Phototherapy in the Pediatric Population

Phototherapy for Psoriasis in the Age of Biologics

Phototherapy has utility as a psoriatic therapy, given its relatively high clinical efficacy, low side effect profile, and lower cost compared to newer effective treatments like biologics and small molecules. Phototherapy has shown Psoriasis Area and Severity Index (PASI)-75 and PASI-90 rates comparable to those of biologics and small molecules, with similarly rapid onsets of action, rates of remission, and quality of life scores. Certain patients may particularly benefit from phototherapy, such as those with localized disease or contraindications to systemic immunomodulatory medication. Phototherapy can be more cost-effective than biologics and conveniently administered at home, making it a valuable therapeutic option for the right patient.

Current practices for pediatric phototherapy: Findings from a cross-sectional study

Phototherapy is broadly utilized for treatment of inflammatory skin conditions affecting pediatric patients. However, there are no specific guidelines or recommendations for implementing phototherapy in pediatric populations leading to variability in treatment procedures. Here, we present findings from a cross-sectional, survey-based study investigating the implementation of phototherapy in pediatric patients across the United States. A total of 39 sites from 19 different states identified via the National Psoriasis Foundation (NPF) Health Care Provider Directory responded. Common practices included a signed informed consent prior to performing phototherapy (86.4%, n = 32), no minimum age requirement for pediatric patients (91.8%, n = 34), the use of Fitzpatrick skin type to determine dosing protocol (100%, n = 37), and allowing parents to accompany their children into the lightbox (65%, n = 20). Our results provide insights into current common practices and themes for further study.

Current and Emerging Therapies in Pediatric Atopic Dermatitis

Atopic dermatitis (AD) is the most common inflammatory skin disease seen in children. It is a heterogeneous disorder, with a variety of associated manifestations and symptoms. Cases may range from mild to severe. As a result, a spectrum of prescription and nonprescription therapies may be utilized when managing this condition. This article provides an extensive overview of these therapies, with equal consideration provided to current, emerging, and alternative options used in the pediatric population.

Treatment Options for Troublesome Itch

Itch (or pruritus) is an unpleasant sensation, inducing the desire to scratch. It is also a major and distressing symptom of many skin and systemic diseases. The involvement of histamine, which is a major itch mediator, has been extensively examined. Recent studies suggest that histamine-independent pathways may play roles in chronic itch. Therefore, antihistamines are not always effective in the treatment of patients with chronic itch. The development of biologics and κ-opioid receptor (KOR) agonists has contributed to advances in the treatment of itch; however, since biologics are expensive for patients to purchase, some patients may limit or discontinue their use of these agents. Furthermore, KOR agonists need to be prescribed with caution due to risks of side effects in the central nervous system. Janus kinase (JAK) inhibitors are sometimes associated with side effects, such as infection. In this review, we summarize antidepressants, antineuralgics, cyclosporine A, antibiotics, crotamiton, phosphodiesterase 4 inhibitor, botulinum toxin type A, herbal medicines, phototherapy, and acupuncture therapy as itch treatment options other than antihistamines, biologics, opioids, and JAK inhibitors; we also explain their underlying mechanisms of action.

Fototerapia – metoda wykorzystywana w leczeniu przewlekłych schorzeń dermatologicznych

Wykorzystanie energii świetlnej w terapii schorzeń o różnej etiologii towarzyszy człowiekowi od czasów starożytnych. Elementem decydującym o powodzeniu terapii jest dobranie odpowiedniej długości promieniowania (terapia NB-UVB, BB-UVB i UVA1) lub wystąpienie interakcji między substancją światłoczułą skumulowaną w zmienionej chorobowo tkance a zastosowanym promieniowaniem (terapia PUVA oraz terapia fotodynamiczna). Metody terapeutyczne wykorzystujące energię świetlną są klasyfikowane na podstawie wykorzystywanego zakresu promieniowania. Obecnie wyróżnia się fototerapię UV, wykorzystującą promieniowanie UVA lub UVB oraz terapię fotodynamiczną (PDT; photodynamic therapy), podczas której stosowane jest promieniowanie o długości fali 350-700 nm.

Fototerapia UV wykorzystywana jest do leczenia schorzeń dermatologicznych, takich jak łuszczyca, bielactwo oraz atopowe zapalenie skóry, ze względu na jej działanie immunosupresyjne i antyproliferacyjne. Jest dostępna w postaci terapii PUVA polegającej na wykorzystaniu synergicznego działania promieniowania ultrafioletowego (UVA) oraz związków o działaniu światłouczulającym (8-metoksypsolaren, 5-metoksypsolaren). Ponadto wyróżniono monoterapię promieniowaniem ultrafioletowym A1 (UVA1), szerokozakresowym UVB (BB-UVB) i wąskozakresowym UVB (NB-UVB). Terapia fotodynamiczna obok konwencjonalnych metod leczenia jest nowoczesną i nieinwazyjną alternatywą wykorzystywaną zarówno w diagnostyce, jak i terapii chorób o różnej etiologii. W 90% przypadków PDT jest stosowana w schorzeniach dermatologicznych, takich jak trądzik pospolity czy łuszczyca. Selektywna aktywność cytotoksyczna wykazywana w kierunku złośliwych komórek nowotworowych powoduje, że terapia fotodynamiczna stosowana jest także z powodzeniem w leczeniu zmian onkologicznych. Duży postęp, przejawiający się zarówno w opracowywaniu innowacyjnych substancji światłoczułych, jak i nowych źródeł promieniowania, sprawia, iż zakres stosowalności terapii fotodynamicznej ciągle się poszerza.

W artykule przedstawiono obecnie dostępne formy fototerapii poprzez opis mechanizmu ich działania, zastosowania oraz możliwości powstania skutków niepożądanych.

Ketoprofen Combined with UVA Irradiation Exerts Higher Selectivity in the Mode of Action against Melanotic Melanoma Cells than against Normal Human Melanocytes

Malignant melanoma is responsible for the majority of skin cancer-related deaths. The methods of cancer treatment include surgical removal, chemotherapy, immunotherapy, and targeted therapy. However, neither of these methods gives satisfactory results. Therefore, the development of new anticancer therapeutic strategies is very important and may extend the life span of people suffering from melanoma. The aim of this study was to examine the effect of ketoprofen (KTP) and UVA radiation (UVAR) therapy on cell proliferation, apoptosis, and cell cycle distribution in both melanotic melanoma cells (COLO829) and human melanocytes (HEMn-DP) in relation to its supportive effect in the treatment of melanoma. The therapy combining the use of pre-incubation with KTP and UVAR causes a significant increase in the anti-proliferative properties of ketoprofen towards melanoma cells and the co-exposure of melanotic melanoma cells induced apoptosis shown as the mitochondrial membrane breakdown, cell-cycle deregulation, and DNA fragmentation. Moreover, co-treatment led to GSH depletion showing its pro-apoptotic effect dependent on ROS overproduction. The treatment did not show a significant effect on normal cells—melanocytes—which indicates its high selectivity. The results suggest a possible benefit from the use of the ketoprofen and ultraviolet A irradiation as a new concept of melanotic melanoma therapy.

A model of the UV skin dose distribution in paediatric whole-body phototherapy

The radiance equation is applied in this study to model the ultraviolet (UV) radiation dose distribution over the skin in paediatric and adult patients treated in a whole-body phototherapy cabin. This approach extends a previously published model of UV radiation dose based on thermal radiation exchange between surfaces (Colemanet al2020Biomed. Phys. Eng. Express6055023). The new model makes it feasible to predict the distribution of UV irradiance over the head, trunk and legs in patients of varying height. The modelled irradiance distributions to directly lamp-facing skin surfaces agree to within 10% of those measured in simulated clinical paediatric treatments in a modern narrowband UVB treatment cabin. For a 10 year old (of height 1.36 m), for example, the model and the clinical measurements both show a UV radiation dose to the face that is around 25% more than that in an adult (of height 1.8 m). The dose to the crown of the head of a 10 year old is both predicted and measured to be more than double that of an adult. The automated dosimetry system, incorporated within the treatment cabin, is also predicted to overestimate irradiance to the body by between 10% and 25% in patients aged between 10 and 4 years (height 1.36-1.0 m). The value of the model and its implications for paediatric whole-body UV treatment in adult-size whole-body treatment cabins are considered.

Therapeutic options and hot topics in vitiligo with special focus on pediatrics' vitiligo: A comprehensive review study

Vitiligo is a common skin disorder with an estimated worldwide prevalence to 2.28% which is connected with selective melanocytes loss which leads to depigmentation and chalky-white macules. Vitiligo may be dismissed as a cosmetic problem and may have psychologic impacts on patients. It is occurring in both children and adults and is considered as the most common depigmenting skin disorder in the world. There are still many unknown topics about this disease regarding to its treatment in pediatrics, curable drugs and manifestations. Therefore, we decided to evaluate the recent studies about its therapeutic strategies in pediatrics. Topical therapies should be considered as first line treatment in children, but phototherapy especially NBUVB may be used after topical treatment modalities failure or in extensive or rapidly progressive disease. Our suggestion for the treatment of this disease in children is to use combine treatment modalities with observing safety according to the patient's age.

Current Perspectives on the Management of Infantile Atopic Dermatitis

Atopic dermatitis (AD) is a common disease of childhood, and infantile AD may manifest from birth to 2 years. Guidelines for the management of infantile AD are lacking, and our aim is to provide a comprehensive review of best practices and possible interventions. We will focus on topical therapy, since the use of systemic immunomodulating agents in infantile AD is rarely advised. Topical agents include emollients, topical corticosteroids (TCS), topical calcineurin inhibitors (TCIs), and phosphodiesterase 4 (PDE-4) inhibitors. We will also provide a brief overview of promising emerging therapies currently under investigation in the pediatric population.

Using rational strategies for children's scars based on more than 5 years assessment after burn

BACKGROUND

Paediatric patients with scars after burn are regularly encountered. Discussion of rational strategies for management are of value. The objective of the study was to describe development and utilisation of strategies for paediatric burn scars up to five years after injury.

METHODS

We included 164 cases aged from 5 to 8 years old in our study; all had burn scar deformities.

RESULTS

Assessments were made up to December 31, 2019. The following strategies were used: sequential treatment, reconstruction based on facial aesthetic units, predicting the effect of surgery on development, releasing skin tension and application of photoelectric technology or other non-surgical measures.

CONCLUSIONS

Using rational strategies for paediatric burn scars is very important.