Photodermatology, photoimmunology & photomedicine最新文献

Background/purpose: While biologics and small-molecule inhibitors are first-line systemic treatments for psoriasis, phototherapy remains an alternative for patients unable to access these treatments because of medical or financial constraints. Narrow-band ultraviolet B (NB-UVB) is effective for localized psoriasis but less so for extensive disease. To address this limitation, bathwater delivery of psoralen plus ultraviolet A (bath-PUVA) was introduced in 2004. This study evaluates the efficacy, safety, and patient characteristics associated with bath-PUVA therapy in a large cohort.

Methods: This retrospective analysis included 229 patients (180 males, 49 females) treated with bath-PUVA from 2004 to September 2021. Baseline characteristics and treatment outcomes were assessed using the psoriasis area and severity index (PASI). Statistical analyses examined relationships between treatment outcomes and factors, including baseline PASI, body mass index (BMI), and smoking status.

Results: The mean baseline PASI score was 24.9. Bath-PUVA achieved PASI 75 in 80.4% of patients, PASI 90 in 44.1%, and PASI 100 in 2.6%, with efficacy comparable to biologics. Patients achieving PASI 90 had significantly higher baseline PASI scores (p = 0.005), while the number of irradiations required did not differ (p = 0.692). Higher baseline PASI scores correlated with elevated BMI (p = 0.002), but BMI did not influence improvement rates (p = 0.094). Smokers had significantly higher baseline PASI scores (p = 0.004) compared with non-smokers, yet smoking status did not affect improvement rates (p = 0.862).

Conclusion: Bath-PUVA demonstrates efficacy comparable with biologics for psoriasis, regardless of BMI or smoking status. This analysis supports its use as an effective and accessible treatment option for patients with extensive disease.

Background: Narrowband-ultraviolet B (NB-UVB) phototherapy is an effective treatment for psoriasis in patients who have failed topical regimens or those who desire to avoid systemic treatment. Despite its regular use in non-white individuals, NB-UVB treatment response for psoriasis in skin of color (SOC) has not been systematically reviewed.

Methods: We conducted a systematic review on the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) on all available studies to date assessing NB-UVB for psoriasis treatment in skin of color (SOC) (up to 15 November 2024). The primary outcome was qualitative data on clinical outcomes of UVB (PASI 75). Random-effects meta-analysis was performed to assess treatment responses. Secondary outcomes of biochemical and immunologic mechanisms of NB-UVB, NB-UVB in combination with other treatments, and NB-UVB compared to other forms of phototherapy were assessed.

Results: Of 1283 articles initially identified, 54 were ultimately included for formal review. We identified 43 articles assessing clinical outcomes of NB-UVB phototherapy in patients with Fitzpatrick skin type III-IV for a total of 1322 patients with chronic plaque psoriasis and 12 patients with palmoplantar psoriasis. Nine studies were included for meta-analysis of PASI75 response; 70.5% of patients achieved PASI75, and all studies demonstrated statistically significant PASI improvement after treatment. NB-UVB demonstrated a higher rate of complete clearance when compared to BB-UVB but did not result in a statistically significant difference in the proportion of the patient population achieving PASI75 when compared to PUVA.

Conclusions: Phototherapy is effective for the treatment of psoriasis in SOC patients and remains a valuable treatment option despite the advent of various topical, systemic, and biologic treatments for psoriasis.

Background: Cyclosporine is currently recommended as a third-line therapy for chronic spontaneous urticaria (CSU), while narrowband ultraviolet B (NB-UVB) phototherapy has shown promise.

Objective: To compare the efficacy and safety of NB-UVB phototherapy versus cyclosporine in antihistamine-refractory CSU.

Methods: This randomized, prospective, non-inferiority study recruited 50 patients with antihistamine-refractory CSU. Participants received either NB-UVB (thrice weekly) or cyclosporine (3 mg/kg/day) for 90 days alongside maximum-regulated doses of antihistamines, with a post-treatment follow-up of 90 days. The primary outcome was the Urticaria Activity Score over 7 days (UAS7), with secondary outcomes including Urticaria Control Test (UCT), Chronic Urticaria Quality of Life (CU-QoL), and biomarkers such as IL-6 and IL-31.

Results: Both treatments significantly reduced UAS7 by Day 15. NB-UVB provided sustained symptom control post-treatment, while cyclosporine achieved rapid relief but led to rebound flares upon discontinuation. The non-inferiority test showed that NB-UVB was not significantly worse than cyclosporine for UAS7 reduction. Both therapies reduced serum IgE, with IL-6 and IL-31 significantly decreasing in the cyclosporine group.

Limitations: Single-center design, short follow-up duration.

Conclusions: NB-UVB phototherapy is an effective and well-tolerated alternative to cyclosporine for antihistamine-refractory CSU, offering sustained disease suppression post-treatment. Further research is needed to explore long-term outcomes and broader applicability.

Trial registration: Clinical Trials Registry of India: CTRI/2022/11/047799.

Background: Intense pulsed light (IPL) is a Food and Drug Administration-approved device for the management of several dermatologic disorders, including Acne vulgaris (AV). Nicotinamide, a form of vitamin B3, constitutes a possible therapeutic approach for AV. It has powerful anti-inflammatory benefits without the danger of bacterial resistance or systemic adverse effects.

Purpose: To contrast the efficacy and safety of IPL and topical nicotinamide 4% cream in the management of AV.

Methods: This comparative work was conducted on 20 participants aged from 18 to 40 years both sexes, with different clinical types of AV. The patients' faces were allocated into two sides: The right side of the face was treated with 4 IPL sessions at two-weeks intervals, while the left side was treated with topical nicotinamide 4% cream twice daily for 2 months. Clinical assessment of acne lesions in all patients was performed before starting treatment and one and 3 months after the last session.

Results: A significant enhancement of inflammatory acne lesions existed after treatment with IPL and nicotinamide 4% topical cream. A significant variation existed between the two sides of the face after treatment according to the degree of enhancement, in which the IPL showed better improvement than the nicotinamide 4% cream. Moreover, patients were more satisfied with IPL treatment.

Conclusions: IPL seems to be a safe and effective therapy in the management of mild to moderate inflammatory acne and an alternative to other systemic modalities of acne treatment when they are contraindicated.

Background/purpose: Sunscreens are a critical component of photoprotection, shielding the skin from the harmful effects of solar radiation. However, current sunscreens have limitations, including insufficient filters with long-wavelength ultraviolet A (UVA) and visible light (VL) coverage. This review briefly discusses the mechanisms of sunscreen filters, newly developed filters that improve broad-spectrum protection, and examines recent advances in sunscreen formulations that enhance efficacy.

Methods: A targeted literature review was conducted using databases such as Pubmed to identify recent studies published on advancements in sunscreen filters.

Results: Recent developments include novel filters with extended UVA and VL coverage. Additives such as antioxidants and anti-inflammatory agents are also being integrated to bolster skin protection.

Conclusion: Although traditional sunscreens have limitations, ongoing innovations in filter development and formulation science are progressively addressing existing gaps in photoprotection.