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
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.
