Showing papers in "Photodermatology, Photoimmunology and Photomedicine in 2017"

Noninvasive Red and Near-Infrared Wavelength-Induced Photobiomodulation: Promoting Impaired Cutaneous Wound Healing

Abstract: Summary The innumerable intricacies associated with chronic wounds have made the development of new painless, noninvasive, biophysical therapeutic interventions as the focus of current biomedical research. Red and near-infrared light-induced photobiomodulation therapy appears to emerge as a promising drug-free approach for promoting wound healing, reduction in inflammation, pain and restoration of function owing to penetration power in conjunction with their ability to positively modulate the biochemical and molecular responses. This review will describe the physical properties of red and near-infrared light and their interaction with skin and highlight their efficacy of wound repair and regeneration. Near-infrared (800–830 nm) was found to be the most effective and widely studied wavelength range followed by red (630–680 nm) and 904 nm superpulsed light exhibiting beneficial photobiomodulatory effects on impaired dermal wound healing.

Prevention of DNA damage in human skin by topical sunscreens.

Abstract: SummaryBackground/purpose There is strong evidence that topical sunscreens, designed to protect against ultraviolet radiation (UVR)-induced erythema, decrease the amount of UVR to which the skin is exposed, but their effectiveness in reducing UVR-induced DNA damage in vivo has not been well quantified. Methods We systematically reviewed the published literature (1990-2015) to determine whether sunscreens prevent DNA damage in human skin when applied prior to UVR exposure. We included experimental studies measuring UVR-induced DNA damage in human skin in vivo with and without sunscreens and excluded studies conducted in animal models and cell lines. Eligible studies were identified by computerized search of bibliographic databases, supplemented by hand-searching the reference lists of retrieved articles. Results We identified ten eligible studies. Despite heterogeneity in methodological approaches, including the sun protection factors of the sunscreens assessed, range of skin types examined, the UVR exposure time and dose, the timing of post-irradiation biopsies and in the markers of DNA damage examined, all studies reported markedly reduced (or nil) UVR-induced DNA damage on sunscreen-protected skin. Conclusion Our review of the experimental evidence supports a protective effect of topical sunscreens in preventing UVR-induced DNA damage in human skin cells in vivo.

Effect of narrow band ultraviolet B phototherapy as monotherapy or combination therapy for vitiligo: a meta-analysis.

Abstract: Background The treatment of vitiligo is still one of the most difficult dermatological challenges, although there are many therapeutic options. Narrow band ultraviolet B (NB-UVB) phototherapy is considered to be a very important modality for generalized vitiligo. Objective The aim of this study was to explore whether a combination of NB-UVB and topical agents would be superior to NB-UVB alone for treating vitiligo. Methods We searched the electronic databases such as PUBMED, EMBASE, Cochrane Library and Web of Science. The primary outcome was the proportion of ≥50% repigmentation (a clinical significance) and secondary outcome was the proportion of ≥75 % repigmentation (an excellent response). Results 7 randomized controlled trials (RCTs) involving 240 patients (413 lessions) were included in this meta-analysis. The study showed no significant difference between NB-UVB combination therapy (NB-UVB and topical calcineurin inhibitor or vitamin D analogues) and NB-UVB monotherapy in the outcomes of ≥50 % repigmentation and ≥75% repigmentation. However, lesions located on the face and neck had better results in ≥50% repigmentation (RR=1.40, 95% CI 1.08-1.81) and ≥75% repigmentation (RR=1.88, 95% CI 1.10-3.20) with NB-UVB and topical calcineurin inhibitor combination therapy versus NB-UVB monotherapy. Conclusions The meta-analysis suggested that adding neither topical calcineurin inhibitors nor topical vitamin-D3 analogs on NB-UVB can yield significantly superior outcomes than NB-UVB monotherapy for treatment of vitiligo. However, addition of topical calcineurin inhibitors to NB-UVB may increase treatment outcomes in vitiligo affecting face and neck. This article is protected by copyright. All rights reserved.

A method to assess the protective efficacy of sunscreens against visible light-induced pigmentation.

Abstract: Background Until now, photoprotection of human skin has involved the development of sunscreens effective in the ultraviolet (UV) domain. During the last ten years several studies have shown that besides the well-known damaging effects of UV, visible (400-700nm) and even infrared light (> 700 nm) can induce damage which contributes to photoaging. Furthermore, many photodermatoses are also known to be triggered by visible light (VL). Objective/ method An in vivo method is proposed to assess the protective efficacy of sunscreens in the VL domain. This method is based on the intensity of pigmentation induced by four repeated daily doses of VL, each equivalent to about one hour of midday sun. Exposures are performed using a solar simulator (xenon lamp) equipped with appropriate filters and pigmentation is measured both clinically and by chromametry. Three commercially available sunscreens designed to protect in the visible range, were evaluated. Results The results indicate that the VL-induced pigmentation was already significantly detectable visually and by chromametry 24 hours after the first exposure on the unprotected zone. Two products with moderate protective activity could be differentiated from the untreated zone from Day 3 to Day 5 and were also significantly less effective than a third tested product within the same study period. Conclusion The method is simple, based on a clinical endpoint of VL-induced skin pigmentation, and can be performed within a 5 day period. It allows discrimination between products of different protective capacities. VL protection factor is also discussed. This article is protected by copyright. All rights reserved.

Protective effects of Aloe sterols against UVB-induced photoaging in hairless mice.

Abstract: SummaryBackground Aloe vera is a traditional medical plant whose gel has been widely used in skin care. Previously, we have identified Aloe sterols from Aloe vera as active ingredients. This study investigated the protective effects of Aloe sterols without polysaccharides, against ultraviolet B (UVB)-induced skin photoaging in mice using Aloe vera gel extract (AVGE) obtained by supercritical fluid extraction. Methods Aloe vera gel extract was supplemented in the diet (12 or 120 ppm), and HR-1 hairless mice were exposed to UVB irradiation for 7 weeks. Skin measurements and histological and analytical studies were performed. Results Repeated UVB irradiation induced rough wrinkling of skin with water content reduction and hyperkeratosis. AVGE administration resulted in the significant improvement of UVB-induced skin dryness, epidermal thickness, and wrinkle formation. The AVGE group also suppressed the degenerations of dermal collagen fibers and the appearance of cutaneous apoptosis cells induced by UVB. Furthermore, AVGE administration reduced the excess elevation of pro-inflammatory cytokines (IL-1β and TNF-α) and matrix metalloproteinases (MMP-2, MMP-9, MMP-12, and MMP-13) in UVB-exposed skin. Conclusion The dietary ingestion of Aloe sterols protected against chronic UVB damage in mouse skin, and our results suggest that Aloe sterols may prevent skin photoaging through the anti-inflammation and MMP regulation.

Evaluation of the efficacy of photodynamic therapy for the treatment of actinic cheilitis

Abstract: Introduction Actinic cheilitis (AC) is a lip intraepithelial neoplasia, whose cells present alterations similar to those presented by invasive squamous cell carcinomas (SCC). Objective To conduct clinical and laboratory evaluation by histopathology and immunohistochemistry of the efficacy of actinic cheilitis treatment using photodynamic therapy (PDT) with methyl aminolevulinate (MAL) and non-coherent red light. Materials and Methods Patients with actinic cheilitis detected by histopathological examination were submitted to two sessions of photodynamic therapy with a two-week interval between them. They were examined immediately after the sessions, four, six and twelve weeks after beginning treatment when a new biopsy was carried out. Clinical histopathological and immunohistochemical parameters were evaluated before and after treatment. Results Of the 23 patients who underwent biopsy, 16 completed two photodynamic therapy sessions and the material of one patient was insufficient for immunohistochemistry. Complete clinical response was achieved in 62,5% (10/16 patients) and 37,5% still remained with clinical evidence of AC. In spite of this, no case of cure by histopathological analysis was found. There was no significant statistical change among the values of Ki-67, survivin and p53 observed before and after treatment. Conclusion Photodynamic therapy, as carried out in this trial, was not an efficacious therapeutic option for treating patients with actinic cheilitis included in this sample. This article is protected by copyright. All rights reserved.

Nonablative fractional laser‐assisted daylight photodynamic therapy with topical methyl aminolevulinate for moderate to severe facial acne vulgaris: Results of a randomized and comparative study

Abstract: Background Photodynamic therapy (PDT) has been reported as an effective alternative treatment for patients with acne. Purpose To evaluate the efficacy and safety of DL-PDT in moderate to severe acne and to compare outcomes with those of laser-assisted daylight photodynamic therapy. Methods Patients were randomly assigned to either a DL-PDT group (D group) or a fractional laser-assisted DL-PDT group (F group). The outcomes were assessed by measuring acne lesion counts and severity grade at 4, 8, 12, and 16 weeks after therapy commenced. Results Twenty-eight subjects completed the study. Compared with baseline, the mean inflammatory lesion counts significantly decreased by 36.0% in the D group and 51.8% in the F group at 8 weeks (p<0.001). The mean acne severity grades in both groups significantly decreased starting at 4 weeks (p=0.012), and the beneficial effects lasted 16 weeks. Conclusion DL-PDT with MAL shows clinically good responses to inflammatory lesions and is well tolerated in patients with moderate to severe acne. This article is protected by copyright. All rights reserved.

5-aminolaevulinic acid patch-photodynamic therapy in the treatment of actinic cheilitis.

Abstract: Background Actinic cheilitis (AC) is a common disease caused by chronic ultraviolet exposure. Objective Alacare is a self-adhesive, skin coloured 5-aminolaevulinic acid (ALA) patch that has been developed for the treatment of mild to moderate actinic keratosis (AK). Considering the good results in the treatment of AK, the standardized delivery of ALA and the simple application Alacare patch PDT appears as an interesting treatment option for AC. Methods We retrospectively assessed the efficacy, tolerability and cosmetic outcome of Alacare patch PDT in eleven patients with AC. After occlusion with the Alacare patches for 4 hours the AC lesions were illuminated with narrow-band red light and a dose of 37 J/cm2. All patients were clinically assessed for efficacy, side effects and cosmetic outcome at 3, 6, 9 and 12 months after treatment. Results Complete clinical response at the 3-month follow up was achieved in 8 out of 11 patients (72,7%) and 12 out of 15 AC lesions (80,0%), respectively. Up to the final 12-month follow up a recurrence was observed in two lesions. The complete clinical cure rate at 1 year after Alacare patch PDT thus was 66,6% (10/15 lesions). The cosmetic outcome of the treatment was excellent in all cases. Conclusion Alacare patch PDT was found to have substantial efficacy in the treatment of mild to moderate AC. Given its ease of use, absence of long-term side effects and the excellent cosmetic results Alacare patch PDT might be considered as a promising new treatment option for the management of AC. This article is protected by copyright. All rights reserved.

Photobiomodulation therapy in breast cancer-related lymphedema: a randomized placebo-controlled trial.

Abstract: SummaryBackground The aim of our study was to examine the effects of photobiomodulation therapy (PBMT) in the treatment of breast cancer-related lymphedema using a compactly designed treatment regime consisting of eight therapy sessions in combination with a cluster laser device covering a total area size of 78.54 cm² over the axillary. Methods Forty patients with unilateral lymphedema were enrolled in this double-blind, placebo-controlled trial in order to evaluate effects of PBMT on lymphedema-related pain, quality of life, grip strength and limb volume difference. Subjects received irradiation for ten minutes per session using a cluster laser covering a beam area of 78.54 cm². The applied energy was 384 Joules resulting in an energy density of 4.89 J/cm². Results Post-treatment, a 50% reduction in median pain scores and an increase in mean quality of life were observed. Mean grip strength was persistently higher after eight sessions of PBMT compared with pretreatment; however, no statistically significant intergroup differences (P > 0.05) were found over the time course. Conclusion PBMT using a compactly designed treatment regime in combination with a cluster laser device did not significantly improve quality of life, pain scores, grip strength and limb volume over the time course.

Photodynamic therapy for dermatologic conditions in the pediatric population: a literature review.

Abstract: Background Photodynamic therapy (PDT), using topical aminolevulinic acid (ALA), has been used for years to treat a variety of dermatologic conditions, including actinic keratosis, superficial basal cell carcinoma, and in situ squamous cell carcinoma. While there is a wide range of neoplastic and non-neoplastic skin diseases for which ALA-PDT is used in adults, there is a knowledge gap when it comes to its use in children. This review highlights what is currently known regarding the use and efficacy of this therapy in the pediatric population. Methods A PubMed search was conducted to identify studies including pediatric patients undergoing monotherapy PDT with topical aminolevulinate (published 2005-2016). Results 20 pediatric articles were identified. ALA-PDT has been used successfully in children to reduce the number and size of basal cell tumors, inflammatory acne lesions, plantar warts, and linear porokeratoses. Conclusions ALA-PDT may be an attractive alternative to surgery for children with basal cell nevus syndrome, or to conventional destructive and/or topical methods used for plantar warts or linear porokeratoses. PDT can be considered for inflammatory acne when topical treatments have failed and systemic medications are not an option. Pain associated with treatment and insurance coverage may be a barrier to use. This article is protected by copyright. All rights reserved.

Phototherapy in systemic sclerosis: Review.

Abstract: Systemic scleroderma-also known as systemic sclerosis (SSc)-is a chronic systemic connective tissue disease characterized by collagen deposition in cutaneous and internal organs, leading to skin sclerosis and multiple organ fibrosis. The pathogenesis is complex and remains poorly understood. Treatment is based on organ involvement and requires a multidisciplinary approach. Skin sclerosis can cause disability, leading to decreasing quality of life. Various systemic antifibrotic therapies have been used; however, most have unsatisfactory results. Recently, phototherapy and in particular ultraviolet A (UVA) has been used to treat skin sclerosis in SSc patients with satisfactory results. The main mechanisms include lymphocyte apoptosis, cytokine alteration, inhibition of collagen synthesis and increased collagenase production, and neovascularization, leading to the breakdown of collagen fibrils resulting in skin softening or even healing digital ulcers. Most studies reported that psoralen plus UVA (PUVA) and UVA1 phototherapy improved clinical outcomes vis-a-vis skin sclerosis, joint mobility, ulcers, and histopathology. PUVA and UVA1 phototherapy therefore have potential as an alternative or adjunctive therapy for patients with SSc.

Porokeratosis ptychotropica responding to photodynamic therapy: An alternative treatment for a refractory disease.

Abstract: Background Porokeratosis ptychotropica (PP) is a rare variant of porokeratosis with a special predisposition to affect body folds, particularly the intergluteal cleft. This disease is resistant to most topical and systemic treatments reported, as shown in the review of the literature we provide here. Itching and discomfort are often a difficult problem to solve. Patients and Methods Two patients with PP that had not responded to multiple topical treatments were treated with photodynamic therapy (PDT). Changes in plaque size, thickness, and symptoms were assessed after treatment. Results Pruritus disappearance was observed in both patients after treatment with PDT. Partial clearance of the plaques was observed in one case. In the other case, a moderate clearance of hyperkeratosis was observed, though the size of the lesions persisted unchanged. Conclusions PDT seems to be a good therapeutic alternative in the treatment of PP, as it can provide symptomatic relief and clinical improvement of the lesions. However, it does not appear to be a curative treatment. Moreover, long-term response is still unknown. This article is protected by copyright. All rights reserved.

Protective effects of Polypodium leucotomos extract against UVB-induced damage in a model of reconstructed human epidermis.

Abstract: BACKGROUND Polypodium leucotomos (PL) exerts potent antioxidant, photo-protective, and immune-modulatory activities. A reconstructed human epidermis (RHE) (Episkin) is a suitable model for the evaluation of acute UV-induced cell damage. No data regarding the photo-protective action of PL in this model are available. PURPOSE We evaluated the effects of PL on the prevention of UVB-induced cell damage assessing sunburn cells, CPD formation, p53, Ki-67, p21 expression, and epidermal growth factor (EGF) production. MATERIALS & METHODS RHE was incubated in standard conditions. PL was topically applied at the concentration of 2 mg/cm2 , immediately before UVB exposition. UVB exposition (300 mJ/cm2 ) was performed using a dedicated UVB lamp. Irradiated samples without PL and non-irradiated samples were used as positive and negative controls. Expression of p53, p21, and Ki-67 was evaluated with immune-histochemical methods. CPD were measured using a monoclonal antibody. RESULTS PL significantly reduced sunburned cells (-80%) in comparison with positive control. PL significantly prevented the increase in EGF production at tested times. PL significantly reduced the p53 (-80%), p21 (-84%), and Ki-67 (-48%) positive cells. Finally, PL prevented the formation of CPD (0% vs. 20% positive cells). CONCLUSION In this model, PL has shown to prevent UVB cell damage, the upregulation of proliferating proteins, and fully blocking the formation of CPD.

Inhibitory effect of 660-nm LED on melanin synthesis in in vitro and in vivo.

Abstract: SummaryBackground Skin hyperpigmentary disorders including postinflammatory hyperpigmentation, melasma, solar lentigines, and conditions like freckles are common. The light-emitting diodes (LEDs) are the latest category of nonthermal and noninvasive phototherapy to be considered in skin pigmentation disorder treatment. Purpose The purpose of this study was to investigate the effects of 660-nm LED on inhibition of melanogenesis. We investigated whether a 660-nm LED affected melanin synthesis in in vitro and in vivo models, and we explored the mechanisms involved. Methods The inhibitory effect of 660-nm LED on melanin synthesis was evaluated in B16F10 cells and HRM-2 melanin-possessing hairless mice were used to evaluate the antimelanogenic effects of 660-nm LED. Results Interestingly, 660-nm LED inhibited alpha-melanocyte-stimulating hormone-induced tyrosinase activity in B16F10 cells. We also found that 660-nm LED decreased MITF and tyrosinase expression and induced the activation of ERK. These findings suggest that the depigmenting effects of 660-nm LED result from downregulation of MITF and tyrosinase expression due to increased ERK activity. The 660-nm LED reduced UVB-induced melanogenesis in the skin of HRM-2 via downregulation of tyrosinase and MITF. Conclusion These findings suggest 660-nm LED is a potentially depigmentation strategy.

Psoralen with ultraviolet A-induced apoptosis of cutaneous lymphoma cell lines is augmented by type I interferons via the JAK1-STAT1 pathway.

Abstract: Background Photochemotherapy with psoralen and ultraviolet A (PUVA), with or without adjuvant interferon-α (IFN-α), is a first-line therapy for early-stage mycosis fungoides and other forms of cutaneous T-cell lymphoma (CTCL). However, the mechanism by which PUVA with IFN-α work in CTCL is poorly understood. Purpose To develop a model to investigate the mechanisms of PUVA and PUVA with IFN-α in CTCL cells. Methods An in vitro model to study the molecular mechanisms of PUVA was created using two different CTCL cell lines, MyLa, which has functional p53, and HuT-78, in which p53 is inactivated due to a homozygous nonsense mutation. Results PUVA caused G2/M cell cycle block and apoptosis of MyLa and HuT-78 accompanied by increase in the expression of the mitochondrial pro-apoptotic genes Bax, BAK, and PUMA and a downregulation in anti-apoptotic Bcl-2. p53 was induced and c-Myc was repressed by PUVA, but neither were essential for PUVA-induced apoptosis. IFN-α augmented PUVA-induced apoptosis via the JAK1 pathway, and this activity could be inhibited by ruxolitinib. Conclusion PUVA induces p53-independent apoptosis in CTCL cell lines, and this process is augmented by type I interferons via the JAK1 pathway.

A cross-sectional, comparative study of home vs in-office NB-UVB phototherapy for vitiligo.

Abstract: Narrowband ultraviolet B (NB-UVB) phototherapy is an effective treatment for vitiligo, resulting in up to 75% repigmentation in 9 months, however, compliance is often poor due to the economic burden and inconvenience associated with this form of therapy. Home phototherapy has been shown to be an effective treatment for a variety of skin conditions, including vitiligo. Despite this evidence, home phototherapy for vitiligo is considered experimental and investigational by health insurance providers. This article is protected by copyright. All rights reserved.

The tanning habits and interest in sunscreen of Google users: what happened in 12 years?

Abstract: Background The incidence of melanoma has been rising worldwide. One possible reason for this is natural and artificial UV exposure. Only little data on actual consumer statistics from tanning studios and the usage of sunscreen are available. Therefore, it is difficult to describe trends for both and identify the impact of preventive measures. Methods To gain knowledge about the popularity of 'tanning bed' and 'sunscreen', normalized search volumes for both search queries were obtained from Google Trends for 11 countries between January 2004 and June 2016. Results With few exceptions, worldwide interest in 'tanning bed' has been declining, whereas interest in 'sunscreen' has been increasing. The assessed countries from the Southern Hemisphere showed minor interest in tanning compared to the Northern Hemisphere. Both search queries were observed to fluctuate in a seasonal pattern. Skin cancer prevention measures influence the interest in tanning beds and sunscreen. Conclusion Google Trends data can act as a first surrogate marker to evaluate the influence of skin cancer campaigns on the popularity of tanning beds and sunscreen. Fine-tuning of skin cancer campaigns according to seasonal and geographic trends and behaviors may help to maximize their success.

Home phototherapy in vitiligo.

Abstract: Vitiligo is a disorder characterized by the development of depigmented macules and patches. Narrowband ultraviolet B phototherapy is a standard of care treatment and is used both as monotherapy and in combination with other treatment modalities to induce repigmentation. Although phototherapy is safe and effective, its use is limited due to the significant time commitment required and associated costs. Home phototherapy is a safe and effective alternative to make phototherapy more accessible to patients. However, it is often underutilized due to lack of physician experience and comfort as well as misconceptions regarding its safety and efficacy. This article provides a brief overview of the use of phototherapy in vitiligo with a focus on home phototherapy in order to increase awareness and use of this treatment modality.

Pirfenidone-induced photo-allergic reaction in a patient with idiopathic pulmonary fibrosis.

Abstract: Idiopathic pulmonary fibrosis (IPF) is a progressive, fibrotic, fatal lung disease associated with inevitable loss of lung function. The prognosis is poor, with a median survival of 2.5–3.5 years after diagnosis (1). Pirfenidone is a novel agent for the treatment of IPF that has anti-fibrotic, anti-inflammatory and antioxidant effects. It may prevent the progression of lung fibrosis through inhibition of fibroblast (2). However, pirfenidone has some adverse effects, which occur in 28% to 53% of patients. Skin reactions were the most commonly reported adverse effects and implicated as the major reason for discontinuation or dose reduction of pirfenidone. Among such effects, photosensitivity has been reported infrequently in a few previously published studies (3). The patient was a 74-year-old fisherman who presented with itchy erythematous patches on the face, neck and dorsal aspects of both the hands since 1 month (Fig. 1a–d). He had been diagnosed with IPF five months before and received pirfenidone (Pirespa) therapy as a regimen with gradually increasing dose until nine capsules of 200 mg per day (total: 1800 mg/day) with good tolerability. After 3 months of treatment, he developed mild itchy erythema on the face, which showed rapid exacerbation. A skin biopsy was performed for the facial lesions, and the histopathological findings showed epidermal spongiosis with lichenoid reaction and basophilic degeneration of upper dermis. Apoptotic keratinocytes were not observed (Fig. 2a, b). A minimal erythema dose (MED) for UVA was determined using UV 801 KL-1 , (Waldmann Medizintechnik Corporation, Villingen-Schwenningen, Germany) in a normal range (70 J/cm, Normal 60–100 J/cm). Two equal sets of allergens (pirfenidone) were prepared with 1% petroleum in 8 mm Finn Chambers for photo-patch testing and applied on symmetrical areas of the back (Fig. 2c). 1 and 3 days after irradiation (10 J/cm of UVA), the irradiated site revealed positive reaction to pirfenidone (Fig. 2d, e). It revealed some itchy papules on irradiated side and tent to mild increase in intensity with in 72 h after irradiation. Based on clinical features (late onset), photo-patch testing (crescendo pattern) and histopathological findings (no apoptotic keratinocyte), present case was diagnosed as a photo-allergic rather than phototoxic reaction to pirfenidone. Subsequently, the patient received oral methylprednisolone as 16 mg/day for 2 weeks, and the dose was gradually tapered off along with additional therapy including topical corticosteroid and oral

Factors predicting pain and effect of oral analgesia in topical photodynamic therapy.

Abstract: To The Editor, Topical photodynamic therapy (PDT) is highly efficacious for the treatment of actinic keratosis (AK), Bowen’s disease (BD) and superficial basal cell carcinoma (sBCC), and efficacious in thin nodular BCCs (nBCC) (1). It is generally well tolerated, with pain or discomfort being a known side effect (1). Pain is typically described as a burning or stinging sensation of varying intensity. Prior studies looking at factors which influence pain during PDT have shown conflicting results (2–5). The aim of our study was to identify any patient or treatment factors associated with higher levels of pain during PDT and to assess the effect of pretreatment analgesia. Treatment is standardised in our centre and documented in a standard treatment proforma. Patients receive one treatment per course for AK and two treatments per course, one week apart, for BD and BCC. Methyl aminolevulinate (MAL–Metvix Photocure ASA, Oslo, Norway) is used as a photosensitising agent. Wood’s lamp fluorescence (WLF) is used to assess absorption of the photosensitiser (excellent/good/poor). The Aktilite (Photocure ASA) (LED red light, 630 nm, 37J/cm) or Waldmann 1200L (Waldmann Medizintechnik, Villingen-Schwenningen, Germany) (filtered halogen lamp, non-coherent red light, 570–730 nm, 50J/cm) light-source is used. Patients complete a visual analogue pain scale (VAPS) to grade their pain during and after treatment. The highest pain score experienced during treatment is documented (range 0–100). Patients who are unable to complete a VAPS, for example, due to eyesight difficulty, are asked to grade their pain on a similar scale. Patients are offered oral analgesia 30 min pretreatment, and type of analgesia taken is documented. A fan and cooling water spray are provided during treatment. Following ethics approval, retrospective chart review was completed. Data were compiled in Microsoft Excel and analysed using SPSS (IBM SPSS Statistics for Macintosh, Version 22.0. Armonk, NY: IBM Corp.). All AK, BD and BCC treated between 2009 and mid-2015 were included in analysis. Complete data sets were available on all patients. Pearson’s chi-square, independent samples t-test and one-way ANOVA were used to obtain Pvalues, unless otherwise stated. Odds ratio (OR) and 95% confidence intervals (CI) were calculated using binary logistic regression. For the purpose of binary logistic regression, a dichotomous pain response was defined by dividing the VAPS into two groups at the median 40 (1–40 and 41–100). In total, 200 cases of AK, BD and BCC, in 109 patients were analysed. The average age was 74.6 years (Standard Deviation [SD] 9.55 range 33–96). The femaleto male-percentage split was 61 : 39. Sixty nine per cent of lesions were located on the limbs, 17% on the trunk and 14% on the head/neck. Fifty four per cent of lesions were BD, 24% BCC and 22% AK.

Daylight photodynamic therapy with methylene blue in plane warts: a randomized double‐blind placebo‐controlled study

Abstract: SummaryBackground Conventional photodynamic therapy is associated with inconveniently long clinic visits and discomfort during therapy. Daylight-photodynamic therapy (DL-PDT) is an effective treatment, nearly pain free and more convenient for both the clinics and patients. There are no published studies of methylene blue (MB) as a photosensitizer (PS) used in DL-PDT. Methods Forty patients had multiple plane warts; 20 patients were subjected to DL-PDT with topical 10% methylene blue gel, and 20 patients were subjected to DL-PDT with hematoxylin (placebo). Improvement was evaluated by change of the number of warts and the dermoscope picture. Results A total of 20 (100%) patients in group II showed no response to placebo, 13 patients (65%) in group I showed complete clearance, 2 (10%) patients showed a good response, and 5 (25%) patients had poor response to treatment (P < 0.01). No serious side effects and patients tolerated the pain well. No relapse was detected during the follow-up period (12 months). Limitation of the study Daylight exposure was not monitored with a dosimeter. Conclusion Daylight-PDT using MB is safe, easy to carry out, economic, effective, acceptable cosmetic results with no recurrence, convenient especially for children and nearly painless treatment.

Ultraviolet‐ and infrared‐induced 11 beta‐hydroxysteroid dehydrogenase type 1 activating skin photoaging is inhibited by red ginseng extract containing high concentration of ginsenoside Rg3(S)

Abstract: Background Sun irradiation is one of major extrinsic stressors responsible for premature skin aging through activation and expression of 11 beta-hydroxysteroid dehydrogenase type 1 (11β-HSD1), which converts inactive cortisone to active cortisol. The aim of this study was to evaluate the inhibitory effects of red ginseng extract containing high concentrations of ginsenoside Rg3 (S) (GERg3) on 11β-HSD1-induced skin photoaging. Methods To evaluate the inhibitory effects of GERg3 on ultraviolet- (UV) or infrared (IR)-induced skin photoaging, human dermal fibroblasts or a normal human 3D skin model was exposed to UV or an IR. RT-PCR, ELISA, Western blot, and H&E staining were used for evaluations. GERg3 was isolated from crude red ginseng. Results GERg3 inhibited the increased expressions of 11β-HSD1, interleukin (IL)-6, and matrix metalloproteinase-1 (MMP-1) in UVB- or IR-exposed Hs68 cells. Additionally, the increased cortisol, IL-6, and MMP-1 expressions were effectively reduced by GERg3 in UVA-exposed 3D skin models. The photoinduced decrease in type 1 procollagen also recovered as a result of GERg3 treatment in Hs68 cells and the 3D skin model. In addition, the UVA-exposed dermal thickness was decreased in comparison with the UVA-protected 3D skin model, recovered with GERg3 treatment. Conclusion GERg3 had antiphotoaging effects in UV- or IR-exposed human dermal fibroblasts and normal human 3D skin model.

Ultraviolet A eye irradiation ameliorates colon carcinoma induced by azoxymethane and dextran sodium sulfate through β-endorphin and methionine-enkephalin.

Abstract: BACKGROUND We previously reported that ultraviolet (UV) A eye irradiation reduces the ulcerative colitis induced by dextran sodium sulfate (DSS). This study examined the effects of UVA on colon carcinoma induced by azoxymethane (AOM) and DSS. METHODS We irradiated the eyes of ICR mice with UVA at a dose of 110 kJ/m2 using an FL20SBLB-A lamp for the experimental period. RESULTS In mice treated with these drugs, the symptom of colon carcinoma was reduced by UVA eye irradiation. The levels of interleukin (IL)-6 and tumor necrosis factor (TNF)-α in the blood were increased in AOM + DSS-treated mice; however, those levels were reduced by UVA eye irradiation. The expression of β-endorphin, methionine-enkephalin (OGF), μ-opioid receptor, and opioid growth factor receptor (OGFR) of the colon was increased in the AOM + DSS-treated mice, and these levels were increased further following UVA eye irradiation. When β-endorphin inhibitor was administered, the ameliorative effect of UVA eye irradiation was reduced, and the effect of eye irradiation disappeared entirely following the administration of naltrexone (inhibitor of both opioid receptor and OGFR). CONCLUSIONS These results suggested that UVA eye irradiation exerts major effects on AOM + DSS-induced colon carcinoma.

23-Hydroxytormentic acid protects human dermal fibroblasts by attenuating UVA-induced oxidative stress.

Abstract: Ultraviolet A (UVA), one of the major components of sunlight, can penetrate the dermal layer of the skin and generate reactive oxygen species (ROS). It causes alterations in the dermal connective tissue and gene expression, inflammation, photoaging, and DNA damage. Therefore, the harmful effects of UVA and strategies to reduce it have been consistently investigated. 23-Hydroxytormentic acid (23-HTA) has been demonstrated to improve drug-induced nephrotoxicity and exhibit several free radical scavenging effects with other molecules. Therefore, the aim of this study was to investigate the anti-inflammatory effects and extracellular matrix (ECM) reconstructive activity of 23-HTA in UVA-irradiated normal human dermal fibroblasts (NHDFs). The antioxidant capacity of 23-HTA was determined by examining its scavenging activities against hydrogen peroxide, 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid), and diphenylpicrylhydrazyl in vitro. Its effect on cell viability was evaluated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tertazolium bromide, and 2,7-dichlorofluorescin diacetate was used to investigate intracellular ROS scavenging activity. The mRNA levels of antioxidant enzymes and pro-inflammatory cytokines were detected using quantitative real-time polymerase chain reaction. A senescence-associated β-galactosidase (SA-β-gal) staining kit was used to assess senescent cells. 23-HTA showed antioxidant capacity mediated by ROS scavenging and regulation of antioxidant-related gene expression. Further, the SA-β-gal analysis and mRNA expression of matrix metalloproteinases and type I procollagen suggested that 23-HTA regulates the gene expression of ECM proteins and cellular senescence under UVA-irradiated conditions. In conclusion, 23-HTA protects against and attenuates UVA-induced oxidative stress in NHDFs likely via the nuclear factor erythroid-derived 2-like 2 signaling pathway. This article is protected by copyright. All rights reserved.

Comparative evaluation of efficacy and safety of calcipotriol versus tacalcitol ointment, both in combination with NBUVB phototherapy in the treatment of stable plaque psoriasis.

Abstract: Background Vitamin D analogues and NBUVB phototherapy are both well-established modalities of treatment in psoriasis. The objective of this open label, intra individual, left right study was to compare two different Vitamin D analogues, calcipotriol and tacalcitol, in combination with NBUVB phototherapy in chronic stable plaque psoriasis. Methods Thirty patients with stable plaque psoriasis were enrolled for a 12 week clinical trial. The target lesion on left side was treated topically with tacalcitol ointment once daily, while that on the right side was treated with calcipotriol ointment twice daily. NBUVB phototherapy was given thrice weekly. Efficacy was assessed by target plaque scoring. Results Both therapies resulted in statistically significant reduction in erythema, scaling, thickness and target plaque score, seen as early as 2 weeks into therapy. However, Calcipotriol combination led to an earlier clearance of plaques and a lesser relapse rate than tacalcitol combination. The number of treatment sessions and cumulative NBUVB doses were significantly lower in the calcipotriol-treated group. Conclusion Both vitamin D analogues appear to be safe, effective and cosmetically acceptable, calcipotriol being more efficacious, well tolerated with a rapid onset of action and a better maintenance of response. This article is protected by copyright. All rights reserved.

Wood's lamp image of porokeratosis.

Abstract: Correspondence: Ms Wei Zhu, Department of Dermatology and Venereology, Xuanwu Hospital, Capital Medical University, 45 ChangchunSt, Xicheng District, Beijing 100053, China. Tel:+86-010-83198322 Fax:+01083198372 e-mail: zhuwei@xwh.ccmu.edu.cn and Mr Shi Lian, Department of Dermatology and Venereology, Capital Medical University, 10 You an men wai xi tou tiao St, Fengtai District, Beijing 100069, China. Tel:+86-010-83198372 Fax: +01083198372 e-mail:drlianshi@sina.com

Skin microtopography as a measure of photoaging and risk of squamous cell carcinoma of the skin in a US population.

Abstract: Background Skin microtopography as a measure of photoaging is a non-invasive approach to measuring chronic ultraviolet radiation (UVR) exposure, and reflects the degree of dermal elastosis in populations of European descent in the subtropics. Less is known about the utility of this approach in populations at different latitudes, and whether it relates to skin cancer risk. Methods A population-based case-control study of 342 SCC cases and 331 age- and gender-matched controls were evaluated for histologic evidence of solar damage and severity of photoaging based on microtopography on a six-grade scale. Odds ratios for SCC associated with degree of photoaging were estimated using logistic regression analysis adjusted for potentially confounding factors. Results After adjustment for known risk factors, SCC was associated with increasing photoaging grade (OR = 1.7, 95% CI = 0.9-3.0 for severe photoaging; OR = 2.8, 95% CI = 1.6-5.0 for very severe photoaging). Associations remained among those with actinic keratosis (OR = 3.4, 95% CI = 0.9-12.4 for severe photoaging, OR = 5.7, 95% CI = 1.7-19.6 for very severe photoaging). Limitations There was limited statistical power, particularly for subgroup analyses. Conclusion Our findings provide further evidence of microtopography as an independent, objective indicator of risk of SCC. This article is protected by copyright. All rights reserved.

Fenofibrate-induced photosensitivity - a case series and literature review.

Abstract: To the Editor, Fenofibrate, a fibric acid derivative, is among the most commonly used antihyperlipidemic medications. The most common side effects are gastrointestinal problems, including abdominal discomfort, diarrhea, and constipation. While cutaneous eruption occurred in 2% of fenofibrate users (1), photosensitivity is a rare manifestation. Jeanmougin et al. (2) presented the first case of fenofibrate-induced photosensitivity in 1983. Herein, we report four cases of fenofibrate-induced photosensitization with different types of cutaneous eruptions as papulovesicular, lichenoid, and sunburn-like rashes, and one among them was confirmed by photopatch testing. We also perform a systematic review for the reported cases of fenofibrateinduced photosensitivity since 1983.

Resolution of aquagenic pruritus with intermittent UVA/NBUVB combined therapy.

Abstract: To the Editor, Aquagenic pruritus (AP) is a rare skin disease of unknown etiology characterized by the abrupt onset of pruritus without visible cutaneous lesions after contact with water or humidity. AP can have a severe impact on the patient’s quality of life. Although AP is mostly idiopathic, it can be associated with polycythemia vera, other hematologic disorders and medications.1 Treatment is challenging and often disappointing, and may consist in topical agents such as capsaicin 0.025%1.0%, alkaline baths and glycerol trinitrate 2%. Systemic therapy includes antihistamines, propanolol, selective serotonin reuptake inhibitors, opioid receptor antagonists, anticonvulsants, and phototherapy— perhaps the most effective treatment1—including psoralene+UVA (PUVA), narrow band UVB (NBUVB), broad band UVB (BBUVB), and UVA/NBUVB combined therapy (UVA/NBUVB).2 Here, we describe a patient with AP who presented complete resolution of the symptomatology with a UVA/NBUVB therapy cycle (17 to 26 sessions) once a year.

Perceptions of U.S. dermatology residency program directors regarding the adequacy of phototherapy training during residency.

Abstract: SummaryBackground/Purpose Phototherapy utilization has declined over the last 20 years despite its efficacy and cost-effectiveness. Adequacy of phototherapy training in residency may be a contributing factor. The purpose of this study was to evaluate perceptions of U.S. dermatology residency program directors (PDs) regarding the effectiveness of their programs’ phototherapy training and what constitutes adequate phototherapy education. Methods A questionnaire was sent to PDs to assess phototherapy training within their program; aspects such as dedicated time, exposure to different modalities, and barriers to resident education were surveyed. We assessed the statistical association between these aspects and the perception by PDs that a program's training was adequate. Statistical testing was reported using Fisher's exact tests. Results A total of 42 PDs responded. Residency training in oral psoralen and ultraviolet A therapy (PUVA), home phototherapy, and excimer laser, respectively, is not provided in 19.0%, 31.0%, and 47.6% of programs. 38.1% of programs provide ≤5 hours of phototherapy training over 3 years of training. 59.5% of PDs cited lack of curriculum time as the most common barrier to phototherapy education. 19.0% of PDs reported completely adequate phototherapy training, which was significantly associated with inclusion of faculty-led didactics, assigned reading, or hands-on clinical training in the curriculum. Conclusions There is a mismatch between the resources devoted to phototherapy education and the need for dedicated training reported by PDs. Limited time is allocated to phototherapy training during dermatology residency, and a large majority of PDs do not feel that the phototherapy training offered is completely adequate. This article is protected by copyright. All rights reserved.