UVA1光疗法治疗脂质渐进性坏死

The primary c ause of collagen degeneration in necrobiosis lipoidica (NL) is proposed to be immunologically mediated vascular disease. Ultraviolet (UV)A1 has been used successfully to treat scleroderma in which both vascular damage and collagen dysregulation also occur. We treated six patients with NL [(five women; mean age of 32 years (range 22-70) and mean disease duration of 2.9 years (range 6 months to 5 years)] with a high-output ultraviolet (UV)A1 2-kW filtered metal halide source (Dr; Dermalight ultrA 1) having an emission spectrum of 340-440 nm. All patients had NL on the shins, which had been unresponsive to potent topical corticosteroid therapy (n = 6) and had responded minimally or not at all to TL-01UVB (n = 2), topical psoralen plus UVA(PUVA) soaking (n = 2) or oral PUVA(n = 1) therapy. Patients received a variable number of total exposures (15-51), given 3-5 times weekly. NL resolved completely in one patient; this patient had minimal improvement after the first course of 16 exposures, but after a further 13 exposures, resolution occurred 6 months later. Two subjects obtained moderate improvement in their overall disease severity after 15 and 24 exposures, while two had only minimal improvement after 15 and 51 exposures. The remaining patient had no improvement after 16 treatments. Patients with the shortest disease duration had the greatest response. UVA1 therapy may be of benefit for the treatment of NL as an adjuvant therapy to topical corticosteroids or as a second-line alternative to other phototherapies, and may have a superior outcome in a proportion of patients.

摄入贯叶连翘生粉(金丝桃素)会增强患者在大剂量UVA1治疗过程中的红斑反应吗?

Background: St John s wort (SJW) is widely used as a treatment for depression. A phototoxic reaction, due to its content of hypericin, can occur in animals and in cell culture, and has been reported in humans. Hypericin displays absorption within the ultraviolet (UV) A1 spectrum and there may therefore be a potential for phototoxicity if taken during high-dose UVA1 therapy. Objectives: To assess the phototoxicity risk of SJW ingestion. Methods: Eleven adult volunteers of skin types I and II were exposed to a geometric dose series of UVA1 irradiation from a high-output source (Dermalight Ultra 1; Dr H nle, Martinsreid, Germany; irradiance 70- 77 mW cm- 2) on the photoprotected lower back skin at eight 1.5-cm2 test areas. Irradiation was carried out at baseline and after 10 days of SJW extract 1020 mg (equivalent to 3000 μ g of hypericin) daily. Four, 8, 24 and 48 h after each exposure, the minimal erythema dose (MED) and the presence or absence of pigmentation were recorded visually and erythema was assessed objectively with an erythema meter. Results: The median MED and D0.025, an objective measure of MED, were lower at all time-points after SJW ingestion. The visual erythemal peak (lowest median MED), which was seen at 8 h postirradiation, was lower after SJW (median 14 J cm- 2, range 10- 56) than at baseline (median 20 J cm- 2, range 14- 56) (P = 0.047). Similarly, the median D0.025 at 8 h postirradiation was lower after SJW(median 22.0 J cm- 2, range 15.2- 53.9) than at baseline (median 33.7 J cm - 2, range 22.9- 136.0) (P = 0.014). The MED and D0.025 were also significantly different at the 48-h and 4-h time-points, respectively. Significance was not reached at the 24-h time-point. Median intensity of postirradiation erythema increased at all time-points after ingestion of SJW. Despite these differences, the maximum slope of the dose-response curve was not increased after SJW ingestion. Conclusions: These data suggest that SJW extract has the potential to lower the erythemal threshold to UVA1 irradiation in a significant proportion of individuals and highlight the importance of ascertaining a full drug history, including herbal remedies, before initiating UVA1 phototherapy.

UVA1红斑的量效与时程特征

Objective: To determine the time course and dose-response characteristics of UV-A1 erythema in the Tayside region of Scotland. Design: Adult volunteers (skin types I and II [n=13]- and III and IV [n=11])were exposed to geometric dose series of UV-A1 irradiation from a high-output source on photoprotected lower back and inner forearm skin. Setting: Photobiology unit in a university hospital. MainOutcomeMeasures: The minimal erythema dose (MED) was recorded visually and erythema was assessed objectively by erythema meter at 4, 8, 24, and 48 hours after exposure. Results: Peak erythema (lowest visual MED) was seen at 8 hours on the back and arm in 11 subjects with skin types I and II and on the back at 8 hours in 9 subjects and on the arm at 4 hours in 10 subjects with skin types III and IV. The lowest median (range) MED was 20 J/cm2 (14- 56 J/cm2) on the back and 42 J/cm2 (20 to >80 J/cm2) on the arm at 8 hours for subjects with skin types I and II and 28 J/cm2 (20- 112 J/cm2) at 8 hours on the back and 56 J/cm2 (28- 80 J/cm2) at 4 hours on the arm for subjects with skin types III and IV. The D0.025, an objective measure that corresponds approximately to the visual MED, demonstrated a broad peak from 8 to 24 hours. Conclusions: Our local population is more erythemally sensitive to UV-A1 radiation than reports suggest. Daily dose regimens may risk cumulative erythema. Lower starting doses should be used in this population. The wide range of MEDs highlights the need for MED testing.

UVA1光疗法治疗生殖器萎缩性硬化苔藓

Background. Lichen sclerosus (LS) is characterized histologically by an inflammatory T-cell infiltrate, sclerosis and thickening of the dermis, and epidermal atrophy. Ultraviolet (UV) A1 therapy has been shown to be effective in the management of morphea and scleroderma, diseases that have some histological and clinical similarities with LS, and more recently in extragenital LS. Aim. To determine the effectiveness of UVA1 therapy for genital LS. Methods. Seven women with severe genital LS uncontrolled by ultrapotent topical corticosteroids, with a median age of 62 years (range 48-78) and disease duration of 6-47 years, were treated with UVA1 therapy from a high output source. After completion of UVA1 therapy, a clinician and the patient graded the overall response of symptoms and physical signs. Results. Five patients improved with therapy. Three obtained moderate improvement in overall disease severity and two had minimal improvement. Of these five, one relapsed within 3 months and another after a year. Both had a further course of UVA1 therapy, resulting in minimal improvement in one and moderate improvement in the other. In the remaining three, disease severity had improved to a point where intermittent use of topical corticosteroids resulted in acceptable control. Discussion. UVA1 therapy may be of benefit in the management of vulval LS, a disease that is often poorly responsive to standard therapies. The therapy is well tolerated and could provide an acceptable therapeutic option for patients with severe disease.

UVA1、UVB和模拟日光照射对p53激活与p21Waf1/Cip1的影响

Background:High-dose ultraviolet (UV) A1 therapy (doses in the order of 130 J cm-2) is effective for atopic dermatitis and scleroderma. UVA1 has been shown to induce a dose-dependent increase in p53 expression in keratinocytes. Objectives:To examine the effect of UVA1 on the activation of p53 by phosphorylation, which has not yet been studied. Methods:Five adult volunteers were exposed to dose series of UVA1 (10-100 J cm-2) and, for comparison, narrowband UVB (TL-01) (25-550 mJ cm-2) and solar-simulated radiation (SSR) (5.6-30 J cm-2)on photoprotected buttock skin and the minimal erythema dose (MED) for each was determined at 24 h. Separate sites on the buttock were subsequently irradiated with a 3-MED dose of UVA1, TL-01 and SSR. At 24 h, punch biopsies (4 mm) were taken from each irradiated site and from an adjacent unirradiated control site, and immunohistochemical staining for p53 (Do-1), activation of p53 (assessed by phosphorylation at serine 12 and serine 392) and p21 was performed. Cell staining was expressed as the mean number of cells stained per three high-power fields (HPFs) and as a percentage of 1000 cells. Sunburn cells (SBCs)were also counted per HPF. Results UVA1 produced negligible numbers of SBCs, relatively little p53 (Do-1) staining (mean±.SD cell count per HPF 16±10),no p53 activation and very little evidence of p21 expression (mean±SD cell count per HPF 5.3±7), in contrast to TL-01 (mean±SD cell count per HPF of 11.83±2.1 SBCs, 146.3±38 for Do-1, 26.6±15 for serine 15, 14.9±12 for serine 392 and 77.9±30 for p21) or SSR irradiation (mean±SD cell count per HPF of 3.5±1.2 SBCs, 147.5±62 for Do-1, 54±50 for serine 15, 38.9±18 for serine 392 and 56.7±30 for p21). Conclusions:These data indicate that there are fundamental differences in the effects of UVA1 on p53 and its activation pathways compared with TL-01 and SSR, and may in part explain the differential effects of these phototherapies.

亚临床刺激或暴露于亚红斑量UV能否引起光斑贴试验阳性

Photopatch test (PhPT) interpretation is difficult and clinical relevance is n ot always apparent. A positive PhPT may reflect photocontact allergy or phototox icity. We hypothesized that it may also reflect the additive or synergistic effe cts of a suberythemal reaction to a contact irritant [e.g. sodium lauryl sulfat e (SLS)] or allergen (e.g. nickel) and suberythemal UV exposure. 10 nickel aller g ic volunteers had duplicate SLS and nickel series applied on either side of the back for 24 h and 48 h, respectively. After removal, one side was irradiated wit h 5J/cm2 UVA or the dose below the minimal erythema dose for solar-simulated ra diation (SSR). The minimal irritancy dose (MID) for SLS and the minimal allergen ic dose (MAD) for nickel were determined visually and objectively by erythema me ter. While photoaugmentation of subclinical contact allergy or irritancy occurre d in some subjects, photosuppression occurred in roughly an equal number. UVA ch anged the nickel MAD at 48 h in 2 of 5 volunteers but not the SLS MID. SSR chang ed the nickel MAD in 4 of 5 and the SLS MID in 3 of 5. 2 subjects (none after UV A) showed erythema only in the irradiated set of p atches, which could have been interpreted as a positive PhPT. We have demonstrat ed photoaugmentation and photosuppression of contact allergy and irritancy, whic h could result in false-positive or false-negative interpretation of PhPTs.

湿巾疗法治疗婴儿中度异位性皮炎初步研究

Wet wrap therapy(WWT) is a well established treatment for severe atopic dermatitis (AD) However little evidence exists to justify widespread use in the community for less severe eczema We compared the efficacy of WWT with a standard regime of hydrocortisone, to control moderate AD in children We carried out a single observer, randomized, controlled pilot study in 19 children under 5 years of age, with AD of 30%or more body surface area, using only 1%hydrocortisone (HC) prior to the study Group one applied HC once in the morning for 2 weeks, with wetwraps twice daily for week 1,but only at night for week 2 Group two applied HC twice daily without wet wraps Both applied emollient twice daily and as necessary The primary outcome measure was the Six Area, Six Sign Atopic Dermatitis (SASSAD) severity score, and the secondary outcome measures were the Infants Dermatology Quality of Life Index (IDQOL), the Dermatitis Family Impact (DFI) score and the weight of topical steroids and emollients used Over the 2-week active therapy period the mean fall in SASSADwas 8 [95%confidence interval (CI), -18 to +2; P =0 11] more in the non WWT group, the median change in the IDQOL was 2 for Group one and 7 for Group two (95%CI for difference, -10 to +3; P = 0 24) and the median change in DFI score was 2 for Group one and 5 for Group two (95%CI for difference, -14 to +2; P = 0 42) This small study has shown that conventional therapy with HC and emollients alone is as effective as WWT for infants with moderately severe, widespread AD, and provides weak evidence to suggest that it may be more effective We would not advocate routine use of WWT formoderate eczema without further