREATMENT OF CHRONIC PLAQUE TYPE PSORIASIS Dissertation Submitted in Partial fulfillment of the University regulations for MD DEGREE IN DERMATOLOGY, VENEREOLOGY AND LEPROSY (BRANCH XX) MADRAS MEDICAL COLLEGE THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY CHENNAI, INDIA. APRIL 2013 CERTIFICATE Certified that this dissertation titled “COMPARATIVE STUDY OF THERAPEUTIC EFFICACY OF PUVA, NBUVB AND PUVASOL IN THE TREATMENT OF CHRONIC PLAQUE TYPE PSORIASIS” is a bonafide work done by Dr.R.AKILA, Post graduate student of the Department of Dermatology, Venereology and Leprosy, Madras Medical College, Chennai – 3, during the academic year 2010 – 2013. This work has not previously formed the basis for the award of any degree. Prof.Dr.K.MANOHARAN MD.,D.D., Professor and Head of the Department, Department of Dermatology, Madras Medical College& Rajiv Gandhi Govt.General Hospital,Chennai-3. Prof. Dr.V. KANAGASABAI, M.D., Dean, Madras Medical College& Rajiv Gandhi Govt. General Hospital,Chennai-3. DECLARATION I, Dr.R.AKILA solemnly declare that this dissertation titled “COMPARATIVE STUDY OF THERAPEUTIC EFFICACY OF PUVA, NBUVB AND PUVASOL IN THE TREATMENT OF CHRONIC PLAQUE TYPE PSORIASIS” is a bonafide work done by me at Madras Medical College during 2010-2013 under the guidance and supervision of Prof. K.MANOHARAN, M.D.,D.D., Professor and head of the department of Dermatology, Madras Medical College,Chennai-600003. This dissertation is submitted to The Tamil Nadu Dr.M.G.R.Medical University, Chennai towards partial fulfillment of the rules and regulations for the award of M.D Degree in Dermatology, Venereology and Leprosy (BRANCH – XX) PLACE : DATE : (Dr.
    [Show full text]
  • Light Therapy for Vitiligo
    MEDICAL COVERAGE GUIDELINES ORIGINAL EFFECTIVE DATE: 06/11/14 SECTION: MEDICINE LAST REVIEW DATE: LAST CRITERIA REVISION DATE: ARCHIVE DATE: LIGHT THERAPY FOR VITILIGO Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Medical Coverage Guideline must be read in its entirety to determine coverage eligibility, if any. The section identified as “Description” defines or describes a service, procedure, medical device or drug and is in no way intended as a statement of medical necessity and/or coverage. The section identified as “Criteria” defines criteria to determine whether a service, procedure, medical device or drug is considered medically necessary or experimental or investigational. State or federal mandates, e.g., FEP program, may dictate that any drug, device or biological product approved by the U.S. Food and Drug Administration (FDA) may not be considered experimental or investigational and thus the drug, device or biological product may be assessed only on the basis of medical necessity. Medical Coverage Guidelines are subject to change as new information becomes available. For purposes of this Medical Coverage Guideline, the terms "experimental" and "investigational" are considered to be interchangeable. BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. All other trademarks and service marks contained in this guideline are the property of their respective owners, which are not affiliated with BCBSAZ. Description: Vitiligo is an idiopathic skin disorder that causes depigmentation of sections of skin, most commonly on the extremities.
    [Show full text]
  • Light Therapy for Dermatologic Conditions
    Corporate Medical Policy Light Therapy for Dermatologic Conditions File Name: light_therapy_for_dermatologic_conditions Origination: 5/2012 Last CAP Review: 10/2020 Next CAP Review: 10/2021 Last Review: 10/2020 Description of Procedure or Service Light therapy for psoriasis and vitiligo includes both targeted phototherapy and photochemotherapy with psoralen plus ultraviolet A (PUVA). Targeted phototherapy describes the use of ultraviolet light that can be focused on specific body areas or lesions. PUVA uses a psoralen derivative in conjunction with long wavelength ultraviolet A (UVA) light (sunlight or artificial) for photochemotherapy of skin conditions. Psoriasis is a common chronic immune-mediated disease characterized by skin lesions ranging from minor localized patches to complete body coverage. There are several types of psoriasis; most common is plaque psoriasis which is associated with red and white scaly patches on the skin. In addition to being a skin disorder, psoriasis can negatively impact many organ systems and is associated with an increased risk of cardiovascular disease, some types of cancer, and autoimmune diseases such celiac disease and Crohn disease. Psoralens are tricyclic furocoumarins that occur in certain plants and can also be synthesized. They are available in oral and topical forms. Oral PUVA is generally given 1.5 hours before exposure to UVA radiation. Topical PUVA therapy refers to directly applying the psoralen to the skin with subsequent exposure to UVA light. Bath PUVA is used in some European countries for generalized psoriasis, but the agent used, trimethylpsoralen, is not approved by the U.S. Food and Drug Administration (FDA). Paint PUVA and soak PUVA are other forms of topical application of psoralen and are often used for psoriasis localized to the palms and soles.
    [Show full text]
  • Bath-Water PUVA Therapy with 8-Methoxypsoralen in Mycosis Fungoides
    Acta Derm Venereol 2005; 85: 329–332 CLINICAL REPORT Bath-water PUVA Therapy with 8-Methoxypsoralen in Mycosis Fungoides Florian WEBER, Matthias SCHMUTH, Norbert SEPP and Peter FRITSCH Clinical Department of Dermatology and Venereology, Medical University of Innsbruck, Innsbruck, Austria PUVA therapy is widely used for early stage mycosis psoriasis showed that bath-water PUVA is as effective as fungoides. While the efficacy of PUVA with oral 8- oral PUVA but requires less cumulative UVA (12, 21, 22). methoxypsoralen (8-MOP) is well documented, the use of To the best of our knowledge, there is only a single report its topical variation, bath-water PUVA therapy with 8- on bath-water PUVA in MF in which trimethylpsoralen MOP has not been studied. The purpose of this study was (TMP) was used instead of 8-MOP (23). The main to assess the effect of 8-MOP bath-water PUVA therapy advantage of bath-water PUVA therapy over oral in adult patients with early stage mycosis fungoides. We PUVA therapy is the avoidance of relevant systemic retrospectively evaluated the outcomes of bath-water absorption, thus diminishing the risk of systemic side delivery of 8-MOP (1 mg l21) in 16 patients with early effects. Cataract development is a problem in oral, but not stage mycosis fungoides. In all patients complete response in topical PUVA therapy. Nausea is a frequent and was achieved after a mean duration of 63 days requiring sometimes limiting side effect of oral 8-MOP. Some 29 treatments and a mean cumulative UVA dose of patients fail to respond to oral PUVA therapy because 33 J cm22.
    [Show full text]
  • The Conundrum of Parapsoriasis Versus Patch Stage of Mycosis Fungoides
    View TThehe cconundrumonundrum ofof parapsoriasisparapsoriasis versusversus patchpatch stagestage Point ooff mmycosisycosis ffungoidesungoides KK.. NN.. SSarveswari,arveswari, PPatrickatrick YYesudianesudian Sundaram Medical Foundation, ABSTRACT Dr. Rangarajan Memorial Hospital, Chennai, Tamilnadu, Terminological confusion with benign dermatosis, such as parapsoriasis en plaques, makes India it difÞ cult to diagnose mycosis fungoides in the early patch stage. Early diagnosis of mycosis fungoides (MF) is important for deciding on type of therapy, prognosis and for further follow-up. Address for correspondence: Dr. K. N. Sarveswari, However, until recently, there has been no consensus on criteria that would help in diagnosing Sundaram Medical the disease early. Some believe that large plaque parapsoriasis (LPP) should be classiÞ ed Foundation, Dr. Rangarajan with early patch stage of MF and should be treated aggressively. However, there is no Þ rm Memorial Hospital, Shanthi clinical or laboratory criteria to predict which LPP will progress to MF and we can only discuss Colony - IV Avenue, Anna about statistical probability. Moreover, long-term outcome analysis of even patch stage of MF Nagar, Chennai - 600 040, Tamilnadu, India. is similar to that of control population. We therefore believe that LPP should be considered E-mail: sarveswari@ as a separate entity at least to prevent the patient from being given a frightening diagnosis. smfhospital.org We also feel that patients need not be treated with aggressive therapy for LPP and will need
    [Show full text]
  • PUVA Phototherapy
    Dermatol Ther (Heidelb) (2016) 6:315–324 DOI 10.1007/s13555-016-0130-9 PATIENT GUIDE The Patient’s Guide to Psoriasis Treatment. Part 2: PUVA Phototherapy Benjamin Farahnik . Mio Nakamura . Rasnik K. Singh . Michael Abrouk . Tian Hao Zhu . Kristina M. Lee . Margareth V. Jose . Renee DaLovisio . John Koo . Tina Bhutani . Wilson Liao Received: May 6, 2016 / Published online: July 29, 2016 Ó The Author(s) 2016. This article is published with open access at Springerlink.com ABSTRACT have shown that patients who viewed videos explaining the treatment procedures for various Background: PUVA treatment is medical conditions had a greater understanding photochemotherapy for psoriasis that of their treatment and were more active combines psoralen with UVA radiation. participants in their health. Although PUVA is a very effective treatment Objective: To present a freely available online option for psoriasis, there is an absence of guide and video on PUVA treatment designed patient resources explaining and for patient education on PUVA. demonstrating the process of PUVA. Studies Methods: The PUVA treatment protocol used at Enhanced content To view enhanced content for this the University of California—San Francisco article go to http://www.medengine.com/Redeem/ Psoriasis and Skin Treatment Center as well as C9D4F0600C816B7E. available information from the literature was B. Farahnik (&) reviewed to design a comprehensive guide for College of Medicine, University of Vermont, patients receiving PUVA treatment. Burlington, VT, USA e-mail: [email protected] Results: We created a printable guide and video resource that reviews the benefits and risks of M. Nakamura Á K. M. Lee Á M.
    [Show full text]
  • Ultraviolet Light Therapy for Skin Conditions Page 1 of 27
    Ultraviolet Light Therapy for Skin Conditions Page 1 of 27 Medical Policy An Independent licensee of the Blue Cross Blue Shield Association Title: Ultraviolet Light Therapy for Skin Conditions Professional Institutional Original Effective Date: September 28, 2014 Original Effective Date: September 28, 2014 Revision Date(s): September 28, 2014; Revision Date(s): September 28, 2014; February 4, 2015; April 28, 2015; February 4, 2015; April 28, 2015; May 28, 2015; October 1, 2015; May 28, 2015; October 1, 2015; March 2, 2016; January 18, 2017; March 2, 2016; January 18, 2017; January 30, 2018; February 1, 2019; January 30, 2018; February 1, 2019; May 23, 2021 May 23, 2021 Current Effective Date: May 23, 2021 Current Effective Date: May 23, 2021 State and Federal mandates and health plan member contract language, including specific provisions/exclusions, take precedence over Medical Policy and must be considered first in determining eligibility for coverage. To verify a member's benefits, contact Blue Cross and Blue Shield of Kansas Customer Service. The BCBSKS Medical Policies contained herein are for informational purposes and apply only to members who have health insurance through BCBSKS or who are covered by a self-insured group plan administered by BCBSKS. Medical Policy for FEP members is subject to FEP medical policy which may differ from BCBSKS Medical Policy. The medical policies do not constitute medical advice or medical care. Treating health care providers are independent contractors and are neither employees nor agents of Blue Cross and Blue Shield of Kansas and are solely responsible for diagnosis, treatment and medical advice.
    [Show full text]
  • Phototherapy, Photochemotherapy, and Excimer Laser Therapy for Dermatologic Conditions
    Medical Coverage Policy Effective Date ............................................. 9/15/2021 Next Review Date ....................................... 9/15/2022 Coverage Policy Number .................................. 0031 Phototherapy, Photochemotherapy, and Excimer Laser Therapy for Dermatologic Conditions Table of Contents Related Coverage Resources Overview .............................................................. 1 Extracorporeal Photopheresis Coverage Policy ................................................... 1 General Background ............................................ 4 Medicare Coverage Determinations .................. 17 Coding/Billing Information .................................. 17 References ........................................................ 18 INSTRUCTIONS FOR USE The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. References to standard benefit plan language and coverage determinations do not apply to those clients. Coverage Policies are intended to provide guidance in interpreting certain standard benefit plans administered by Cigna Companies. Please note, the terms of a customer’s particular benefit plan document [Group Service Agreement, Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may differ significantly from the standard benefit plans upon which these Coverage
    [Show full text]
  • 059 BCBSA Reference Number: 2.01.47; 2.01.86
    Medical Policy Phototherapy: PUVA, UV-B and Targeted Phototherapy Table of Contents • Policy: Commercial • Coding Information • Information Pertaining to All Policies • Policy: Medicare • Description • References • Authorization Information • Policy History • Endnotes Policy Number: 059 BCBSA Reference Number: 2.01.47; 2.01.86 Related Policies Dermatologic Applications of Photodynamic Therapy, #463 Policy Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity Medicare HMO BlueSM and Medicare PPO BlueSM Members Photochemotherapy with psoralen plus ultraviolet A (PUVA) - OFFICE SETTING PUVA treatment for the following conditions may be considered MEDICALLY NECESSARY: • Parapsoriasis • Atopic dermatitis/ Eczema • Lichen planus • Urticaria pigmentosa • Chronic recalcitrant dermatitis • Pruritus • Dyshidrosis • pityriasis lichenoides chronica • Alopecia areata (if conservative treatment has failed) • Vitiligo. PUVA for the treatment of severe, disabling psoriasis, which is not responsive to other forms of conservative therapy (eg, topical corticosteroids, coal/tar preparations, and ultraviolet light), may be considered MEDICALLY NECESSARY.5 PUVA treatment as initial (primary) treatment for mycosis fungoides stage I (early infiltrative) and stage II (infiltrative plaques) may be considered MEDICALLY NECESSARY. PUVA treatment is INVESTIGATIONAL for other conditions not listed above. 1 Relative Contraindications to PUVA Therapy1 The following are relative contraindications to PUVA therapy. Coverage is determined at the physician’s
    [Show full text]
  • Tracing the Photoaddition of Pharmaceutical Psoralens to DNA
    molecules Article Tracing the Photoaddition of Pharmaceutical Psoralens to DNA Janina Diekmann , Isabell Theves , Kristoffer A. Thom and Peter Gilch * Institut für Physikalische Chemie, Heinrich-Heine-Universität Düsseldorf, Universitätsstr. 1, 40225 Düsseldorf, Germany; [email protected] (J.D.); [email protected] (I.T.); kristoff[email protected] (K.A.T.) * Correspondence: [email protected] Received: 30 September 2020; Accepted: 7 November 2020; Published: 10 November 2020 Abstract: The psoralens 8-methoxypsoralen (8-MOP), 4,50,8-trimethylpsoralen (TMP) and 5-methoxypsoralen (5-MOP) find clinical application in PUVA (psoralen + UVA) therapy. PUVA treats skin diseases like psoriasis and atopic eczema. Psoralens target the DNA of cells. Upon photo-excitation psoralens bind to the DNA base thymine. This photo-binding was studied using steady-state UV/Vis and IR spectroscopy as well as nanosecond transient UV/Vis absorption. The experiments show that the photo-addition of 8-MOP and TMP involve the psoralen triplet state and a biradical intermediate. 5-MOP forms a structurally different photo-product. Its formation could not be traced by the present spectroscopic technique. Keywords: psoralen; 8-MOP; TMP; 5-MOP; DNA damage; PUVA; photochemistry; UV/Vis spectroscopy; IR spectroscopy; time-resolved spectroscopy 1. Introduction The light-dependent PUVA (psoralen + UVA) therapy is a well-established symptomatic treatment of skin diseases like psoriasis [1,2], atopic eczema [3], vitiligo [4,5] and cutaneous T-cell lymphoma [6,7]. In the treatment, patients are administered psoralen derivatives and the affected skin regions are exposed to UVA radiation [8]. Concerning the molecular mechanism of the therapy, it was shown that the uptake of psoralens in the cellular nuclei is the first step [9].
    [Show full text]
  • UV-B Therapy for Small Plaque Parapsoriasis and Early-Stage Mycosis Fungoides
    OBSERVATION Narrowband (311-nm) UV-B Therapy for Small Plaque Parapsoriasis and Early-Stage Mycosis Fungoides Angelika Hofer, MD; Lorenzo Cerroni, MD; Helmut Kerl, MD; Peter Wolf, MD Background: Broadband UV-B phototherapy has been (range, 7.4-36.4 J/cm2) within a mean time of 6 weeks used for many years in the treatment of small plaque para- (range, 5-10 weeks). Biopsy specimens taken immedi- psoriasis (SPP) and early-stage mycosis fungoides (MF). ately after the end of phototherapy showed only sparse Our purpose was to investigate the effect on these dis- inflammatory infiltrates but no signs of SPP or MF. Re- eases of narrowband (311-nm) UV-B therapy, which was lapses at cutaneous sites occurred in all patients within recently established for the treatment of psoriasis and a mean time of 6 months (range, 2-15 months). found to be more effective than broadband UV-B therapy. Conclusions: Narrowband UV-B therapy is an effective Observations: Twenty patients (5 women, 15 men; age short-term treatment modality for clearing SPP and early- range, 39-85 years) with histologically confirmed SPP or stage MF. However, the treatment response did not sus- early-stage MF were enrolled. Six patients had early- tain long-term remission. Further studies are necessary stage MF (patch stage), and 14 had SPP. Treatment with to examine how the clinical response to and follow-up 311-nm UV-B was given 3 to 4 times a week for 5 to 10 after narrowband UV-B therapy compares with that of weeks. In 19 patients, lesions completely cleared after a established phototherapy modalities in these diseases.
    [Show full text]