Riboflavin-ultraviolet A (UVA) collagen cross-linking has not only achieved good clinical efficacy in the treatment of corneal diseases such as dilatation keratopathy, bullae keratopathy, infectious keratopathy, and in the combined treatment of corneal refractive surgeries, but also its efficacy and safety in scleral collagen cross-linking have been initially confirmed. To better promote the application of cross-linking in the clinical treatment of corneal and scleral diseases, exploring controllability and predictability of the surgical efficacy are both important for evaluating the surgical efficacy and personalized precision treatment. In this paper, the progress on the cross-linking depth of riboflavin-UVA collagen cross-linking, and its relationship with the cross-linking effect will be reviewed. It will provide the reference for further application of this procedure in ophthalmology clinics.
Riboflavin/pharmacology* ; Humans ; Collagen/radiation effects* ; Ultraviolet Rays ; Cross-Linking Reagents ; Corneal Diseases/drug therapy* ; Photosensitizing Agents/therapeutic use*

INTRODUCTION

Excimer light is a targeted phototherapy that uses 308-nanometer wavelength ultraviolet radiation to treat photoresponsive dermatoses such as psoriasis, vitiligo, and alopecia areata. Ideally, the minimal erythema dose (MED) should be determined to guide the initial treatment dose. However, due to convenience, estimation based on skin phototype is more commonly used.

OBJECTIVES

To determine the MED to excimer light in adult Filipinos using a visual erythema scale.

MATERIALS AND METHODS

A prospective interventional, cross-sectional study was conducted among adult Filipinos in a tertiary government hospital in the Philippines. Participants underwent phototesting with six incremental doses of excimer light. MED was defined as the lowest dose that produced uniform, well-defined erythema over the exposed area. Descriptive statistics summarized clinicodemographic data, MED, and adverse events. Fisher’s exact test assessed associations between MED, sex, and skin type.

RESULTS

A total of 149 adult Filipinos with Fitzpatrick skin types III to V were enrolled. MED values ranged from 150 to 400 mJ/cm2, with 200 mJ/cm² being the median and mode (33.56%). No association was found between MED and skin phototype. Sex correlated with MED, with females having higher MEDs than males.

CONCLUSIONS

The median MED was 200 mJ/cm2 in Filipino patients with skin types III to V. This may serve as the initial starting dose for phototherapy (except in vitiliginous skin). With the variation in the MED within the population, MED determination is still the ideal method to identify the most appropriate initial treatment dose.

Human ; Phototherapy ; Ultraviolet Therapy

Porokeratosis is a rare epidermal disorder characterized by annular or linear hyperkeratotic plaques with slightly raised thread-like borders, and in most cases, atrophic centers. Disseminated superficial porokeratosis and disseminated superficial actinic porokeratosis (DSAP), which primarily involve sun-exposed areas, are common types of porokeratoses. Histologically, a column of parakeratotic cells, a so-called cornoid lamella, is a hallmark of porokeratosis. Porokeratosis is considered to result from the inability to eliminate an abnormal keratinocyte clone induced by genetic factors and various stimuli, including sunlight, artificial ultraviolet light, viral infections, immunosuppressive conditions (hematologic malignancies, organ transplants, or autoimmune disease), and immunosuppressive therapies. Here, we report a 59-year-old Korean woman with DSAP that developed after narrowband ultraviolet B (NB-UVB) therapy for psoriasis. Our case emphasizes the occurrence of DSAP due to NB-UVB that is able to induce local immunosuppression at the irradiated site; the pathogenesis of DSAP remains unclear.
Clone Cells ; Female ; Humans ; Immunosuppression ; Keratinocytes ; Middle Aged ; Phototherapy* ; Porokeratosis* ; Psoriasis* ; Sunlight ; Transplants ; Ultraviolet Rays ; Ultraviolet Therapy

Discoid lupus erythematosus (DLE) is a chronic form of cutaneous lupus that can cause permanent scarring. Treatment of DLE includes protection from sunlight and artificial sources of ultraviolet light, as well as systemic and topical medications. The first-line standard therapies are antimalarials and topical steroids. Other systemic therapies include systemic steroid, azathioprine, dapsone, and immunosuppressive agents. Topical tacrolimus and pimecrolimus have also been evaluated. Recent studies reported that several treatments, including pulsed dye laser, CO₂ laser, intense pulsed light (IPL), and 1,064-nm long-pulse neodymium-doped yttrium aluminum (Nd:YAG) have been used for the cosmetic treatment of DLE. Here, we report a case of a DLE scar that was successfully treated with a combination therapy of IPL and Q-switched 1,064-nm Nd:YAG laser.
Aluminum* ; Antimalarials ; Azathioprine ; Cicatrix* ; Dapsone ; Immunosuppressive Agents ; Intense Pulsed Light Therapy ; Lasers, Dye ; Lupus Erythematosus, Discoid* ; Steroids ; Sunlight ; Tacrolimus ; Ultraviolet Rays ; Yttrium*

Secondary cutaneous amyloidosis refers to clinically unapparent amyloid deposits within the skin in association with a pre-existing skin condition or skin tumors, such as basal cell carcinoma, porokeratosis, solar elastosis, Bowen's disease, and mycosis fungoides. A 70-year-old woman presented with a 6-month history of asymptomatic multiple yellowish plaques on both legs. She had been diagnosed with mycosis fungoides 7 years ago and was treated with psoralen and ultraviolet A radiation (PUVA) therapy, narrow-band ultraviolet B (UVB) therapy, and acitretin for 5 years. Finally, she reached complete remission of mycosis fungoides. However, new yellowish lesions started to appear 1 year after discontinuing the phototherapy. A physical examination revealed multiple yellowish plaques on both extremities. The plaques were well circumscribed and slightly elevated. All laboratory tests were normal. A biopsy specimen showed multiple nodular deposits of eosinophilic amorphous material in papillary dermis and upper reticular dermis. The deposits represented apple green birefringence on Congo red stain viewed under polarized light. Acellular small nodules in the upper dermis consisted of randomly oriented, non-branching, 6.67~12.7 nm thick amyloid fibrils on electron microscopy. We report an interesting and rare case of secondary cutaneous amyloidosis after narrow-band UVB therapy and PUVA therapy in a patient with mycosis fungoides.
Acitretin ; Aged ; Amyloid ; Amyloidosis* ; Biopsy ; Birefringence ; Bowen's Disease ; Carcinoma, Basal Cell ; Congo Red ; Dermis ; Eosinophils ; Extremities ; Female ; Ficusin ; Humans ; Leg ; Microscopy, Electron ; Mycosis Fungoides* ; Phototherapy ; Physical Examination ; Plaque, Amyloid ; Porokeratosis ; PUVA Therapy ; Skin ; Ultraviolet Therapy

Secondary cutaneous amyloidosis refers to clinically unapparent amyloid deposits within the skin in association with a pre-existing skin condition or skin tumors, such as basal cell carcinoma, porokeratosis, solar elastosis, Bowen's disease, and mycosis fungoides. A 70-year-old woman presented with a 6-month history of asymptomatic multiple yellowish plaques on both legs. She had been diagnosed with mycosis fungoides 7 years ago and was treated with psoralen and ultraviolet A radiation (PUVA) therapy, narrow-band ultraviolet B (UVB) therapy, and acitretin for 5 years. Finally, she reached complete remission of mycosis fungoides. However, new yellowish lesions started to appear 1 year after discontinuing the phototherapy. A physical examination revealed multiple yellowish plaques on both extremities. The plaques were well circumscribed and slightly elevated. All laboratory tests were normal. A biopsy specimen showed multiple nodular deposits of eosinophilic amorphous material in papillary dermis and upper reticular dermis. The deposits represented apple green birefringence on Congo red stain viewed under polarized light. Acellular small nodules in the upper dermis consisted of randomly oriented, non-branching, 6.67~12.7 nm thick amyloid fibrils on electron microscopy. We report an interesting and rare case of secondary cutaneous amyloidosis after narrow-band UVB therapy and PUVA therapy in a patient with mycosis fungoides.
Acitretin ; Aged ; Amyloid ; Amyloidosis* ; Biopsy ; Birefringence ; Bowen's Disease ; Carcinoma, Basal Cell ; Congo Red ; Dermis ; Eosinophils ; Extremities ; Female ; Ficusin ; Humans ; Leg ; Microscopy, Electron ; Mycosis Fungoides* ; Phototherapy ; Physical Examination ; Plaque, Amyloid ; Porokeratosis ; PUVA Therapy ; Skin ; Ultraviolet Therapy

Disseminated superficial actinic porokeratosis, a variant of porokeratosis, is an uncommon, hereditary or acquired keratinization disorder. It is characterized histologically by cornoid lamella and clinically by central atrophy with elevated borders. Porokeratosis lesions may be triggered by UV light exposure, infection, hematopoietic malignancies, or immunosuppression, but are rarely reported associated with malignancies of visceral organs. We herein report an unusual case of a patient with colon cancer who noted sudden exacerbation of a previously unrecognized disseminated superficial actinic porokeratosis lesion after being treated with chemotherapy.
Atrophy ; Colon* ; Colonic Neoplasms* ; Drug Therapy ; Hematologic Neoplasms ; Humans ; Immunosuppression ; Porokeratosis* ; Ultraviolet Rays

Psoriasis vulgaris and bullous pemphigoid represent 2 clinically and histologically distinct, chronic inflammatory skin conditions. The concomitant occurrence of these 2 diseases is rare, and the pathogenic relationship between psoriasis and bullous pemphigoid remains unclear. The development of bullous pemphigoid in patients with psoriasis is considered to be related to treatments for psoriasis, especially ultraviolet therapy. However, some recent reports have suggested that an immunologic or biochemical association between these two diseases plays a role in the pathogenesis. Herein, we report 3 cases of bullous pemphigoid occurring in patients with psoriasis, and we discuss the possible pathogenic mechanisms of an association between psoriasis and bullous pemphigoid.
Humans ; Pemphigoid, Bullous* ; Psoriasis* ; Skin ; Ultraviolet Therapy

OBJECTIVETo observe the effect of electroacupuncture (EA) combined with ultraviolet therapy on herpes zoster at the acute stage and the impacts on serum interleukin 2 (IL-2), interleukin 6 (IL-6) and interleukin 10 (IL-10) in the patients.

METHODSThirty-four patients of herpes zoster were randomized into a medicine group and a combined therapy group, 17 cases in each one. In the medicine group, the intravenous drops with acyclovir injection, muscular injection with cobamamide and the topical with acyclovir ointment were applied. Additionally, TDP was radiated locally. In the combined therapy group, on the basis of the treatment as the medicine group, EA and ultraviolet therapy were supplemented. The duration of treatment was 10 days in the two groups. Before and after treatment, blister relief, incrustation time and the visible analogue scale (VAS) were recorded in the two groups. The clinical efficacy was assessed in the two groups and the levels of serum IL-2, IL-6 and IL-10 were determined in the two groups.

RESULTSIn the combined therapy group, the time of blister relief and incrustation was earlier apparently than that in the medicine group (both P<0.05). VAS score after treatment were reduced as compared with that before treatment in the two groups (both P<0.01), and the reducing amplitude in the combined therapy group was larger than that in the medicine group (P<0.01). The total effective rate was 94. 1% (16/17) in the combined therapy group, higher than 76.4% (13/17) in the medicine group (P<0.05). After treatment, IL-2 levels were increased as compared with those before treatment in the two groups (both P<0.05), the levels of IL-6 and IL-10 were reduced obviously as compared with those before treatment in the two groups (all P<0.01). After treatment, the levels of IL-6, IL-10 were reduced much more apparently in the combined therapy group as compared with those in the medicine group (both P<0.05).

CONCLUSIONEA combined with ultraviolet irradiation more rapidly and effectively relief the symptoms of herpes zoster, significantly relief pain, shorten the duration of sickness, improve the body immunity and reduce nerve injury.

Acyclovir ; administration & dosage ; Adult ; Combined Modality Therapy ; Electroacupuncture ; Female ; Herpes Zoster ; blood ; drug therapy ; therapy ; Humans ; Interleukin-10 ; blood ; Interleukin-2 ; blood ; Interleukin-6 ; blood ; Male ; Middle Aged ; Treatment Outcome ; Ultraviolet Therapy

OBJECTIVEOnly a few clinical reports in the treatment of early mycosis fungoides (MF)(IA, IB, IIA stage) are available in the literature. The purpose of this study was to compare the efficacy and safety of narrow-band UVB and psoralen plus ultraviolet A (PUVA) photochemoterapy in 24 patients with early-stage MF, and explore a new approach for the treatment of early mycosis fungoides.

METHODSA total of 24 identified early mycosis fungoides patients received PUVA, NB-UVB and a combined therapy of PUVA followed by NB-UVB (n = 9/6/9) irradiation. A retrospective study was carried out to analyze the sex, age of onset, TNM stage, treatment, and duration of treatment, and times of treatment, duration of maintenance treatment, effective and recurrence in these patients. The data were analyzed using SPSS 17.0 and a two-sided test at the α = 0.05 level of significance was conducted.

RESULTSOf the 24 patients studied, the average treatment was 104.5 (95% CI, 75.71-133.29) times. The average duration of treatment was 12.88 (95% CI, 9.90-15.85) months. The average maintenance treatment time was 11.08 (95% CI, 2.13-20.04) months. The effective rate (CR+PR) of PUVA treatment was 88.9%, recurrence rate was 11.1% (n = 9). In the NB-UVB treatment group, the effective rate was 100.0%, and the recurrence rate was 33.3% (n = 6). In the PUVA followed by NB-UVB (combination therapy) treatment group, the effective rate was 77.8% and the recurrence rate was 55.6% (n = 9). There were no significant differences among the three groups in terms of number of treatments, treatment duration, maintenance treatment duration, effective rate and recurrence rate (P > 0.05).

CONCLUSIONSPUVA and NB-UVB are effective and safe in the targeted therapy of early stage mycosis fungoides. The combined therapy of PUVA followed by NB-UVB can reduce the total PUVA dose and risk of developing skin cancer.

Combined Modality Therapy ; methods ; Ficusin ; Humans ; Mycosis Fungoides ; therapy ; Neoplasm Recurrence, Local ; PUVA Therapy ; Photochemotherapy ; Physical Examination ; Retrospective Studies ; Treatment Outcome ; Ultraviolet Therapy