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PURPOSE Antibiotic use in acne treatment raises concerns about increased resistance, necessitating alternatives. We assessed the effectiveness of blue-light therapy for acne. METHODS We analyzed randomized controlled trials comparing blue light with nonlight interventions. Studies included people of any age, sex, and acne severity, in any setting, and reported on investigator-assessed change in acne severity, patients' assessment of improvement, change in inflammatory or noninflammatory lesions, and adverse events. Where data were sufficient, mean differences were calculated. RESULTS Eighteen references (14 trials) including 698 participants were included. Most of the trials were small and short ( CONCLUSION Methodological and reporting limitations of existing evidence limit conclusions about the effectiveness of blue light for acne. Clinicians and patients should therefore consider the balance between its benefits and adverse events, as well as costs. Key words: acne vulgaris; humans; light; phototherapy, INTRODUCTION Approximately 50 million Americans have acne vulgaris (1); it is the eighth most prevalent disease globally (2) and one of the most common reasons for clinical consultations, (3) including [...]

ABSTRACT Nephrogenic systemic fibrosis (NSF) is a recently described, debilitating systemic disease most commonly seen in patients with renal insufficiency. Exposure to gadolinium-containing contrast agent has been associated with the [...]

ABSTRACT Phototherapy is well-recognized as effective therapy in early stage cutaneous T-cell lymphoma (patch and plaque), often resulting in complete clearance of clinical disease and subsequent remission. Although not curable, [...]

The aim of this pilot study was to investigate whether light therapy improves healthy subjects' neurocognitive performance of attention, memory, and language. Ten subjects were treated with white bright light for 5 days and a control group of 10 with no treatment were assessed with a battery of neurocognitive tests which included the Stroop Colour Word Interference Test, the Verbal Fluency Test, the Story Recall Test, and the Word Pairs Recall Test. Analysis showed improvements in cognitive scores in both groups, although on all the cognitive tests the mean difference scores between baseline and endpoint were significantly larger in the light-treated group. These preliminary results suggest that short-term bright light may exert beneficial effects on cognitive functions.

Neuropsychiatric behaviors are common in people with Alzheimer's disease (AD) and make both professional and lay caregiving difficult. Light therapy has been somewhat successful in ameliorating disruptive behaviors. This randomized trial tested the effects of morning or afternoon bright light exposure compared with usual indoor light on the presence, frequency, severity, and occupational disruptiveness of neuropsychiatric behaviors in nursing home residents with AD. Light was administered for 1 hr daily (Monday-Friday) for 10 weeks. The Neuropsychiatric Inventory-Nursing Home was used to assess behavior at baseline and end of the intervention. Analyses revealed statistically significant differences between groups on agitation/aggression, depression/dysphoria, aberrant motor behavior, and appetite/eating disorders. The magnitude of change was small and may not represent clinically significant findings. Agitation/aggression and nighttime behaviors commonly occurred and were highly correlated with occupational disruptiveness. Interventions that decrease the presence and/or severity of neuropsychiatric behaviors have the potential to significantly decrease caregiver burden. Keywords: caregivers; dementia; light therapy; NPI-NH; nursing home

31 subjects, age 55 yr. or older, suffering from mild early morning awakening were randomized to either a bright light (10,000 lux) or to a red dim light placebo condition (200 lux). Light exposure took place in the evening in the patients' homes, 60 to 30 min. before bedtime and lasted for 3 wk. The subjects kept a sleep diary for 2 wk. and wore an actigraph for 1 wk. both before treatment and at post-treatment. Of the eight sleep diary outcome variables, significant effects that could be attributed to the light treatment were only detected for time spent in bed after final morning awakening. None of the six actigraph outcome variables yielded any significant effect of the light therapy. Explanations for the limited therapeutic effects of bright light treatment obtained in the present study are discussed, such as the criteria defining early morning awakening, the selection procedure, problems with compliance, age of the sample, and the dose of light. The lack of an objective circadian marker in this study could represent a problem concerning the timing of the light exposure. Despite the limited success of bright light therapy in this study, bright light therapy should still be considered as a treatment option for early morning awakening.

Therapists investigated the use of light therapy with a 17-year-old eating-disordered female patient. They had noted that the patient's condition worsened during the winter months. An improvement in mood, energy and eating occurred after four days of light therapy for 30 minutes each morning. The patient showed significant improvements in nutritional intake and her rating on the Eating Attitudes Test decreased from 78 to 64 within one month of commencing treatment. Her depression rating on the Beck Depression Inventory also dropped from 37 to 17 within the month.

Treatment with Sn-mesoporphyrin (SnMP) may control neonatal jaundice. SnMP is an enzyme that inhibits bilirubin production. Bilirubin is a yellow pigment that builds up in the blood because the newborn's immature liver lacks the ability to adequately dispose of it. At an Athens, Greece hospital, 92 term and near-term healthy, mildly jaundiced newborns aged 36 to 84 hours were randomly assigned to standard treatment under ultraviolet light or to a single injection of SnMP. Infants with conditions that would cause dangerously high bilirubin levels were excluded. None of the 44 infants treated with SnMP required supplemental light therapy. The time period for tracking bilirubin levels before considering the problem resolved was 30 hours less for SnMP-treated infants. Larger trials should be mounted to evaluate the safety and efficacy of this experimental drug., ABSTRACT. Background. Sn-mesoporphyrin (SnMP) is a potent inhibitor of bilirubin production. In our previous studies a single dose (6 [mu]mol/kg birth weight) significantly moderated hyperbilirubinemia and reduced phototherapy (PT) time [...]

Psoriasis may exist in various forms, the most common of which is chronic plaque psoriasis. Psoriasis may first occur during two times of life: adolescence and young adulthood, around 16 to 22 years of age, and in later life, around age 57 to 60. It is characterized by the presence of scaly plaques which consist of a thickened, horny layer of skin. Plaques are caused by a T-lymphocyte-mediated immune response in the skin to unknown stimuli. There is no known cure for psoriasis, but certain treatments may alleviate the symptoms and control the extent of the disease. Initial treatment usually consists of topical agents such as emollients, salicylic acid ointment, coal tar, anthralin, topical corticosteroids, and calcipotriene. Phototherapy or systemic drug therapy may be used for patients with physically, socially, or economically disabling psoriasis that has not been helped by topical treatment. Methotrexate, etretinate, systemic corticosteroids, and cyclosporine are systemic agents used to treat severe psoriasis. The benefits of treatment may need to be weighed against adverse side effects.

The most common cause of hospitalization of full-term newborns is an excess of bilirubin in the blood, called hyperbilirubinemia. Phototherapy, which has been demonstrated to be an effective way of decreasing bilirubin concentration, is expensive and requires hospitalization. This can interrupt breast-feeding by separating the infant from the mother. An alternative to bilirubin, oral agar, can bind bilirubin to the gut and thereby lessen enterohepatic circulation of bilirubin. Oral agar was compared with three other modes of treatment: phototherapy alone, oral agar alone or phototherapy plus oral agar. Results showed that the combination of phototherapy and oral agar was the most effective of the three treatments. However, oral agar alone can be used for the treatment of hyperbilirubinemia, because it has been demonstrated to be as effective as phototherapy., Objective. To determine the value of oral agar in the treatment of neonatal hyperbilirubinemia and to compare it with two other treatment modalities: phototherapy alone and phototherapy plus oral agar. Methods. Two hundred eight jaundiced full-term newborns were divided into four groups. They were given either phototherapy alone, phototherapy plus oral agar, oral agar alone, or no treatment (control group). The changes in the serum bilirubin values were determined and the results were compared statistically, mainly using analysis of variance. Results. In all three therapy groups, the time required to reduce the bilirubin level to either 15 mg/dL or to 10 mg/dL was significantly shorter than that required by the control group. Although oral agar was found to be as effective as phototherapy, the most significant decrease in bilirubin level was in the combination group. Conclusions. The efficacy of phototherapy in decreasing the serum bilirubin level in neonatal hyperbilirubinemia can be augmented with the use of oral agar. Oral agar can also be used as a single agent for the treatment of neonatal hyperbilirubinemia, since it is as effective as phototherapy. Pediatrics 1993;92:86-89; phototherapy, oral agar, hyperbilirubinemia, neonate.

Many pediatricians may hospitalize newborn infants with jaundice even though those who recommend home phototherapy have found few problems associated with the treatment. Of 92 pediatricians surveyed on their attitudes toward home phototherapy, only 30 had ever prescribed it. Few followed the American Academy of Pediatrics guidelines for selecting infants who would likely benefit. While the guidelines list many contraindications for treatment, many of the pediatricians would treat infants who had contraindications. Nonusers said they did not prescribe home phototherapy because of perceived problems including compliance, parental anxiety and legal problems. However, most of the users experienced few problems., Rather than using home phototherapy (HP), many pediatricians admit neonates to the hospital for the treatment of unconjugated hyperbilirubinemia. This study investigates the concerns and experiences of pediatricians related to HP use. A questionnaire was sent to 150 pediatricians in the Philadelphia, PA, area and 94 returned questionnaires. Of the responders, 30 of 94 had used HP. Twenty-nine users and 62 of 64 nonusers answered detailed questions regarding HP. Few practitioners follow American Academy of Pediatrics guidelines in selection of HP candidates. Among 29 pediatricians, prematurity (7), Rh incompatibility (13), positive direct Coombs (21), and ABO incompatibility (22) were not considered contraindications, although the American Academy of Pediatrics recommends all as contraindications. Almost all (29/30) HP users identified at least one problem with home treatment. The most commonly reported problems were parental anxiety, blood testing difficulties, and reimbursement issues. Nonusers (62) were asked their reasons for not using HP. The most common replies related to concerns about noncompliance (25), medical-legal issues (23), and administrative difficulties (22), none of which were cited as problems by HP users. Pediatrics 1993; 91:97-100; unconjugated hyperbilirubinemia, neonatal jaundice, phototherapy, home phototherapy.

Now is the winter of our discontent Made glorious summer by this sun of York --W. Shakespeare, Richard III Humans were biologically programmed to sleep at times that in the [...]

Standard recommendations for evaluating and treating jaundice in term babies include following all babies closely for jaundice, obtaining several laboratory tests in those with early jaundice or bilirubin levels more than 12 to 13 mg/dL (205 to 222 [mu]mol/L), using phototherapy to try to keep bilirubin levels below 20 mg/dL (342 [mu]mol/L), and doing exchange transfusions if phototherapy fails, regardless of the cause of the jaundice. These recommendations are likely to lead to unnecessary testing and treatment of many jaundiced term infants. Because most jaundiced infants have no underlying illness, and the generally recommended laboratory tests lack sensitivity and specificity, they are seldom useful. In most babies, the only blood tests needed to evaluate jaundice are the blood type and group (of baby and mother) and a direct Coombs' test. A determination of direct bilirubin level should be added if jaundice is prolonged (> 2 to 4 weeks) or the baby has other signs of illness. Bilirubin toxicity is rare in term babies without hemolysis. In this low-risk group, the risks and cost of identifying and treating high bilirubin levels may exceed the benefits. Such infants need not to be closely followed for jaundice. If significant jaundice is nonetheless found, treatment should be deferred to relatively high levels of serum bilirubin, with a goal of keeping bilirubin levels below 400 to 500 [mu]mol/L (23.4 to 29.2 mg/dL). Babies with hemolytic disease should be followed more closely, and their bilirubin levels kept below 300 to 400 [mu]mol/L (17.5 to 23.4 mg/dL). These recommendations should be reevaluated as a new data become available. In the meantime, currently available data justify an approach to the jaundiced term infant that is less aggressive than previously recommended. Pediatrics 1992;89:809-818