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Joanna Narbutt,1 Janusz Krzyścin,2 Piotr Sobolewski,2 Małgorzata Skibińska,1 Marcin Noweta,1 Witold Owczarek,3 Bonawentura Rajewska-Więch,2 Aleksandra Lesiak1 1Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Łódź, Łódź, Poland; 2Institute of Geophysics, Polish Academy of Sciences, Warsaw, Poland; 3Department of Dermatology, Military Institute of Medicine, Warsaw, PolandCorrespondence: Janusz KrzyścinInstitute of Geophysics, Polish Academy of Sciences, Warsaw, 01-452, PolandTel +48-2269-15950Email jkrzys@igf.edu.plBackground: Nowadays, patients with moderate-to-severe psoriasis are treated with conventional immunosuppressants or with new biological agents. Phototherapy is the first-line treatment for patients in whom topical therapy is insufficient. Although numerous studies have been carried out, it is still difficult to predict the outcome of phototherapy in individual patients.Methods: Prior to standard narrow band (NB) ultraviolet B (UVB) phototherapy, the patients filled out a questionnaire about personal life and health status. Several standard blood tests, including selected cytokine levels, were performed before and after a course of 20 NB-UVB treatments. The questionnaire answers, results of the blood tests, and treatment outcomes were analyzed using an artificial intelligence approach—the random forest (RF) classification tool.Results: A total of 82 participants with moderate-to-severe psoriasis were enrolled. Prior to starting phototherapy, the patients with expected good outcome from the phototherapy, shorter remission, and quitting a possible second course of the NB-UVB treatment could be identified by the RF classifier with sensitivity over 84%, and accuracy of 75%, 85%, and 79%, respectively. The inclusion of cytokine data did not improve the performance of the RF classifier.Conclusion: This approach offers help in making clinical decisions by identifying psoriatic patients in whom phototherapy will significantly improve their skin, or those in whom other therapies should be recommended beforehand.Keywords: psoriasis, phototherapy, outcome prediction, artificial intelligence

Narrowband UV-B (NBUVB) phototherapy is the mainstay of vitiligo treatment, but hyperpigmentation is one of the limitations. Meanwhile, topical tretinoin is effective against pigmentary disorders.To determine whether tretinoin 0.05% cream would prevent hyperpigmentation when patients with facial vitiligo underwent phototherapy.A randomized, controlled, split-face trial was conducted. Adult patients with stable, non-segmental facial vitiligo were enrolled. The left/right sides of the face were randomly allocated to receive either topical tretinoin 0.05% cream or moisturizer twice daily. The entire face was subjected to NBUVB phototherapy twice weekly for 12 weeks. The degree of hyperpigmentation was assessed as the delta L* (brightness) value of the darkest spot in each side of the face at baseline and every 4 weeks. The degree of repigmentation was assessed.Twenty-five patients were enrolled; 21 completed the study. The delta L* value was significantly different between the two groups: -0.5% in the tretinoin group and -8.7% in the control group at 12 weeks (Tretinoin 0.05% cream prevented hyperpigmentation during NBUVB phototherapy in patients with facial vitiligo, and did not compromise the overall treatment response.ClinicalTrials.gov NCT03933774.

Background: Psoriasis-specific proteins dysregulated in keratinocytes and involved in the pathophysiological process of psoriasis remains elusive.Objective: This study aimed to investigate the seru...

Background: Psoriasis is a common chronic and immune-mediated inflammatory skin disease.Objectives: This study aimed to investigate the serum levels of Chitinase-3-like protein 1 (YKL-40) i...

Psoriasis is a major inflammatory disorder in the dermatological field. Phototherapy is effective and safe for psoriasis vulgaris. Narrow-band ultraviolet (UV) B and psoralen plus UVA are known to be the common modality as conventional non-targeted phototherapy. Non-targeted phototherapy making unnecessary irradiation to the unaffected skin may cause long-term adverse effects of UV. Targeted phototherapies with advantages, for example, higher dosages for lesional skin, a rapid clearing and longer remission rates, have been developed. Targeted phototherapies are preferably used for childhood, palmoplantar psoriasis, scalp and nail psoriasis as well as refractory lesions remained after whole-body UV therapy. Light sources of targeted phototherapy include broad-band UVB, narrow-band UVB, 308-nm excimer laser and light, 307-nm excimer light and 312-nm flat-type fluorescent lamp. This comprehensive review focuses recent evolution of target phototherapy for the treatment of psosriasis.

Objective: The purpose of this study is to compare the efficacy of three therapies in the treatment of non-segmental vitiligo: a combination of topical calcipotriol, narrowband-ultraviolet B (NB-UVB), and betamethasone therapies; a combination of NB-UVB and topical calcipotriol; and NB-UVB alone. Material and methods: Forty-five patients with non-segmental vitiligo presenting to our Dermatology clinic were recruited to participate in the study. Patients were randomly divided into three groups. For each patient the size of the depigmented areas was assessed according to the rule of nines. The first group was treated with a combination of topical calcipotriol, NB-UVB, and betamethasone therapies. The second group was treated with a combination of NB-UVB and topical calcipotriol and third group was treated with NB-UVB alone. Since the patients' vitiligo lesions had similar phototypes, all patients were started with 0.1 j/cm(2), regardless of their skin phototype. The dose of NB-UVB was increased 10% in each session and no further increment was done after reaching 2.5 j/cm(2). Treatment effectiveness was evaluated according to the percentage improvement in repigmentation. The quality of life of the patients was measured by the Dermatology Life Quality Index (DLQI). Results: The patients were aged from 13 to 55 years (mean: 25.29). The duration of disease ranged from 3 months to 20 years. Family history was positive for vitiligo in 10 patients (22.2%). The percentage of recovery after treatment was 63.33% +/- 7.55 in group 1, 60.67% +/- 5.75 in group 2, and 46.67% +/- 7.98 in group 3. There was no statistically significant difference between groups 1 and 2, and groups 2 and 3, but there was a statistically significant difference between groups 1 and 3 (p = 0.0048). Conclusions: In conclusion, NB-UVB-alone therapy and the combined therapies are effective treatment options in the treatment of vitiligo. Future studies with larger groups are warranted to confirm our results.

Broadband ultraviolet B (BB-UVB) phototherapy has demonstrated efficacy in the treatment of cutaneous disorders including psoriasis, atopic dermatitis, uremic pruritus and idiopathic pruritus. In the last decade, there has been a rapidly escalating process of replacing BB-UVB phototherapy units with narrowband ultraviolet B (NB-UVB) equipment, as studies have demonstrated that NB-UVB (ranging from 311 mm to 312 nm) is more efficacious in the treatment of psoriasis. Nevertheless, it is important to recognize the efficacy of BB-UVB phototherapy in the treatment of uremic pruritus, idiopathic pruritus, eosinophilic folliculitis and other inflammatory pruritic conditions. Furthermore, as highlighted in this report, there is a small but significant proportion of psoriasis and atopic dermatitis patients who do not tolerate NB-UVB but demonstrate an excellent clinical response to BB-UVB. It is critical for dermatologists to recognize the role of BB-UVB as a complement to NB-UVB phototherapy for patients who cannot tolerate or experience an inadequate therapeutic response from NB-UVB.

Ultraviolet (UV) radiation has been widely used in medicine, and in recent years there has been a growing interest in narrow-band UVB therapies, especially those employing pulses of the 308-nm line of XeCl excimer lasers. Comparative studies in several skin pathologies showed that narrow-band UVB was more effective than classical broad-band UVB radiation. Simultaneously, UVB is carcinogenic and there is a need for data to establish the risk associated with phototherapies involving irradiations of human skin with different doses of narrow- and broad-band UVA and/or UVB radiation. Relevant data are sparse predominantly due to a lack of suitable model systems for study of this phenomenon. Our comparative study of human and porcine skin responses to pulses of narrow-band UVB radiation demonstrated that for doses ranging from 5 to 10,000 mJ/cm(2) both skin types have similar susceptibility to UVB-induced breaking of nuclear DNA, indicating that pig skin might serve as good model for studies of sensitivity of human skin to UVB radiation.

Sequential displays of several treatment options for vitiligo have been scanned from the literature, and are presented here. A few of the medical modalities have been resigned to history, whereas others have become customary in clinical practice. There has also been a recent surge of interest in the surgical treatment of this disease. Accordingly, this has been appraised and summarized. Special attention has been given to prevalent medical modalities so that they may be effectively utilized by those currently in practice.

Impetigo herpetiformis is a rare pustular eruption with usual onset during the third trimester of pregnancy. The disease tends to remit after delivery, but may recur in subsequent pregnancies. Here we present a recurrent case of impetigo herpetiformis with earlier onset and poor response to corticosteroids in the subsequent pregnancy. She had widespread, erythematosquamous patches with tiny superficial pustules in the third trimester of her first pregnancy. Histopathological and clinical findings were consistent with impetigo herpetiformis. She was treated with systemic prednisolone and had a healthy baby without any complication. Three years later, the patient presented with impetigo herpetiformis again in the second trimester of her second pregnancy. After six weeks of oral prednisolone treatment, the lesions improved, but there were still new pustule formations and narrowband ultraviolet B treatment was added. Skin eruption cleared and she had a healthy baby in the 38th week of her second pregnancy. The corticosteroid dose was tapered gradually and stopped after delivery. Early diagnosis and treatment is crucial in impetigo herpetiformis because of the risk of maternal and fetal complications. When prednisolone is not enough to control the eruption alone, narrowband UVB can safely be added to the treatment.

Editoral commentOver the past 10 years narrowband UVB has become established as a standard treatment for recalcitrant chronic plaque psoriasis. Dr Pravit Asawanonda and Dr Charles Taylor of the Mas...