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

Chronic graft-versus-host disease (cGVHD) is a common complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT), which is also one of the major causes of patients' death following transplantation. Recently, extracorporeal photochemotherapy (ECP) has shown a considerable efficacy in cGVHD treatment, which is based on the infusion of autologous peripheral blood mononuclear cells collected by aphesis, incubated with the photoactivable drug 8-methoxypsoralen (8-MOP) and UV-A irradiation. The therapeutic effect of ECP is mainly achieved by the induction of cell apoptosis, influencing the function of dendritic cells and the induction of immune tolerance. ECP has many advantages in the treatment of cGVHD, such as no increasing the risk of infection in patients, unaffecting the graft-versus-leukemia effect, nearly no side effect and so on. Many medical centers have done a lot of research on the treatment of cGVHD in both children and adults by using ECP and achieved good results. CD19(+) CD21(-) B lymphocytes, serum BAFF and serum TNFα can be used to measure and early evaluate the efficacy of ECP treatment. The effect of ECP is associated with many factors, and certain complications may occur during the treatment. At present, the application of ECP treatment is limited by the unclear mechanisms, varying treatment cycles in different studies, and small number of patients in clinical research. In the near future, with deeper basic research, increasing the case number and standard clinical treatment, ECP will have a more extensive application prospects. This review focuses mainly on the clinical advances of ECP in the treatment of cGVHD.
Apoptosis ; Graft vs Host Disease ; Humans ; Leukocytes, Mononuclear ; Photochemotherapy ; Photopheresis ; Ultraviolet Rays

OBJECTIVETo evaluate the efficacy and safety of topical PUVA treatment of refractory lesions of mycosis fungoides.

METHODSFrom January 2008 to 2014, a total of 10 patients (4 males and 6 females) with mycosis fungoides were treated with topical PUVA in Peking Union Medical College Hospital, including 7 cases in plaque stage and 3 cases in tumor stage. The average number of lesions were 1.9±0.9. The median age of these patients was (46.0±9.4) years. The average course of disease was (12.4±7.7) years. Psoralen was applied topically on treatment area 30 min before total body UVA irradiation treatment, 3 times a week. And the efficiency and safety of the therapy were evaluated.

RESULTSAll the patients were treated with topical PUVA with a median total dose of (161.60±135.96) J/cm2 in an average of (18.10±14.61) fractions. Total dose of UVA was (1 953.25±829.73) J/cm2, and total number of treatment was (261.90±116.79) fractions. The total treatment time was (45.80±26.64) months. Complete clinical response (CR) rate was 60.0%, partial response (PR) rate was 30.0%, and the overall response rate (CR+PR) was 90.0%. One patient showed no response. No severe acute or chronic side effects were observed.

CONCLUSIONTopical PUVA therapy is effective in the treatment of refractory lesions of mycosis fungoides with little severe side effects.

Adult ; Female ; Ficusin ; therapeutic use ; Humans ; Male ; Middle Aged ; Mycosis Fungoides ; drug therapy ; pathology ; PUVA Therapy ; Photosensitizing Agents ; therapeutic use ; Treatment Outcome

Pigmented purpuric dermatosis (PPD) represents a group of cutaneous lesions exhibiting petechiae, pigmentation, and occasionally telangiectasia in the absence of an associated venous insufficiency or hematological disorder. PPD may resolve spontaneously but tends to persist for months to years. Various treatment modalities such as oral griseofulvin, pentoxifylline, cyclosporine, ascorbic acid, topical corticosteroids, and PUVA therapy have been used with unsatisfactory results. Recently, some studies reported that PPD showed a dramatic response to narrowband ultraviolet B (UVB) phototherapy. In these studies, narrowband UVB phototherapy was an effective treatment method with few side effects. Here, we present the case of a 7-year-old boy with generalized PPD that improved rapidly following narrowband UVB phototherapy.
Adrenal Cortex Hormones ; Ascorbic Acid ; Child* ; Cyclosporine ; Griseofulvin ; Humans ; Male ; Pentoxifylline ; Phototherapy* ; Pigmentation ; Purpura ; PUVA Therapy ; Skin Diseases* ; Telangiectasis ; Venous Insufficiency

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