Background The carcinogenic potential of 8-methoxypsoralen photochemotherapy (psoralen-UVA [PUVA]) is correlated with the total number of treatments and cumulative UVA dose applied during oral PUVA therapy. Objective ...Background The carcinogenic potential of 8-methoxypsoralen photochemotherapy (psoralen-UVA [PUVA]) is correlated with the total number of treatments and cumulative UVA dose applied during oral PUVA therapy. Objective We sought to determine whether reducing treatment frequency and UVA dose affects the therapeutic efficacy of oral PUVA for patients with chronic plaque psoriasis. Methods This was a prospective, randomized, half-side study performed in a photodermatology department in a dermatology hospital. Eighteen consecutive patients with chronic plaque psoriasis received paired PUVA regimens (0.5 minimal phototoxic dose [MPD] 4 times/wk vs 1 MPD twice/wk, 0.5 MPD twice/wk vs 1 MPD twice/wk, and 0.5 MPD twice/wk vs 0.75 MPD twice/wk). The PUVA regimens were assessed for reduction of Psoriasis Area and Severity Index (PASI) score and the number of treatments and cumulative UVA dose required to reduce PASI score to defined end points (ie, PASI reductions of 25%, 50%, and 75%) or to induce complete remission (PASI< 3). Results Reducing the number of treatments while maintaining the same UVA dose per week did not reduce overall therapeutic efficacy. Reducing the number of treatments to twice a week and reducing the UVA dose from 1 MPD to 0.75 or 0.5 MPD per treatment only slightly affected intermediate therapeutic efficacy (between the second and seventh weeks of therapy) but had no effect on final clearance rates. The time to complete clearance did not significantly differ between regimens. The mean cumulative UVA dose was significantly lower for the least intensive dose regimen (0.5 MPD twice/wk) than for the more intensive regimens. Conclusions Reducing treatment frequency and UVA dose does not substantially compromise the therapeutic efficacy of PUVA.展开更多
Background:Recently the beneficial effect of excimer laser treatment has been reported for patients with vitiligo. The influence of treatment frequency on this effect is not clear. Objectives:To determine the optimal ...Background:Recently the beneficial effect of excimer laser treatment has been reported for patients with vitiligo. The influence of treatment frequency on this effect is not clear. Objectives:To determine the optimal frequency of 308-nm excimer laser therapy for vitiligo. Methods:In this prospective, university-based hospital study over 12 weeks we enrolled 14 patients. Each had at least three stable vitiligo lesions in the same body area. The three stable vitiligo lesions in each subject were randomly assigned to receive excimer laser treatment once (1×), twice (2×) and three times (3×) weekly, respectively. The initial ultraviolet (UV) dose was 50 mJ cm-2 less than the 308-nm minimal erythematous dose in vitiligo skin. The UV dose was increased at each treatment session according to the erythematous response to the previous treatment. Results:Thirteen subjects were treated for at least 6 weeks; seven were treated for all 12 weeks. At 6 weeks, the repigmentation rates for treated lesions were 8%(1/13) after 1×weekly treatment, 23%(3/13) after 2×weekly treatment and 62%(8/13) after 3×weekly treatment (P=0.0134; 3×vs. 1×weekly); at 12 weeks, these rates were 46%(6/13), 62%(8/13) and 69%(9/13), respectively (P=NS;3×vs. 1 ×weekly). Repigmentation initiation correlated with treatment number, regardless of frequency (P=NS). As shown by Kaplan-Meier analysis, repigmentation occurred earliest in the most frequently treated lesions (P=0.0336). At 12 weeks, the projected repigmentation rates for 1×,2×and 3×weekly treatment approached each other (60%, 79%and 82%, respectively); the mean repigmentation grades (on a scale of 0-5) for 1×,2×and 3×weekly treatment were 1.7, 2.4 and 3.3, respectively(P=0.018;3×.vs. 1×weekly). Laser-induced repigmentation persisted in most cases over the entire follow-up of 12 months after the end of treatment. Conclusions:308-nm excimer laser therapy is effective against vitiligo. Although repigmentation occurs fastest with 3×weekly treatment, the ultimate repigmentation initiation seems to depend entirely on the total number of treatments, not their frequency. However, treatment periods of more than 12 weeks may be necessary to obtain a satisfactory clinical repigmentation, particularly when vitiligo lesions are treated only 1×or 2×compared with 3×weekly.展开更多
Background: Psoralen plus ultraviolet (UV) A (PUVA) is the standard treatment for early stage mycosis fungoides (MF).When 8-methoxypsoralen (8-MOP) is used in PUVA therapy, it often produces intolerance reactions such...Background: Psoralen plus ultraviolet (UV) A (PUVA) is the standard treatment for early stage mycosis fungoides (MF).When 8-methoxypsoralen (8-MOP) is used in PUVA therapy, it often produces intolerance reactions such as nausea, vomiting and headache. Objectives: To investigate whether 5-methoxypsoralen (5-MOP) is a safe and effective alternative to 8-MOP in PUVA therapy for MF. Methods: A retrospective database search and chart review was done to identify patients with MF who received PUVA with either 5-MOP or 8-MOP as initial monotherapy at our institution. Between 1990 and 2004, 14 patients [seven men and seven women; mean age 70 years,range 51-82; National Cancer Institute disease stages IA (n =6) and IB (n = 8)] received 5-MOP, and 24 patients [21 men and three women; mean age 58 years, range 28-89; disease stages IA (n = 11), IB (n = 12) and IIB (n = 1)] received 8-MOP.Results: Twelve of 14 patients (86%) in the 5-MOP group and 22 of 24 (92%) in the 8-MOP group had a complete response to PUVA. These two subgroups of complete responders did not differ significantly in terms of PUVA therapy duration, number of treatments or cumulative UVA dose. They also did not differ significantly in terms of relapse-free rate [8%(one of 12) vs.23%(five of 22)] or time to relapse [17 months (range 4-31) vs.14 months (range 4-33)]. Moreover, PUVA maintenance therapywith either 5-MOP or 8-MOP in a subset of patients [26%(nine of 34)] did not affect long-term relapse-free status either.Conclusions: 5-MOP and 8-MOP have comparable therapeutic efficacy when used in PUVA therapy for MF.展开更多
Background: The treatment with XeCl-excimer laser generated 308- nm UVB radiation has shown promising results in patients with vitiligo. Objective: In this controlled, prospective trial we studied the primary efficacy...Background: The treatment with XeCl-excimer laser generated 308- nm UVB radiation has shown promising results in patients with vitiligo. Objective: In this controlled, prospective trial we studied the primary efficacy (start and grade of repigmentation) and patient’ s satisfaction of XeCl-excimer laser for treatment of vitiligo patches at different body sites and re-evaluated the achieved repigmentation 12 months after the end of therapy. Methods: Twenty-five patients with generalized or localized vitiligo with a total of 85 lesions at different body sites were enrolled in this study. Vitiligo patches were treated with 308- nm XeCl-excimer laser 3 times a week for 6 to 10 weeks. The overall repigmentation grade of each treated lesion was evaluated once a week on a 5 point scale rating from 0 (no repigmentation), 1 (1- 5% ), 2 (6- 25% ), 3 (26- 50% ), 4 (51- 75% ), to 5 (76- 100% ). Results: Twenty-four patients completed the study. Within 6 to 10 weeks of treatment 67% of the patients (16/24) developed follicular repigmentation of at least one of their vitiligo lesions. Lesion repigmentation started after a mean of 13 treatments in lesions located on the face, trunk, arm, and/or leg (high-responder location), and after a mean of 22 treatments in lesions located on the elbow, wrist, dorsum of the hand, knee, and/or dorsum of the foot (low-responder location). Untreated control lesions and lesions located on the fingers did not achieve any repigmentation. After 10 weeks of treatment repigmentation of more than 75% was found in 25% (7/28) of lesions of the high-responder location group versus 2% (1/43) of lesions of the low-responder location group. In most cases, laser-induced repigmentation was persistent, as determined 12 months after the end of treatment. Conclusions: 308- nm excimer laser is an effective modality for the treatment of vitiligo. However, similar to other non-surgical treatment modalities, the therapeutic effect is mainly dependent on the location of vitiligo lesions.展开更多
文摘Background The carcinogenic potential of 8-methoxypsoralen photochemotherapy (psoralen-UVA [PUVA]) is correlated with the total number of treatments and cumulative UVA dose applied during oral PUVA therapy. Objective We sought to determine whether reducing treatment frequency and UVA dose affects the therapeutic efficacy of oral PUVA for patients with chronic plaque psoriasis. Methods This was a prospective, randomized, half-side study performed in a photodermatology department in a dermatology hospital. Eighteen consecutive patients with chronic plaque psoriasis received paired PUVA regimens (0.5 minimal phototoxic dose [MPD] 4 times/wk vs 1 MPD twice/wk, 0.5 MPD twice/wk vs 1 MPD twice/wk, and 0.5 MPD twice/wk vs 0.75 MPD twice/wk). The PUVA regimens were assessed for reduction of Psoriasis Area and Severity Index (PASI) score and the number of treatments and cumulative UVA dose required to reduce PASI score to defined end points (ie, PASI reductions of 25%, 50%, and 75%) or to induce complete remission (PASI< 3). Results Reducing the number of treatments while maintaining the same UVA dose per week did not reduce overall therapeutic efficacy. Reducing the number of treatments to twice a week and reducing the UVA dose from 1 MPD to 0.75 or 0.5 MPD per treatment only slightly affected intermediate therapeutic efficacy (between the second and seventh weeks of therapy) but had no effect on final clearance rates. The time to complete clearance did not significantly differ between regimens. The mean cumulative UVA dose was significantly lower for the least intensive dose regimen (0.5 MPD twice/wk) than for the more intensive regimens. Conclusions Reducing treatment frequency and UVA dose does not substantially compromise the therapeutic efficacy of PUVA.
文摘Background:Recently the beneficial effect of excimer laser treatment has been reported for patients with vitiligo. The influence of treatment frequency on this effect is not clear. Objectives:To determine the optimal frequency of 308-nm excimer laser therapy for vitiligo. Methods:In this prospective, university-based hospital study over 12 weeks we enrolled 14 patients. Each had at least three stable vitiligo lesions in the same body area. The three stable vitiligo lesions in each subject were randomly assigned to receive excimer laser treatment once (1×), twice (2×) and three times (3×) weekly, respectively. The initial ultraviolet (UV) dose was 50 mJ cm-2 less than the 308-nm minimal erythematous dose in vitiligo skin. The UV dose was increased at each treatment session according to the erythematous response to the previous treatment. Results:Thirteen subjects were treated for at least 6 weeks; seven were treated for all 12 weeks. At 6 weeks, the repigmentation rates for treated lesions were 8%(1/13) after 1×weekly treatment, 23%(3/13) after 2×weekly treatment and 62%(8/13) after 3×weekly treatment (P=0.0134; 3×vs. 1×weekly); at 12 weeks, these rates were 46%(6/13), 62%(8/13) and 69%(9/13), respectively (P=NS;3×vs. 1 ×weekly). Repigmentation initiation correlated with treatment number, regardless of frequency (P=NS). As shown by Kaplan-Meier analysis, repigmentation occurred earliest in the most frequently treated lesions (P=0.0336). At 12 weeks, the projected repigmentation rates for 1×,2×and 3×weekly treatment approached each other (60%, 79%and 82%, respectively); the mean repigmentation grades (on a scale of 0-5) for 1×,2×and 3×weekly treatment were 1.7, 2.4 and 3.3, respectively(P=0.018;3×.vs. 1×weekly). Laser-induced repigmentation persisted in most cases over the entire follow-up of 12 months after the end of treatment. Conclusions:308-nm excimer laser therapy is effective against vitiligo. Although repigmentation occurs fastest with 3×weekly treatment, the ultimate repigmentation initiation seems to depend entirely on the total number of treatments, not their frequency. However, treatment periods of more than 12 weeks may be necessary to obtain a satisfactory clinical repigmentation, particularly when vitiligo lesions are treated only 1×or 2×compared with 3×weekly.
文摘Background: Psoralen plus ultraviolet (UV) A (PUVA) is the standard treatment for early stage mycosis fungoides (MF).When 8-methoxypsoralen (8-MOP) is used in PUVA therapy, it often produces intolerance reactions such as nausea, vomiting and headache. Objectives: To investigate whether 5-methoxypsoralen (5-MOP) is a safe and effective alternative to 8-MOP in PUVA therapy for MF. Methods: A retrospective database search and chart review was done to identify patients with MF who received PUVA with either 5-MOP or 8-MOP as initial monotherapy at our institution. Between 1990 and 2004, 14 patients [seven men and seven women; mean age 70 years,range 51-82; National Cancer Institute disease stages IA (n =6) and IB (n = 8)] received 5-MOP, and 24 patients [21 men and three women; mean age 58 years, range 28-89; disease stages IA (n = 11), IB (n = 12) and IIB (n = 1)] received 8-MOP.Results: Twelve of 14 patients (86%) in the 5-MOP group and 22 of 24 (92%) in the 8-MOP group had a complete response to PUVA. These two subgroups of complete responders did not differ significantly in terms of PUVA therapy duration, number of treatments or cumulative UVA dose. They also did not differ significantly in terms of relapse-free rate [8%(one of 12) vs.23%(five of 22)] or time to relapse [17 months (range 4-31) vs.14 months (range 4-33)]. Moreover, PUVA maintenance therapywith either 5-MOP or 8-MOP in a subset of patients [26%(nine of 34)] did not affect long-term relapse-free status either.Conclusions: 5-MOP and 8-MOP have comparable therapeutic efficacy when used in PUVA therapy for MF.
文摘Background: The treatment with XeCl-excimer laser generated 308- nm UVB radiation has shown promising results in patients with vitiligo. Objective: In this controlled, prospective trial we studied the primary efficacy (start and grade of repigmentation) and patient’ s satisfaction of XeCl-excimer laser for treatment of vitiligo patches at different body sites and re-evaluated the achieved repigmentation 12 months after the end of therapy. Methods: Twenty-five patients with generalized or localized vitiligo with a total of 85 lesions at different body sites were enrolled in this study. Vitiligo patches were treated with 308- nm XeCl-excimer laser 3 times a week for 6 to 10 weeks. The overall repigmentation grade of each treated lesion was evaluated once a week on a 5 point scale rating from 0 (no repigmentation), 1 (1- 5% ), 2 (6- 25% ), 3 (26- 50% ), 4 (51- 75% ), to 5 (76- 100% ). Results: Twenty-four patients completed the study. Within 6 to 10 weeks of treatment 67% of the patients (16/24) developed follicular repigmentation of at least one of their vitiligo lesions. Lesion repigmentation started after a mean of 13 treatments in lesions located on the face, trunk, arm, and/or leg (high-responder location), and after a mean of 22 treatments in lesions located on the elbow, wrist, dorsum of the hand, knee, and/or dorsum of the foot (low-responder location). Untreated control lesions and lesions located on the fingers did not achieve any repigmentation. After 10 weeks of treatment repigmentation of more than 75% was found in 25% (7/28) of lesions of the high-responder location group versus 2% (1/43) of lesions of the low-responder location group. In most cases, laser-induced repigmentation was persistent, as determined 12 months after the end of treatment. Conclusions: 308- nm excimer laser is an effective modality for the treatment of vitiligo. However, similar to other non-surgical treatment modalities, the therapeutic effect is mainly dependent on the location of vitiligo lesions.
