Stellenwert der Phototherapie in der Behandlung des chronischen Pruritus

Current insights and future perspectives of ultraviolet radiation (UV) exposure: Friends and foes to the skin and beyond the skin

Ultraviolet (UV) radiation is ubiquitous in the environment, which has been classified as an established human carcinogen. As the largest and outermost organ of the body, direct exposure of skin to sunlight or UV radiation can result in sunburn, inflammation, photo-immunosuppression, photoaging and even skin cancers. To date, there are tactics to protect the skin by preventing UV radiation and reducing the amount of UV radiation to the skin. Nevertheless, deciphering the essential regulatory mechanisms may pave the way for therapeutic interventions against UV-induced skin disorders. Additionally, UV light is considered beneficial for specific skin-related conditions in medical UV therapy. Recent evidence indicates that the biological effects of UV exposure extend beyond the skin and include the treatment of inflammatory diseases, solid tumors and certain abnormal behaviors. This review mainly focuses on the effects of UV on the skin. Moreover, novel findings of the biological effects of UV in other organs and systems are also summarized. Nevertheless, the mechanisms through which UV affects the human organism remain to be fully elucidated to achieve a more comprehensive understanding of its biological effects.

The impact of phototherapy on itch intensity and itch-related quality of life amongst different skin diseases, skin phototypes and genders - A prospective study with 102 patients

BACKGROUND

Phototherapy is a mainstay to treat itchy conditions. However, only little is known about differences in the antipruritic effect of phototherapy amongst different skin conditions, phototypes and genders.

METHODS

In this prospective, single-center study, we analyzed the effect of phototherapy on itch intensity and itch-related quality of life amongst these subgroups after a treatment duration of 4 weeks, while on-demand treatment with topical corticosteroids, topical calcineurin inhibitors and/or antihistamines was allowed.

RESULTS

Of 102 patients (age 53.0 ± 18.7, 56 females [54.9%]), 72 (78.3%) reported a significant reduction of itch intensity by Δ -2.76 on a 0-10 Numerical Rating Scale (NRS), p = <.001, 95% CI [2.2; 3.3] paralleled by a significant improvement of itch-related quality of life as measured by the German version of the ItchyQoL by Δ 7.3, p = <.001, 95% CI [4.4; 11.6]. The best improvement of itch intensity and itch-related QoL was reported by patients with pruritus on non-diseased skin (ΔNRS -3.5; Δ 9.7 Ger-ItchyQoL points), followed by patients with atopic dermatitis and psoriasis. We found no statistical differences in the response to phototherapy amongst Fitzpatrick phototypes I-VI. Women had higher itch intensities at baseline but itch-related quality of life impairment at baseline and phototherapy treatment response did not significantly differ between genders.

CONCLUSION

Phototherapy appears to induce a meaningful itch reduction in various itchy skin conditions, all phototypes and both genders within 4 weeks that directly translates into improvement of itch-related quality of life.

Chronic Kidney Disease-Associated Pruritus and Quality of Life: Learning from Our Patients

Chronic kidney disease-associated pruritus is itching directly related to kidney disease that cannot be explained by any other condition. Despite technological advances in the different aspects of dialysis sessions and the best treatment for chronic kidney disease patients, it is still a common problem in our patients. The many complex physiological mechanisms involved, the different hypotheses made over the years on the aetiology of the condition, and the great clinical variability may partially explain the limited knowledge about this problem and the difficulties in treating it. The presence of all these factors leads to the persistence of unpleasant symptoms, which must affect the disease burden and quality of life of kidney patients. Through the presentation of an illustrative clinical case, the aim of this review article is to highlight the need for adequate diagnosis and an improved approach to all aspects of chronic kidney disease-associated pruritus, in view of the heavy burden of the disease and the huge impact on the patient's quality of life.

Intense Pulsed Light Attenuates Oxidative Stress in Perennial Allergic Conjunctivitis

Objective: To assess the effects of intense pulsed light (IPL) on oxidative stress (OS) in perennial allergic conjunctivitis (PAC). Background: IPL treatment has been proven effective for dry eye disease (DED). However, we have observed that, after IPL treatment, some patients with DED combined with allergic conjunctivitis (AC), an immune response condition in which excessive OS causes and exacerbates inflammatory damage, not only show an improvement in eye dryness, but also their AC-related eye itching is relieved. The mechanism by which IPL inhibits allergic reactions is not clear. Methods: Five patients with moderate-to-severe PAC were given two IPL treatments on the periorbital skin with a 2-week interval. Visual analog scale (VAS) scores and signs of AC, including eye redness and conjunctival follicles, were assessed before the first treatment (day 1) and 2 weeks after the second treatment (day 30). Tears were also collected at the same time, and lipid oxidation (LPO) metabolite analysis was performed using liquid chromatography tandem mass spectrometry (LC-MS/MS) to investigate the effects of IPL on OS response. Results: The average VAS score significantly decreased with treatment (30.2 for day 1, 10.6 for day 30; p < 0.001). The general signs of PAC showed no difference (p > 0.05). LPO metabolite analysis revealed that 17,18-diHETE, which is an oxidation product of eicosapentaenoic acid, and 13-OXoODE, which is an oxidation product of linoleic acid, are significantly downregulated after IPL treatment. Conclusions: The photothermal effect of IPL attenuates OS in PAC, and this seems to be one of the mechanisms by which IPL treatment improves PAC. Clinical Trial Registration number: ChiCTR1900022202.

Differential Diagnosis and Treatment of Itching in Children and Adolescents

Itching is prevalent in children with skin disorders and associated with effects on their mood, quality of life, and social functioning. Surprisingly, there are no data on childhood prevalence of pruritus in the general population. The aim of this article is to explore the epidemiology, clinical manifestation, and treatment for itch (pruritus) in the pediatric population (from infancy to adolescence), and to be helpful to primary care physicians who assess and diagnose pediatric patients with itching. In this study, we searched for specific keywords using PubMed and MEDLINE (Ovid) and, then, refined the retrieved searches for each cause and treatment. As a result of reviewing the literature, atopic dermatitis was shown to be the most common cause of itching, especially during infancy and through preschool. Not only skin disorders but also systemic diseases, drugs, and postburn states can predispose an individual to itching in childhood. There are traditional and newly developed treatment modalities for itching in pediatric patients. However, because the pharmacokinetics and pharmacodynamics of childhood are different from those of adults, the medications for itching have to be applied carefully for these age groups. There are many areas to be elucidated regarding the prevalence and objective assessment of pruritus in pediatric patients. Moreover, the safety profiles of medications in the pediatric population need to be better understood. Further studies to investigate itching in childhood are warranted.

Accurate surface ultraviolet radiation forecasting for clinical applications with deep neural network

Exposure to appropriate doses of UV radiation provides enormously health and medical treatment benefits including psoriasis. Typical hospital-based phototherapy cabinets contain a bunch of artificial lamps, either broad-band (main emission spectrum 280-360 nm, maximum 320 nm), or narrow-band UV B irradiation (main emission spectrum 310-315 nm, maximum 311 nm). For patients who cannot access phototherapy centers, sunbathing, or heliotherapy, can be a safe and effective treatment alternative. However, as sunlight contains the full range of UV radiation (290-400 nm), careful sunbathing supervised by photodermatologist based on accurate UV radiation forecast is vital to minimize potential adverse effects. Here, using 10-year UV radiation data collected at Nakhon Pathom, Thailand, we developed a deep learning model for UV radiation prediction which achieves around 10% error for 24-h forecast and 13-16% error for 7-day up to 4-week forecast. Our approach can be extended to UV data from different geographical regions as well as various biological action spectra. This will become one of the key tools for developing national heliotherapy protocol in Thailand. Our model has been made available at https://github.com/cmb-chula/SurfUVNet .

Intense Pulsed Light Treatment for Itch Associated with Allergic Keratoconjunctivitis: A Retrospective Study of 35 Cases

Objective: To conduct a preliminary assessment of intense pulsed light (IPL) treatment for allergic keratoconjunctivitis (AKC)-associated ocular itch. Background: Current control measures for AKC rely primarily on drugs. IPL is effective for dry eye disease (DED). Furthermore, phototherapy is effective for managing skin inflammation and pruritus, suggesting that eye itching could decrease in some patients having AKC complicated with DED following IPL treatment to control dry eye symptoms. Methods: Thirty-five patients having DED complicated with mid-to-severe AKC were administered three IPL treatments to the periorbital skin. The eye scores of subjective symptoms and signs of AKC and tear film breakup time (TBUT) were retrospectively assessed before and after each treatment. Results: The scores for AKC-related symptoms and signs were determined four times: on Day 1 (time 0), Day 15 (time 1), Day 45 (time 2), and Day 75 (time 3) before each treatment. The average symptom score significantly decreased with treatments (time 0: 30.97, time 1: 15.03, time 3: 10). The average sign score for both eyes decreased after the first IPL treatment (left eye: 7.97 vs. 11.38; right eye: 8.1 vs. 11.1). There were no further improvements in the signs after the last treatment. The TBUT value in the right eye increased from times 0 to 3 (2.31 vs. 4.66 vs. 7.71 vs. 7.74). The TBUT value in the left eye increased from times 0 to 3 (2.50 vs. 6.97 vs. 7.57 vs. 8.24). Conclusions: Symptoms and signs improved after IPL treatment in patients with AKC. Eye itching was gradually controlled and rarely recurred. IPL may be effective for AKC treatment.

Content and value of rehabilitation in dermatology

The therapy of chronic skin diseases is challenging for both the dermatologist and the patient. Current standards of therapy and individual circumstances of the patient have to be considered. Furthermore, chronic skin diseases are often associated with comorbidities that require treatment adapted to the individual. Therefore, optimal education of the patient and a holistic concept of therapy are needed, in many cases in collaboration with various medical disciplines. In this case, rehabilitation provides an opportunity to address important aspects such as comorbidities, psychosocial burden and limitations at work, in addition to treating the underlying disease. This article describes the differences between acute and rehabilitation health care in dermatology, and illustrates the importance of rehabilitation in dermatology, based on examples of chronic inflammatory skin diseases, chronic pruritus and dermato-oncological diseases.

Pathophysiology and Treatment of Pruritus in Elderly

Pruritus is a relatively common symptom that anyone can experience at any point in their life and is more common in the elderly. Pruritus in elderly can be defined as chronic pruritus in a person over 65 years old. The pathophysiology of pruritus in elderly is still unclear, and the quality of life is reduced. Generally, itch can be clinically classified into six types: Itch caused by systemic diseases, itch caused by skin diseases, neuropathic pruritus, psychogenic pruritus, pruritus with multiple factors, and from unknown causes. Senile pruritus can be defined as a chronic pruritus of unknown origin in elderly people. Various neuronal mediators, signaling mechanisms at neuronal terminals, central and peripheral neurotransmission pathways, and neuronal sensitizations are included in the processes causing itch. A variety of therapies are used and several novel drugs are being developed to relieve itch, including systemic and topical treatments.

A Controlled Study of the Feasibility and Efficacy of a Cloud-Based Interactive Management Program Between Patients with Psoriasis and Physicians

BACKGROUND Dermatology patients continue to receive improved treatment, but for patients with psoriasis, there have been few studies on ways to improve patient management by improving communication with patients and their dermatologists. This study aimed to investigate the feasibility and efficacy of cloud-based interactive patient and physician management of psoriasis. MATERIAL AND METHODS The cloud-based platform was created by professional software engineers to educate and manage patients with psoriasis in a single hospital, where patients and research staff had a network platform for sharing data. A total of 79 patients with psoriasis were included in this study and were randomly divided into the control group (n=39) and the intervention group (n=40). Patients in the control group were given a psoriasis nursing manual and underwent regular follow-up. Patients in the intervention group were managed using the cloud platform, with the same management as the control group. The Psoriasis Area Severity Index (PASI), the Self-Rating Anxiety Scale (SAS), the Dermatology Life Quality Index (DLQI), and the Symptom Checklist-90-Revised (SCL-90-R) were used. RESULTS Cloud-based interactive patient and physician management resulted in clinical improvement, and reduced the degree of anxiety in patients with psoriasis and improved their physical and mental health. Patients in the intervention group had an improved understanding of psoriasis treatment, resulting in an improved relationship with the medical staff and improved treatment compliance. CONCLUSIONS Cloud-based interactive patient and physician management improved the mental health and quality of life for patients with psoriasis and allowed patients to manage their disease more effectively.