BACKGROUND

Narrow-band ultraviolet B (NB-UVB) phototherapy is a mainstay in the treatment of psoriasis, with dosage related to the minimal erythema dose (MED), with initial dose at 50-70%, followed by dose increments.

OBJECTIVE

To determine the MED of Filipino adult patients with psoriasis using NB-UVB phototherapy at a tertiary government hospital.

METHODOLOGY

This is an analytical, observational, cross-sectional study with prospective data collection among Filipino adults with psoriasis, at Dr. Jose N. Rodriguez Memorial Hospital and Sanitarium, from March 2023 to June 2024. Participants underwent MED determination using NB-UVB phototherapy cabinet. MED was defined as the square with definite redness, very light pink, or faintly detectable erythema over the entire exposed site after 24 hours. Clinicodemographic information were gathered and analyzed for possible associations with obtained MED.

RESULTS

Forty-eight participants were enrolled with MED as follows: 600 mJ/cm² (47.92%), 800 mJ/cm² (25%), 1000 mJ/cm² (12.50%), 1200 mJ/cm² (10.42%), and 400 mJ/cm² (4.17%). Age appeared to be directly proportional to MED dose (p-value =0.047). A statistically significant association of having lower MED values (p=0.017) were observed in patients with concomitant diabetes mellitus. Sex, Fitzpatrick skin type, psoriasis severity, and the body site used for testing, had no association with obtained MED values.

CONCLUSION

The median MED was 600 mJ/cm². Based on this, the suggested initial dosage of NB-UVB at 50-70% is 300-420 mJ/cm². These findings demonstrate that the current starting dose being used at DJNRMHS can either be maintained at 300 mJ/cm² or can be safely increased up to 420 mJ/cm².

Human ; Phototherapy ; Psoriasis

Infantile hemangiomas are known to be the most common tumors of childhood. These vascular tumors have a distinctive clinical course characterized by a proliferation phase (early and late), followed by a plateau phase and lastly the involution phase. Despite the ability to involute, certain complications, ulcerations being the most common, indicate prompt treatment. Early intervention during the proliferative phase with oral propranolol has been emphasized to achieve an optimum outcome. In this case, a 7-month-old infant presented with a 4.4cm by 3.2cm infantile hemangioma (IH) with ulceration on the left intergluteal area during the late proliferative phase. Prior to propranolol treatment, routine laboratory workup, 21-lead electrocardiogram and ultrasound of the kidneys, ureter and bladder were done, revealing unremarkable results. The patient was referred to a Pediatric Cardiologist and assessment deemed no contraindications for beta-blocker treatment. That patient was placed on a 12-hour day admission for the initiation of oral propranolol at a starting dose of l.0mg/kg/dose and was later discharged, stable, at 1.5mg/kg/dose. Escalation of doses were done by 0.5 every 2 weeks under close supervision on subsequent follow-ups via telemedicine. Four months following the initiation of propranolol treatment regression of the size of the lesion with residual fibrosis were observed. Oral propranolol appears to be an effective and safe therapeutic approach for ulcerated infantile hemangiomas, even during the late proliferative phase. Results achieved significant contraction and resolution of the ulceration and rapid involution of the lesion.

Human ; Female ; Infant: 1-23 Months ; Hemangioma ; Propranolol