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Purpose: There are limited treatment options available for hematopoietic stem-cell transplant patients (HSCT) with oral graft-versus-host disease (GVHD). Intraoral phototherapy is a novel, yet promising therapeutic regimen. Research question: To assess the safety and effectiveness of intraoral narrowband UVB (nbUVB) phototherapy in the treatment of oral GVHD. Methods: This case series evaluated 10 patients with refractory oral GVHD, who were treated at Northwestern Memorial Hospital with nbUVB between July 2019 and October 2023. Primary outcomes were to evaluate the safety and efficacy of phototherapy. Efficacy was measured by objective improvement in symptom scores and subjective improvement in patient reported symptoms. Safety was determined by the withdrawal due to adverse events. Total nbUVB exposure, number of treatments, and change in systemic immunosuppressive medications were also examined. Results: The study cohort comprised 10 patients who developed oral GVHD at a median of 9.5 months after HSCT. The total median dose of nbUVB was 36 J/cm2, and the median number of sessions was 55. All 10 patients demonstrated some degree of improvement in symptoms. Notably, there was a reduction in the number of patients who reported symptoms of oral pain (83%), bleeding (67%), xerostomia (50%), and oral sensitivity (78%) after initiating phototherapy. There was also a statistically significant decrease in the levels of pain, erythema, and edema (p ≤ 0.001, < 0.001, 0.01, respectively). Most patients tolerated phototherapy well, but 1 patient withdrew from treatment due to adverse effects. Seventy-five percent of patients who were on immunosuppressive medications were able to decrease or stop these medications. Conclusion: This case series suggests that nbUVB phototherapy is well tolerated and efficacious in patients with oral GVHD. [ABSTRACT FROM AUTHOR]

Background: Vitiligo is characterized by depigmented patches resulting from loss of melanocytes. Phototherapy has emerged as a prominent treatment option for vitiligo, utilizing various light modalities to induce disease stability and repigmentation. Aims and Methods: This narrative review aims to explore the clinical applications and molecular mechanisms of phototherapy in vitiligo. Results and Discussion: The review evaluates existing literature on phototherapy for vitiligo, analyzing studies on hospital‐based and home‐based phototherapy, as well as outcomes related to stabilization and repigmentation. Narrowband ultra‐violet B, that is, NBUVB remains the most commonly employed, studied and effective phototherapy modality for vitiligo. Special attention is given to assessing different types of lamps, dosimetry, published guidelines, and the utilization of targeted phototherapy modalities. Additionally, the integration of phototherapy with other treatment modalities, including its use as a depigmenting therapy in generalized/universal vitiligo, is discussed. Screening for anti‐nuclear antibodies and tailoring approaches for non‐photo‐adapters are also examined. Conclusion: In conclusion, this review provides a comprehensive overview of phototherapy for vitiligo treatment. It underscores the evolving landscape of phototherapy and offers insights into optimizing therapeutic outcomes and addressing the challenges ahead. By integrating clinical evidence with molecular understanding, phototherapy emerges as a valuable therapeutic option for managing vitiligo, with potential for further advancements in the field. [ABSTRACT FROM AUTHOR]

We have discovered that human vitiligo patients treated with narrow‐band UVB (NBUVB) demonstrated localized resistance to repigmentation in skin sites characterized by distinct cellular and molecular pathways. Using immunostaining studies, discovery‐stage RNA‐Seq analysis, and confirmatory in situ hybridization, we analyzed paired biopsies collected from vitiligo lesions that did not repigment after 6 months of NBUVB treatment (non‐responding) and compared them with repigmented (responding) lesions from the same patient. Non‐responding lesions exhibited acanthotic epidermis, had low number of total, proliferative, and differentiated melanocyte (MC) populations, and increased number of senescent keratinocytes (KCs) and of cytotoxic CD8+ T cells as compared with responding lesions. The abnormal response in the non‐responding lesions was driven by a dysregulated cAMP pathway and of upstream activator PDE4B, and of WNT/β‐catenin repigmentation pathway. Vitiligo‐responding lesions expressed high levels of WNT10B ligand, a molecule that may prevent epidermal senescence induced by NBUVB, and that in cultured melanoblasts prevented the pro‐melanogenic effect of α‐MSH. Understanding the pathways that govern lack of NBUVB‐induced vitiligo repigmentation has a great promise in guiding the development of new therapeutic strategies for vitiligo. [ABSTRACT FROM AUTHOR]

Background: Narrowband UVB (NBUVB) has recently been used in Vietnam for the treatment of psoriasis. However, there are no data on Vietnamese patients to adopt a uniform national protocol. Objectives: This study aimed to establish an optimal NBUVB therapy for the treatment of psoriasis in Vietnamese patients. Materials and Methods: One hundred and twenty-two patients with psoriasis vulgaris were included. They were randomly allocated to two groups: the percentage dose (group 1, 62 patients) and the fixed dose (group 2, 60 patients). In group 1, the starting dose was 50% of the minimal erythema dose (MED) and the 10% increment dose adjusted in the next sessions. In group 2, the starting dose was based on Fitzpatrick skin types (fixed dose). Psoriasis area and severity index (PASI) was used to evaluate efficacy. Results: More than 68% of the patients get PASI75 at session 36. Group 2 had significantly fewer sessions (20 ± 5 vs 25 ± 7, P- value = 0.0004) and lower cumulative dose than group 1 (14.1 ± 4.3 J/cm² vs 18.0 ± 8.0 J/cm², P- value = 0.0075) to achieve PASI75. Adverse effects were more common in group 2 than group 1, including burning sensation/erythema (43.33% vs 14.52%, P- value = 0.0009) and pruritus (75.00% vs 22.58%, P- value <0.0001). Conclusion: NBUVB therapy was safe and effective for Vietnamese psoriasis patients. Fixed doses produced a quicker clinical response with fewer sessions and lower cumulative doses. Adverse effects were mild in both groups and less noted for the MED-based dose. For the recommendation, a fixed dose should be applied for patients who have less concern about side effects, while a MED-based dose can be suitable for patients having conditions related to light sensitivity. [ABSTRACT FROM AUTHOR]

Phototherapy is a useful treatment modality for atopic dermatitis (AD). This is a prospective randomised double‐blind study comparing the clinical efficacy of combined ultraviolet‐A (UVA)/narrowband ultraviolet‐B (NBUVB) versus NBUVB phototherapy in the treatment of chronic AD. Patients with moderate‐to‐severe AD were randomised to receive either UVA/NBUVB or NBUVB phototherapy twice weekly over 12 weeks. At baseline, weeks 6 and 12, Eczema Area And Severity Index (EASI), itch score and adverse effects were assessed. At baseline and week 12, disease‐related quality of life was evaluated using the Dermatology Life Quality Index (DLQI). Nine patients were randomised to receive UVA/NBUVB and 10 received NBUVB. At week 12, both groups showed significant improvement in EASI and itch scores (p < 0.05). Significant improvement in DLQI was seen in the UVA/NBUVB arm (p = 0.009) with a trend towards improvement in the NBUVB arm (p = 0.11). The efficacy of both modalities were comparable, as were reported adverse effects aside from skin dryness which was higher in the NBUVB arm (40% vs. 0%, p = 0.033). Combined UVA/NBUVB and NBUVB phototherapy have comparable clinical efficacy and safety in the treatment of chronic AD. NBUVB may induce greater skin dryness. [ABSTRACT FROM AUTHOR]

Purpose: Vitiligo is an idiopathic depigmenting skin disorder. The study compares the efficacy of topical tacrolimus 0.1% with calcipotriol/betamethasone dipropionate in vitiligo patients receiving NB-UVB treatment. Materials and methods: Forty-one adult patients with generalized type vitiligo were recruited. Patients were assigned to phototherapy and then classified into either group one (20 patients), receiving calcipotriol/betamethasone dipropionate cream (D group), or group two (21 patients), receiving tacrolimus 0.1% ointment (T group). They were followed-up at 3 and 6 months. Results: The D group witnessed an increase in the repigmentation area from 35.4% in the third month to 54.7% in the sixth month (p = 0.001) and the T group from 32.2% to 45.6% (p = 0.011). However, the differences between the treatment groups were not statistically significant. Body sites demonstrated different levels of improvement ranging from the highest in the face to the lowest in the Hand & Feet with the other body sites in between. A negative correlation was identified between the duration since diagnosis and the response to D treatment (3 months: r = −0.612, p = 0.007; 6 months: r = −0.755, p = 0.001). Conclusions: Although both combinations are efficacious, they did not significantly differ in efficacy at three and six months follow-up points. Clinical trial registration: The study was registered at clinicaltrials.gov (NCT04440371).

Purpose: Vitiligo is an idiopathic depigmenting skin disorder. The study compares the efficacy of topical tacrolimus 0.1% with calcipotriol/betamethasone dipropionate in vitiligo patients receiving NB-UVB treatment. Materials and methods: Forty-one adult patients with generalized type vitiligo were recruited. Patients were assigned to phototherapy and then classified into either group one (20 patients), receiving calcipotriol/betamethasone dipropionate cream (D group), or group two (21 patients), receiving tacrolimus 0.1% ointment (T group). They were followed-up at 3 and 6 months. Results: The D group witnessed an increase in the repigmentation area from 35.4% in the third month to 54.7% in the sixth month (p = 0.001) and the T group from 32.2% to 45.6% (p = 0.011). However, the differences between the treatment groups were not statistically significant. Body sites demonstrated different levels of improvement ranging from the highest in the face to the lowest in the Hand & Feet with the other body sites in between. A negative correlation was identified between the duration since diagnosis and the response to D treatment (3 months: r = −0.612, p = 0.007; 6 months: r = −0.755, p = 0.001). Conclusions: Although both combinations are efficacious, they did not significantly differ in efficacy at three and six months follow-up points. Clinical trial registration: The study was registered at clinicaltrials.gov (NCT04440371). [ABSTRACT FROM AUTHOR]

Background: Psoriasis is a chronic common skin condition which alters the skin appearance, causes an inflammation in the outer epidermis, and proliferates the skin epidermal layers. It is influenced by both genomic and other external factors like environmental factors. OBJECTIVES: To know and compare the efficacy and safety of 1. Oral -Methotrexate alone. 2. Combination of both oral -Methotrexate and NBUVB for the treatment of chronic plaque psoriasis. MATERIAL & METHODS: Study Design: Prospective hospital based observational study. Study area: The study was conducted in Department of Department of Dermatology, Narayana Medical College, Nellore, A.P. Study Period: 1 year. Study population: Patients of chronic plaque psoriasis not responding to any other therapeutic modality. Sample size: study consisted a total of 50 subjects. Sampling method: Simple Random sampling method. Study tools and Data collection procedure: Initially a detailed history regarding the age of onset, the duration of illness, past modalities of treatment, family history of the disease, seasonal variation, other triggering factors, occupation were taken. The patients were explained regarding the duration of treatment, the need for regular follow up of therapy, clinic and probable side effects that could be encountered during treatment. Complete haemogram, urine for albumin, sugar and microscopy, skin biopsy, blood sugar, liver function test, renal function test were done in all the patients before initiation of therapy and were done periodically to observe for any systemic involvement and the response to treatment was evaluated every week by PASI Score and also the patients were observed clinically for any cutaneous or systemic side effects. Results: Among all (n=50 including group A and B, 25 of each) participants, relapse of treatment in weeks observed between the range of 6-12, mean was 9 with the standard deviation of 1.6 in group A. For group B relapse of medical regimen in weeks observed between the range 8-12, Mean was 10.5 with the standard deviation of 1.9 which is nearly similar in group A. This results were statistically significant as p= 0.01 where p<0.05. CONCLUSION: From our study it, we concluded that Combination therapy of oral methotrexate and NBUVB is found to be most effective, feasible from the economic point of view as well as the side effects profile and patient compliance. [ABSTRACT FROM AUTHOR]

In this study, we have serially assessed the dermatoscopic features of disease stabilisation and markers of repigmentation in NSV patients undergoing narrow band ultraviolet B (NBUVB) phototherapy. Keywords: dermatoscopy; NBUVB; phototherapy; repigmentation; vitiligo EN dermatoscopy NBUVB phototherapy repigmentation vitiligo 279 281 3 05/11/23 20230501 NES 230501 To the Editor, Dermatoscopy is increasingly being used as an ancillary tool in the diagnosis and monitoring of various dermatoses, including vitiligo. Dermatoscopic evaluation of treatment response in patients undergoing NBUVB phototherapy for the treatment of non-segmental vitiligo: A prospective study. [Extracted from the article]

Purpose: Although the pathogenesis of psoriasis involves the dermis, most previous studies collected samples using the swab technique. A recent study examining the microbiomes obtained via both skin biopsies and swabs revealed a significant difference in normal skin. We hypothesized that the microbiome profile of patients with psoriasis from tape stripping and skin biopsy might be different. This study sought to contribute to microbiome research on psoriasis by investigating the changes in the microbiome during narrowband ultraviolet B (NBUVB) therapy by comparing the results from the different sampling techniques of tape stripping and skin biopsy. Patients and Methods: Twenty-three participants, including 14 patients with chronic plaque psoriasis and nine healthy controls, were recruited, and nine patients with psoriasis completed 20-sessions of NBUVB treatment. Skin microbiota from both techniques was analyzed using the 16S rRNA gene at baseline and after treatment. Results: A clear difference was observed between the results from the two sampling techniques. Alpha diversity of the microbiota obtained from tape stripping was higher than that of the microbiota from skin biopsy, whereas beta diversity was clustered into two groups by sampling technique. The microbiome was altered during NBUVB treatment using both sampling techniques. Conclusion: Different sampling techniques resulted in different microbiome profiles in patients with psoriasis. Tape stripping and swabs are feasible procedures and are mostly used in psoriasis and other skin microbiome studies; however, skin biopsy may also expand our understanding of psoriasis and other skin diseases that pathophysiology involves deeper to the dermis or subcutaneous tissue. [ABSTRACT FROM AUTHOR]

Pityriasis rubra pilaris (PRP) is a rare, chronic, inflammatory papulosquamous skin disease. Here, we report a case of a 43-year-old female with a known history of atopic dermatitis, bronchiectasis, and goiter who presented with a six-month history of persistent itchy skin lesions on her extremities. A skin examination revealed multiple diffuse, well-defined, fine, scaly erythematous patches with areas of spared skin over all four extremities, along with palmoplantar keratoderma. The trunk was spared. The differential diagnosis included atopic eczema, pityriasis rubra pilaris, dermatomyositis, mycosis fungoides, parapsoriasis, psoriasis, and drug-induced eczematous dermatitis. A skin biopsy revealed hyperkeratosis, acanthosis, spongiosis, follicular plugging, and mild perivascular lymphohistiocytic cellular infiltrates in the dermis. Based on the clinicopathological findings, the patient was diagnosed with atypical adult pityriasis rubra pilaris (PRP) (type II). She was started on narrowband UVB phototherapy (NBUVB). Two months after starting NBUVB treatment, all the skin lesions had cleared. She was put under periodic follow-up, and the lesions have remained clear for two years up to the time of this publication., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: Third party editing professional services were received for this case report from Scribbr. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Almoqati et al.)

Phototherapy is an extremely effective and established therapeutic modality in a variety of dermatological disorders. However, there has been a constant concern with respect to its long‐term usage as some of the studies have identified the risk of cutaneous malignancy associated with phototherapy. The carcinogenic potential of PUVA has been demonstrated in most US studies; however, the studies done on Asian and Arabian–African population have not corroborated similar findings, thus suggesting that the darker skin may confer protection against the development of cutaneous malignancy following phototherapy. The main aim of the present study was to assess the safety of phototherapy (bath PUVA and NBUVB) in Indian population (Fitzpatrick skin types IV and V) with respect to its carcinogenic potential and to determine the maximum cumulative dose that our patients could tolerate without developing any untoward complications such as cutaneous malignancy. All patients who received phototherapy between January 2006 and October 2016 were enrolled in the study. Details such as cumulative dose, number of phototherapy sessions received, indication for phototherapy, adverse effects such as pigmentary changes, new growths on the skin surface following the therapeutic sessions were entered in a predesigned proforma. This ambispective study had 1300 patients who had received phototherapy over a period of 10 years. A total of 929 patients had received PUVA, and the remaining 371 patients had received NBUVB for various dermatological indications. The average follow‐up period for PUVA was 3 years and 6.5 years for NBUVB. The maximum cumulative dose of UVA and UVB that could be safely administered in our patients was 2085 J/cm2 and 1985 mJ/cm2, respectively. None of our patients developed any features of cutaneous malignancy during their follow‐up. Both bath‐PUVA and NBUVB are safe and efficacious in treating patients of darker skin types (IV and V). The risk of developing cutaneous malignancy is negligible in this subset of patients. However, more studies need to be done on the Asian population to substantiate the same. [ABSTRACT FROM AUTHOR]

Background: Several different treatment modalities are available to treat vitiligo. One of them is topical corticosteroids but it has limitations if used for longer time. To overcome the side effects, we evaluated the efficacy of oral steroids in minipulse form along with antimetabolite methotrexate (MTX) and narrow-band ultraviolet B (NBUVB). Aim: This article aims to compare the efficacy of oral MTX with NBUVB vs. oral minipulse with betamethasone along with NBUVB in the patients of vitiligo vulgaris. Materials and Methods: A prospective study was conducted in 100 clinically diagnosed cases of vitiligo vulgaris; 50 of them were given NBUVB twice in a week along with MTX orally in a dose of 7.5 mg once weekly for 6 months. Remaining 50 were given NBUVB twice in a week along with betamethasone in a dose of 5 mg on two consecutive days per week for 6 months. The patients were assessed after every 2 weeks for 6 months. Blood pressure was checked regularly at each visit. Complete blood count, liver function tests, kidney function tests, blood sugar levels, and even ophthalmic examination was done at the end of 3 months. Repigmentation in the patients was assessed at the end of 6 months according to the Vitiligo European Task Force scoring system. Results: There was a significant reduction (P < 0.05) in depigmented area and staging with complete cessation of spreading of the vitiligo lesion after 6 months of therapy with MTX and NBUVB and also with another group taking oral minipulse betamethasone and NBUVB. Limitations: It was an open-labeled study. Conclusion: MTX along with NBUVB is equally an effective modality in controlling the progression of vitiligo vulgaris with minimal side effects, and hence MTX can be used as a steroid-sparing drug in patients with active vitiligo wherever corticosteroids are contraindicated.

Vitiligo is an acquired pigmentation disorder, characterized by depigmented patches on the skin. Treatment of vitiligo with Narrow Band Ultraviolet B light (NBUVB) is an important component of the current standard of care. However, there are no consistent guidelines regarding the dosing and administration of NBUVB in vitiligo. Initial dosing in accordance with MED is more appropriate because it complies with skin sensitivity of the patient against ultraviolet. However, there is no data about MED of vitiligo patient in Indonesia. This study aims to determine the MED value of vitiligo to NBUVB. This clinical pre-experimental study was post-test only design. Vitiligo patients in Dermatology-venereology clinic Dr. Ramelan Naval Hospital Surabaya were enrolled to this study. Home-phototherapy NBUVB was given on non-lesional skin and on vitiligo lesion. Fourteen patients were enrolled, 9 patients were in skin type 5 and 5 patients skin type 4. The lowest non-lesional MED value was 600 and the highest was 1000 mJ/cm². The lowest lesional MED value was 400 and the highest was 800 mJ/cm². This MED value may be used as a reference dose in providing phototherapy for vitiligo patient. We suggest to give the initial dose of NBUVB for Indonesian patient skin type 4-5 70% MED, 280 mJ/cm². [ABSTRACT FROM AUTHOR]

Background: Artificial ultraviolet (UV) radiation is a mainstay in the treatment of a variety of inflammatory skin disorders. Despite existence from a wealth of studies on the impact of narrow-band UVB (NBUVB) on serum levels of nutrients, clinical data on its effect on serum homocysteine (HC) level, which is thought to be a risk factor for cardiovascular disorders, dementia, and depression, are scarce. Objective: To assess serum HC status before and after treatment with at least 30 sessions of NBUVB exposure in patients with various cutaneous disorders. Methods: A prospective cohort study was conducted on 39 patients with psoriasis, vitiligo, atopic dermatitis, and mycosis fungoides who underwent at least 30 sessions of NBUVB phototherapy. Serum HC was measured and compared before and after phototherapy. This study was approved by relevant ethics committee. Results: Levels of HC decreased by 24.8% after 30 sessions of NBUVB phototherapy (10.53 - 3.64 lmol/L vs. 7.92 - 3.26 lmol/L, p-value <0.0001) and this decrease was more prominent in male participants and patients older than 40 years. Conclusions: Based to our findings, NBUVB phototherapy might be a modality of choice especially for older male patients not only as an effective treatment for cutaneous conditions, but also as a modality with potential protective effects against cardio--cerebro--vascular accidents. [ABSTRACT FROM AUTHOR]

We propose the use of protective coverings—gloves, socks, or clothing, with windows cut out into them, to ensure that the phototherapy targets only the affected areas.

Sphingolipids (SLs), are structural components of the skin that contribute to the regulation of the proliferation and differentiation of keratinocytes as well as regulation of the skin epidermal barrier. A prospective cross sectional comparative controlled study was designed to evaluate the serum level of sphingosine 1 phosphate (S1P) and ceramide (CER) before and after narrow band ultraviolet B (NBUVB) in psoriatic patients. The study included 32 patients presented with psoriasis and 32 healthy age and sex matched control volunteers. (S1P and CER) levels were measured before and after NBUVB sessions for psoriatic patients and their levels were correlated to psoriasis area and severity index (PASI) improvements. PASI scores and serum values of the studied sphingolipids demonstrated a significant difference between the baseline and at the end of the 12 weeks NBUVB treatment. A statistically significant positive correlation was established between psoriasis severity and S1P serum levels before and after treatment while no correlation was observed between psoriasis severity and CER serum levels. Decreased total CER and increased S1P serum levels reflect altered sphingolipid metabolism in psoriasis and can be predictors of disease severity. [ABSTRACT FROM AUTHOR]

Acute phase reactants (APR) are proteins that had been associated with psoriasis severity. We aimed to evaluate the association between psoriasis disease severity and some inflammatory markers as (CRP, ESR, and fibrinogen) before and after narrow band ultraviolet NB (NB‐UVB) therapy. The present study included 38 psoriatic patients and 38 controls of matching age and sex. The 38 included patients were divided according to their pretreatment PASI score into 2 subgroups: moderate 13 (34.2%) and severe 25 (65.8%). CRP, ESR, and fibrinogen levels were measured before and after NBUVB sessions for psoriatic patients and their levels were correlated to psoriasis area and severity index (PASI) improvements. PASI scores and laboratory values of APRs showed a significant difference before and after NBUVB sessions. PASI scores significantly correlated with CRP and FBG levels before and after treatment whereas no significant correlation was demonstrated between PASI and ESR levels before and after treatment. A combination of inflammatory markers and clinical assessment could be used in the formation of a new diagnostic tool to evaluate psoriasis severity and response to treatment. [ABSTRACT FROM AUTHOR]

Context: Vitiligo is a psychosocial problem which significantly affects quality of life in Indian scenario. Aims: The purpose of this study was to compare the changes in quality of life in patients of vitiligo before and after treatment with narrowband ultraviolet B (NBUVB) phototherapy. Subjects and Methods: A total of 54 patients had completed the study. The age ranged between 16 and 70 years with a mean age of 26.77±14.2 years. The initial dose of NBUVB was 300 mJ/cm2 in adults and 150 mJ/cm2 in children twice weekly with 20% dose increment on subsequent visits. It was given for a maximum period of 6 months and was followed up for another 6 months to determine stability of repigmentation. Results: The average number of exposure given to the patients was 45.63±12.74 while the mean irradiation cumulative dose was 39.8 J/cm2. Mean Dermatology Life Quality Index (DLQI) of the vitiligo patients was 8.64±4.32 while those patients with acrofacial vitiligo had a mean DLQI of 11.78±5.61. After treatment with NBUVB, mean DLQI of all vitiligo patients was significantly reduced to 5.86±2.15 (P

Introduction: Vitiligo is an acquired, hypomelanotic disease, characterized by circumscribed depigmented macules. Phototherapy, which is the use of ultraviolet irradiation with or without exogenous photosensitizer is a well established treatment option. Psoralens with sunlight as the source of ultraviolet A-rays is known as PUVASOL. Narrow band Ultraviolet B phototherapy (NBUVB; 311–313 nm) has been introduced over the past decade. Aims: To study the clinical effectiveness and assess the safety of NBUVB and PUVASOL therapy in Vitiligo patients. Methods: The patients were randomly allocated in to two groups containing 25 patients each. Group A patients received NBUVB with an initial dose of 250 mJ/cm2, incremented by 20% with each subsequent visit till optimum dose was achieved, twice a week on non-consecutive days. Group B patients received PUVASOL-oral Trimethylpsoralen or topical 0.2% w/w Trioxsalen followed by exposure to sunlight, twice a week on non-consecutive days. The extent of repigmentation was documented at regular intervals upto 6 months. Results: Amongst patients receiving NBUVB and PUVASOL, 56% and 48% had ≥50% repigmentation respectively. Disease was unstable in 48% and 36% of patients prior to commencement of therapy which reduced to 12% and 16% after therapy, respectively. 16% and 36% of the patients experienced side effects and 76% and 48% showed excellent colour match of the repigmented patches respectively. Conclusion: While both PUVASOL and NBUVB are both good therapeutic options; NBUVB therapy is found to be more effective and more cosmetically acceptable, with better colour matching of lesions and minimal adverse effects.

Background: Narrowband UVB (NBUVB) has recently been used in Vietnam for the treatment of psoriasis. However, there are no data on Vietnamese patients to adopt a uniform national protocol., Objectives: This study aimed to establish an optimal NBUVB therapy for the treatment of psoriasis in Vietnamese patients., Materials and Methods: One hundred and twenty-two patients with psoriasis vulgaris were included. They were randomly allocated to two groups: the percentage dose (group 1, 62 patients) and the fixed dose (group 2, 60 patients). In group 1, the starting dose was 50% of the minimal erythema dose (MED) and the 10% increment dose adjusted in the next sessions. In group 2, the starting dose was based on Fitzpatrick skin types (fixed dose). Psoriasis area and severity index (PASI) was used to evaluate efficacy., Results: More than 68% of the patients get PASI75 at session 36. Group 2 had significantly fewer sessions (20 ± 5 vs 25 ± 7, P- value = 0.0004) and lower cumulative dose than group 1 (14.1 ± 4.3 J/cm 2 vs 18.0 ± 8.0 J/cm 2 , P- value = 0.0075) to achieve PASI75. Adverse effects were more common in group 2 than group 1, including burning sensation/erythema (43.33% vs 14.52%, P- value = 0.0009) and pruritus (75.00% vs 22.58%, P- value <0.0001)., Conclusion: NBUVB therapy was safe and effective for Vietnamese psoriasis patients. Fixed doses produced a quicker clinical response with fewer sessions and lower cumulative doses. Adverse effects were mild in both groups and less noted for the MED-based dose. For the recommendation, a fixed dose should be applied for patients who have less concern about side effects, while a MED-based dose can be suitable for patients having conditions related to light sensitivity., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Journal of Dermatology.)

Conventional, full-body phototherapy equipment is costly and therefore patients are usually treated in dermatology centres. Such office-based therapy is often not feasible for those patients who live far away from a phototherapy centre due to lost time and wages, inability to travel because of extensive skin disease, or prohibitive travel costs. Home phototherapy has emerged as a modality that meets the needs of those patients. Our aim was to review available studies on UV sources, treatment protocols, efficacy, and safety of home phototherapy. A literature review was conducted on PubMed using the terms "home" AND "phototherapy" AND ("guide" OR "approach" OR "review" OR "protocol"). From the data extracted, narrowband UVB (311 nm) offers the best balance between safety and efficacy and is recommended for home phototherapy by most authors. Treatment is safe and possible adverse effects are related to overexposure (erythema, blistering). The usual treatment protocol was administering treatments on alternating days, including weekends, with dosing based on the patient's Fitzpatrick skin type. We also provide information on the available home phototherapy systems in Canada and their reimbursement. Home phototherapy is underused in Canada. Narrowband UVB phototherapy sources equipped with a 3-dimensional panel provides a practical and safe option. [ABSTRACT FROM AUTHOR]

Context: Vitiligo is a psychosocial problem which significantly affects quality of life in Indian scenario. Aims: The purpose of this study was to compare the changes in quality of life in patients of vitiligo before and after treatment with narrowband ultraviolet B (NBUVB) phototherapy. Subjects and Methods: A total of 54 patients had completed the study. The age ranged between 16 and 70 years with a mean age of 26.77±14.2 years. The initial dose of NBUVB was 300 mJ/cm² in adults and 150 mJ/cm² in children twice weekly with 20% dose increment on subsequent visits. It was given for a maximum period of 6 months and was followed up for another 6 months to determine stability of repigmentation. Results: The average number of exposure given to the patients was 45.63±12.74 while the mean irradiation cumulative dose was 39.8 J/cm². Mean Dermatology Life Quality Index (DLQI) of the vitiligo patients was 8.64±4.32 while those patients with acrofacial vitiligo had a mean DLQI of 11.78±5.61. After treatment with NBUVB, mean DLQI of all vitiligo patients was significantly reduced to 5.86±2.15 (P<0.01). Conclusions: This study showed that phototherapy had a positive therapeutic outcome in vitiligo, especially in younger patients. Even a small, depigmented lesion in a child could be psychosocially devastating. [ABSTRACT FROM AUTHOR]

In our study, tacrolimus/NBUVB therapy led to a significant improvement in vitiligo lesions over three months based on VASI scores and melanin values, with no skin or systemic complications being observed. Keywords: NBUVB; pentoxifylline; phototherapy; tacrolimus; vitiligo EN NBUVB pentoxifylline phototherapy tacrolimus vitiligo 255 256 2 02/22/22 20220201 NES 220201 Vitiligo is the most common depigmenting disease and involves 0.5-4% of the population, without any age or gender predominance. Topical pentoxifylline can be an effective and safe adjunctive therapy to NBUVB therapy in treating vitiligo: A split-side clinical trial. [Extracted from the article]

We propose the use of protective coverings--gloves, socks, or clothing, with windows cut out into them, to ensure that the phototherapy targets only the affected areas. [ABSTRACT FROM AUTHOR]

Introduction: Calcipotriol and narrow-band ultraviolet B (NBUVB) phototherapy are widely used to effectively treat psoriasis. To reduce the cumulative NBUVB doses and to enhance clearance of psoriatic plaques, combination therapies have been established. Objectives: To compare the clinical efficacy of NBUVB alone and in combination with topical calcipotriol ointment in psoriasis. Patients and Methods: Fifty five patients with psoriasis vulgaris were included in the study. Patients were randomized into two treatment groups. Group I consisted of 30 patients who received NBUVB phototherapy as monotherapy and group II consisted of 25 patients who were treated with topical calcipotriol ointment combined with NBUVB. The treatment was continued till the patients achieved PASI-75. Results: Twenty patients, in each group, completed the study. At baseline, the mean PASI scores were 15±4 and 16.4±3 in group I and group II respectively, and at the end of treatment, the mean PASI scores were 6.5±3 in group I and 3.4±2 in group II (P=0.000). The total cumulative NBUVB dose and the number of sessions were significantly higher in group I compare to group II. Conclusion: Topical calcipotriol combined with NBUVB reduces the cumulative dose of NBUVB and improves the response of psoriasis vulgaris to phototherapy. [ABSTRACT FROM AUTHOR]

Background The potential of psoralen-narrowband ultraviolet B ( NBUVB) photochemotherapy has been investigated in vitiligo. The present study aims to evaluate the efficacy of psoralen- NBUVB ( P- NBUVB) vs. NBUVB in vitiligo. Methods In a randomized study, 45 Indian patients (age above 13 years) with vitiligo involving more than 5% body surface area were randomly allocated to receive either NBUVB or P- NBUVB treatment. Both groups received NBUVB exposure thrice weekly, with a total of 60 sessions. The extent of repigmentation achieved was calculated on the basis of Vitiligo Area Severity Index ( VASI) scoring. Results Forty patients were available for analysis at the end of the study. The extent of repigmentation in the P- NBUVB group was statistically significantly greater in face and neck ( P = 0.006, t-test) and hands ( P = 0.007, t-test) in comparison with the NBUVB group ( t-test). Percentage reduction in VASI scores was statistically significantly greater in the P- NBUVB group (29.2% vs. 21.7%, P = 0.043, t-test). The response to P- NBUVB therapy started earlier than the response to NBUVB. After excluding sunlight as a confounding factor, treatment response was also significantly better in the P- NBUVB group ( P = 0.005). Conclusion Addition of psoralen increased the extent of repigmentation due to NBUVB therapy in vitiligo. Further studies are required to determine the long-term efficacy and safety of P- NBUVB. [ABSTRACT FROM AUTHOR]

Background: No comparative and simultaneous in vitro studies have been performed to determine the cytotoxic dose of narrowband UVB (NBUVB) and broadband UVB (BBUVB) for keratinocytes, melanocytes, and fibroblasts. Culture medium was often replaced with phosphate-buffered saline (PBS) before UV irradiation; however, its amount differed across studies. We determined the cytotoxic doses of NBUVB and BBUVB and tested for changes in viability according to the amount of PBS. Methods: We exposed cultured human keratinocytes, melanocytes, and fibroblasts to ultraviolet light in the range 12.5–1000 mJ/cm2 for NBUVB and 1.25–100 mJ/cm2 for BBUVB. The viability was assessed after 24 h. We also determined changes in viability at cytotoxic doses according to the amount of PBS (40, 80, and 120 μl/well in a 96-well plate). Results: Cytotoxicity was observed at doses of 100, 200, and 400 mJ/cm2 for NBUVB and 5, 10, and 25 mJ/cm2 for BBUVB in keratinocytes, melanocytes, and fibroblasts, respectively. At cytotoxic doses, there was no change in viability according to the amount of PBS. Conclusions: Fibroblasts are more resistant to UVB irradiation, irrespective of the amount of NBUVB and BBUVB, than keratinocytes and melanocytes. The amount of PBS during irradiation had no effect on viability. [ABSTRACT FROM AUTHOR]

Background Vitiligo is a common pigmentary disorder with great cosmetic and psychological morbidity and an unpredictable course. No treatment available is a definitive cure. Systemic psoralen and ultraviolet A (PUVA) has been the mainstay of treatment. Narrow-band UVB (NBUVB) was later introduced. In this study, we have compared the phototherapy modalities PUVA and NBUVB in inducing stability in vitiligo, assessed by using vitiligo disease activity score (VIDA), for the first time. Aims To investigate the position of NBUVB vis-à-vis PUVA in terms of stability achieved during therapy as indicated by the VIDA scores. Subjects and methods It was an open, prospective study of 50 patients divided equally in PUVA and NBUVB groups. The study period was from January 2004 to June 2005. This study was done as a part of a larger project to compare the efficacy of mentioned modalities in degree of repigmentation. Results In the NBUVB group, disease activity was present in 40% patients before commencement of therapy, which was reduced to 16% at the end of therapy (statistically significant, P = 0.049). In the PUVA group, similar figures were 20% and 16%, respectively. In the NBUVB group, 50% of patients whose disease was active prior to commencement of therapy had less than 50% repigmentation, whereas an equal number of patients had repigmentation of more than 50%. Almost an equal number of stable patients had less than and more than 50% repigmentation. In the PUVA group, 4 of the 5 (80%) patients who had active disease had less than 50% repigmentation, whereas only 1 patient (20%) with active disease obtained more than 50% repigmentation. The time to attain stability was 3.6 ± 2.1 months in the NBUVB group and 3.22 ± 3.1 months in the PUVA group. Eight of the 10 (80%) patients with unstable disease in the NBUVB group achieved stability, whereas 2 of the 5 (40%) patients of similar pre-treatment status in the PUVA group achieved stability. Conclusion NBUVB was in a more statistically advantageous position vis-à-vis PUVA, in respect to stability achieved and efficacy in both active and stable disease in a comparable time period. [ABSTRACT FROM AUTHOR]

Background/purpose: Atopic dermatitis (AD) is a common and extremely burdensome skin disorder with limited therapeutic options. Ultraviolet (UV) phototherapy is a well tolerated, efficacious treatment for AD, but its use is limited by a lack of guidelines in the optimal choice of modality and dosing. Given this deficit, we aim to develop suggestions for the treatment of AD with phototherapy by systematically reviewing the current medical literature. Methods: Data sources: All data sources were identified through searches of MEDLINE via the Ovid interface, the Cochrane Central Register of Controlled Trials, and a complementary manual literature search. Study selection: Studies selected for review met these inclusion criteria, as applied by multiple reviewers: controlled clinical trials of UV phototherapy in the management of AD in human subjects as reported in the English-language literature. Studies limited to hand dermatitis and studies in which subjects were allowed unmonitored use of topical corticosteroids or immunomodulators were excluded. Data extraction: Included studies were assessed by multiple independent observers who extracted and compiled the following data: number of patients, duration of treatment, cumulative doses of UV radiation, adverse effects, and study results. Data quality was assessed by comparing data sets and rechecking source materials if a discrepancy occurred. Results: Nine trials that met the inclusion criteria were identified. Three studies demonstrated that UVA1 is both faster and more efficacious than combined UVAB for treating acute AD. Two trials disclosed the advantages of medium dose (50 J/cm2) UVA1 for treating acute AD. Two trials revealed the superiority of combined UVAB in the management of chronic AD. Two additional studies demonstrated that narrow-band UVB is more effective than either broad-band UVA or UVA1 for managing chronic AD. Conclusion: On the basis of available evidence, the following suggestions can be made: phototherapy with medium-dose (50 J/cm2) UVA1, if available, should be used to control acute flares of AD while UVB modalities, specifically narrow-band UVB, should be used for the management of chronic AD. [ABSTRACT FROM AUTHOR]

Vitiligo, particularly in darker skinned individuals, is a psychosocial disaster. With patient education, proper therapeutic selection and persistence, favorable repigmentation can be achieved in the majority of individuals with vitiligo. Attention to the activity state of the disease, the type, location and extent of the vitiligo must be carefully balanced against the patient's expectations, time commitment and assumption of risks. In this review, Dr Taneja succinctly summarizes the wide range of therapeutic options available today for the vitiligo patient. [ABSTRACT FROM AUTHOR]

Eosinophilic pustular folliculitis of Ofuji is a recalcitrant disease typified by non-infective eosinophilic spongiosis involving the infundibular region of the hair fofficle. We present a case of a 49-year-old Chinese man with known palmoplantar pustulosis and acrodermatitis continua of Hallopeau which was promptly resolved with methotrexate therapy. He returned with an erythematous papulopustular eruption with coalescence to annular plaques, occurring over the face, chest and back with active palmoplantar pustulation. Histology from skin biopsy of the palmar lesion was in keeping with palmoplantar psoriasis, while biopsy of the facial and truncal lesions revealed florid perifollicular eosinophilic congregation diagnostic of eosinophilic pustular fofficulitis of Ofuji. Indomethacin was initiated with partial improvement of lesions with cyclical flares. A trial of narrowband ultraviolet-B phototherapy at a frequency of thrice weekly achieved sustained clearance of both eosinophilic pustular folliculitis and palmoplantar lesions. Indomethacin was tailed down and eventually discontinued with maintenance of narrowband ultraviolet-B therapy; this achieved successful control of the disease. [ABSTRACT FROM AUTHOR]

Treatment for progressive macular hypomelanosis (PMH) has been disappointing. Recently, Propionibacterium acnes had been postulated as the causative agent and narrow-band ultraviolet B (NBUVB) had been shown to stimulate melanogenesis and has antibacterial properties. The aim of this study was to evaluate the effectiveness of NBUVB in the treatment of PMH. A retrospective analysis of PMH cases diagnosed and treated with NBUVB treatment from 1 January 2007 to 30 April 2009 at the National Skin Centre (NSC) was conducted. The diagnosis of PMH was clinical. Treatment with NBUVB (311 nm) was given twice to thrice weekly. The initial treatment dose was determined as 70% of the patients' individual 311 nm UVB minimal erythema dose. The dose was increased by 10–20% if previous treatment had caused no or slight erythema. Percentage repigmentation from baseline was assessed at each follow-up. A total of six patients diagnosed with PMH were treated with NBUVB in NSC in the past 2 years. Three patients had good improvement and the remainder had moderate improvement. Recurrence did occur. No adverse events were documented. The success of NBUVB as a monotherapy provides a viable and relatively safe, albeit temporary relief, for these individuals. [ABSTRACT FROM AUTHOR]

Treatment of refractory palmar-plantar vitiligo is particularly challenging because the skin in these regions has a limited supply of follicle-derived melanocytic stem cells. Autologous hair transplantation monotherapy is effective in some forms of vitiligo through the provision of melanocytic stem cells. CO 2  laser followed by exposure to light (i.e., sunlight or narrow-band ultraviolet-B [nbUVB]) has independently shown to be an effective treatment strategy. Recently, it was found that the combination of hair transplantation and CO 2  laser followed by nbUVB exposure had superior efficacy to either modality as monotherapy. Similar to CO 2  laser, microneedling produces skin cell proliferation and releases pro-pigmentary cytokines. Given the important role of the cytokines in vitiliginous skin, microneedling may also be an effective therapeutic modality for refractory vitiligo. Herein, we conducted a pilot study to evaluate the efficacy of hair transplantation and CO 2  laser or microneedling followed by nbUVB. Microneedling and fractional CO 2  laser in combination with hair transplantation and nbUVB both demonstrated utility in the induction of repigmentation in refractory palmar-plantar vitiligo; however, a larger trial would be needed to determine a difference in treatment efficacy. Nonetheless, microneedling is cost-effective and requires minimal training; therefore, microneedling can be easily incorporated into standard dermatological practice., Competing Interests: Ultraviolet radiation (UVR) therapy in treating human disease., (Copyright © 2020, Feily et al.)

Phototherapy has been used successfully to treat a wide range of pediatric skin conditions. It is a viable option in children with severe dermatologic disease or who have failed first-line treatments, and several studies have demonstrated its efficacy and safety in the pediatric population. Despite the growing body of evidence on the use of phototherapy in children, large controlled trials and long-term studies are lacking. Moreover, special considerations must be taken when using phototherapy in children. This review highlights the recent evidence supporting the efficacy and safety of phototherapy in children, with focus on the common light-sensitive pediatric skin conditions., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Phototherapy in skin of color requires special consideration. Pigmented skin is an efficient ultraviolet filter. Hence, higher doses of ultraviolet radiation are generally more effective and well tolerated in skin of color. An objective and practical system has not yet been established to determine optimal phototherapy dosing in skin of color. The authors recommend obtaining a detailed history of each individual patient's response to sun exposure before prescribing a phototherapy dosing regimen. In addition, providers should consider the role of socioeconomic factors and their impact on phototherapy-related outcomes, including barriers to access and compliance., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Vitiligo is a common disorder with a severe impact on quality of life. The authors review recent advances in phototherapy for vitiligo focusing on narrowband ultraviolet B including mechanisms, treatment recommendations, and combination therapies. Phototherapy is the first-line treatment of choice for vitiligo with narrowband UVB preferred for widespread vitiligo and excimer used for localized lesions. However, unfamiliarity with prescribing phototherapy may be limiting clinicians from using it to its full potential. This article provides clinicians with the critical information needed to safely and effectively provide phototherapy for their patients with vitiligo., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Vitiligo is an autoimmune disease in which cutaneous depigmentation occurs. Existing therapies are often inadequate. Prior reports have shown benefit of the Janus kinase (JAK) inhibitors.Objective: To evaluate the efficacy of the JAK 1/3 inhibitor tofacitinib in the treatment of vitiligo.Method: This is a retrospective case series of 10 consecutive patients with vitiligo treated with tofacitinib. Severity of disease was assessed by body surface area of depigmentation.Results: Ten consecutive patients were treated with tofacitinib. Five patients achieved some repigmentation at sites of either sunlight exposure or low-dose narrowband ultraviolet B phototherapy. Suction blister sampling revealed that the autoimmune response was inhibited during treatment in both responding and nonresponding lesions, suggesting that light rather than immunosuppression was primarily required for melanocyte regeneration.Limitations: Limitations include the small size of the study population, retrospective nature of the study, and lack of a control group.Conclusion: Treatment of vitiligo with JAK inhibitors appears to require light exposure. In contrast to treatment with phototherapy alone, repigmentation during treatment with JAK inhibitors may require only low-level light. Maintenance of repigmentation may be achieved with JAK inhibitor monotherapy. These results support a model wherein JAK inhibitors suppress T cell mediators of vitiligo and light exposure is necessary for stimulation of melanocyte regeneration. [ABSTRACT FROM AUTHOR]

Progressive macular hypomelanosis (PMH) is an acquired disorder of skin pigmentation, which is mostly under-diagnosed. It is characterized by nummular hypopigmented lesions appearing on the trunk in young persons. Several treatment options are available, although topical clindamycin and benzoyl peroxide have been used traditionally. However, good results have recently been achieved using narrow-band ultraviolet B (NBUVB) phototherapy. We present the case of a 13-year-old girl with hypopigmented lesions on the trunk and limbs that had progressed over 1 year and that were diagnosed as PMH. The patient was initially treated with topical clindamycin and benzoyl peroxide. However, little improvement was seen and treatment was then started with NBUVB phototherapy. After 25 sessions, with a total cumulative dose of 18 J/cm, the patient showed almost total repigmentation of the lesions. The treatment of PMH is often difficult, and very little is currently known about the treatment response in this disorder, as most reports have very small series of patients with a short disease progression time. NBUVB phototherapy has been shown to be effective, as seen in our patient, although in many cases, there is recurrence after the cessation of treatment. [ABSTRACT FROM AUTHOR]