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Branisteanu D, Dirzu D, Toader M, Branisteanu D, Nicolescu A, Brihan I, Bogdanici C, Branisteanu G, Dimitriu A, Anton N, Porumb E. Phototherapy in dermatological maladies (Review). Exp Ther Med 2022; 23:259. [PMID: 35251325 PMCID: PMC8892600 DOI: 10.3892/etm.2022.11184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Since the introduction of modern phototherapy in 1903 by Nobel Prize-winner Niels Ryberg Finsen, the usage of this therapy in the medical field has grown, techniques have been refined and developed, and it has gained widespread acceptance. Psoriasis vulgaris, parapsoriasis, lichen planus, atopic dermatitis, neonatal jaundice, urticaria, morphea, vitiligo, granuloma annulare and cutaneous T cell lymphoma are only a few dermatological indications that come along with satisfactory results. Most often, it is a 2nd or 3rd line therapy being an alternative in more severe or refractory diseases. Despite the side effects that may occur after phototherapy, which are often minor, the benefits can be significant. Unfortunately, the absolute contraindications limit the use of this type of treatment and implicitly the management of these patients. The current review aimed to combine the recommendations of phototherapy in dermatology, the types of phototherapy that can be suitable for certain dermatological diseases and to emphasize its importance in certain conditions that are associated with significant remission rates.
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Affiliation(s)
- Daciana Branisteanu
- Department of Dermatology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Diana Dirzu
- Department of Dermatology, Railway Clinical Hospital, 700506 Iasi, Romania
| | - Mihaela Toader
- Department of Oral Dermatology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Daniel Branisteanu
- Department of Ophthalmology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Alin Nicolescu
- Department of Dermatology, ‘Roma’ Medical Center for Diagnosis and Treatment, 011773 Bucharest, Romania
| | - Ilarie Brihan
- Dermatology Department, Dermatology Clinic, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Camelia Bogdanici
- Department of Ophthalmology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - George Branisteanu
- Faculty of Medicine, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Andreea Dimitriu
- Department of Dermatology, ‘Arcadia’ Hospitals and Medical Centers, 700620 Iasi, Romania
| | - Nicoleta Anton
- Department of Ophthalmology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena Porumb
- Department of Dermatology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
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Muylaert BPB, Almada R, Vasconcelos RCFD. Granuloma annulare treated with narrowband UVB phototherapy. An Bras Dermatol 2018; 92:82-84. [PMID: 29267455 PMCID: PMC5726686 DOI: 10.1590/abd1806-4841.20174994] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 04/24/2016] [Indexed: 11/21/2022] Open
Abstract
Granuloma annulare is a benign cutaneous inflammatory disease, whose lesions have
spontaneous improvement in two years in 50% of cases, but there is recurrence in
40% of patients. Treatment may be topical, intralesional or systemic. The use of
phototherapy with narrowband UVB is highlighted, whose mechanism of action in
this disease is still unclear, probably related to the inhibition of T
lymphocytes. Herein, a case of a disseminated granuloma annulare of difficult
therapeutic management is described. It was treated with narrowband UVB
phototherapy twice a week for six months, with good clinical improvement, being
a good low-risk therapeutic option and that, in this case, provided quick and
satisfactory response.
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3
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Lakdawala N, Ferenczi K, Grant-Kels JM. Granulomatous diseases: Kids are not just little people. Clin Dermatol 2017; 35:555-565. [PMID: 29191347 DOI: 10.1016/j.clindermatol.2017.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Granulomatous diseases represent a heterogeneous group of conditions characterized by histiocytic inflammation that affect patients of any age. These diseases differ widely in their pathogenesis and include infectious and noninfectious conditions. This review focuses on noninfectious granulomatous conditions, with particular emphasis on age-related differences in the onset, epidemiology, clinical manifestations, prognosis, and age-specific management of specific granulomatous disorders. Knowledge of age-specific aspects of granulomatous conditions in adults and children improves both the extent of the diagnostic workup and the management of these patients.
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Affiliation(s)
- Nikita Lakdawala
- Department of Dermatology, Medical College of Wisconsin, Milwuakee, WI.
| | - Katalin Ferenczi
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
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Bala HR, Khan S, Chong AH. Two cases of generalised granuloma annulare successfully treated with acitretin and NB UVB therapy. Australas J Dermatol 2016; 57:327-329. [PMID: 29896835 DOI: 10.1111/ajd.12500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Sant Khan
- Melbourne Pathology, Melbourne, Australia
| | - Alvin H Chong
- Skin and Cancer Foundation Inc, University of Melbourne, Melbourne, Australia
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5
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Piette EW, Rosenbach M. Granuloma annulare. J Am Acad Dermatol 2016; 75:467-479. [DOI: 10.1016/j.jaad.2015.03.055] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/10/2015] [Accepted: 03/20/2015] [Indexed: 11/25/2022]
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Mikami E, Yanase M, Ito M, Kanzaki A, Saeki H. Generalized granuloma annulare successfully treated with narrowband ultraviolet B and anti-hepatitis C virus therapy. J Dermatol 2016; 43:975-7. [PMID: 26891771 DOI: 10.1111/1346-8138.13320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Erina Mikami
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Mikio Yanase
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Michiko Ito
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Akiko Kanzaki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
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Pavlovsky M, Samuelov L, Sprecher E, Matz H. NB-UVB phototherapy for generalized granuloma annulare. Dermatol Ther 2015; 29:152-4. [PMID: 26626163 DOI: 10.1111/dth.12315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Granuloma annulare (GA) is a benign, usually self-limited, granulomatous skin disease of unknown etiology. The generalized form of the disease shows a more chronic, relapsing course, rare spontaneous resolution, and poorer response to therapy. Psoralen plus UVA phototherapy has been reported to be effective for GA. However, little is known regarding the efficacy of narrowband UVB phototherapy. Our goal was to determine the efficacy of NB-UVB phototherapy in generalized GA. We carried out a retrospective study of patients with generalized GA treated with NB-UVB phototherapy over a period of 3 years. On completion of treatment, outcome was assessed as complete response (complete clearance of the lesions), partial response (>50% clearance of the lesions), and poor response (<50% clinical response). Therapy was stopped if no improvement was seen after 20 treatments. Thirteen patients were included in the study. 54% of patients treated with NB-UVB had a complete/partial response by the end of the treatment period. NB-UVB phototherapy was well-tolerated, with no serious adverse effects. NB-UVB phototherapy is effective in a substantial portion of patients with generalized GA. To determine the true efficacy of this therapeutic modality, a prospective study comparing it to PUVA is warranted.
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Affiliation(s)
- Mor Pavlovsky
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Liat Samuelov
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Eli Sprecher
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Hagit Matz
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Cunningham L, Kirby B, Lally A, Collins P. The efficacy of PUVA and narrowband UVB phototherapy in the management of generalised granuloma annulare. J DERMATOL TREAT 2015; 27:136-9. [PMID: 26447167 DOI: 10.3109/09546634.2015.1087461] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Generalised granuloma annulare (GGA) is a significant cosmetic issue for patients but evidence is lacking to guide optimum treatment. We reviewed our patients with GGA treated with PUVA and narrowband UVB (NBUVB). A telephone questionnaire obtained the patients' perspective in terms of treatment response, remission and overall satisfaction. Twenty patients, all female, were treated. Twelve patients had 15 courses of PUVA therapy (10 oral, 5 bath PUVA) and 10 had 12 courses of NB UVB (two patients had both). There was clearance or minimal residual disease (MRD) on clinical examination in eight of 12 patients after PUVA. Remission was for six months in seven patients extending to one year or more in five patients. Nine patients were contactable after PUVA therapy. They reported their satisfaction as excellent (n = 1), very good (n = 2) or good (n = 4), and two were disappointed. There was clearance or MRD in seven patients treated with NBUVB. Remission was for six months in at least three patients and greater than 1 year in at least 2 patients. Eight patients were contactable and reported satisfaction as excellent (n = 1) or good (n = 5) and two were disappointed. PUVA and NBUVB were effective in at least half of patients and they achieved satisfactory remission. Patients' perceptions of the improvement after phototherapy were lower compared with their dermatologists' assessment.
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Affiliation(s)
- L Cunningham
- a Department of Dermatology , The Charles Centre, St. Vincent's University Hospital , Dublin , Ireland
| | - B Kirby
- a Department of Dermatology , The Charles Centre, St. Vincent's University Hospital , Dublin , Ireland
| | - A Lally
- a Department of Dermatology , The Charles Centre, St. Vincent's University Hospital , Dublin , Ireland
| | - P Collins
- a Department of Dermatology , The Charles Centre, St. Vincent's University Hospital , Dublin , Ireland
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10
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Wolf's post-herpetic isotopic response: Infections, tumors, and immune disorders arising on the site of healed herpetic infection. Clin Dermatol 2015; 32:561-8. [PMID: 25160097 DOI: 10.1016/j.clindermatol.2014.04.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Herpes simplex viruses (HSV-1/HSV-2) and varicella-zoster virus (VZV) have several characteristics in common. Both are epidermoneurotropic, cause skin eruptions accompanied by sensory symptoms (itch, pain), damage peripheral sensory nerve fibers and cutaneous nerve endings, and interfere with neuromediator release, which can alter local mechanisms of immune control. For this reason, herpes-infected areas may become a preferential location for the subsequent onset of immunity-related skin disorders (infections, tumors, and dysimmune reactions), an event first reported by a neurologist and focused on by two brothers, a dermatologist and a pediatrician. The phenomenon therefore named Wolf's post-herpetic isotopic response (PHIR) refers to the occurrence of a new skin disorder at the site of a previous and already healed herpetic eruption (herpes zoster in most cases). Until now, we have been able to gather 189 well-documented cases of PHIR (all reported in the reference section), but our list is far from being complete. Some of the most emblematic cases are briefly described here. In some circumstances, the opposite of PHIR occurs, with diffuse skin disorders or eruptions that selectively spare herpes-infected areas (Wolf's post-herpetic isotopic nonresponse). Experimental investigations with patch testing have been performed in seven patients who were sensitized to nickel and had had herpes zoster in the past years. The tests were carried out bilaterally on the affected dermatomes and on the unaffected contralateral ones. The uneven immune responses we obtained have shown that the immune behavior of an herpes zoster-affected dermatome can be different from that of the corresponding contralateral dermatome, thus supporting the existence of immune dysregulation in herpes-infected areas.
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Resolución de granuloma anular diseminado con fototerapia UVB de banda estrecha. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:240-1. [DOI: 10.1016/j.ad.2014.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/03/2014] [Accepted: 08/31/2014] [Indexed: 11/21/2022] Open
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Solano-López G, Concha-Garzón M, de Argila D, Daudén E. Successful Treatment of Disseminated Granuloma Annulare With Narrowband UV-B Phototherapy. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2015.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Thornsberry LA, English JC. Etiology, diagnosis, and therapeutic management of granuloma annulare: an update. Am J Clin Dermatol 2013; 14:279-90. [PMID: 23696233 DOI: 10.1007/s40257-013-0029-5] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Granuloma annulare (GA) is a common cutaneous disorder classically presenting as annular groups of skin-colored to erythematous papules without epidermal change localized to the dorsal hands and/or feet. In addition to the localized form, there are variants including generalized (including generalized annular GA, disseminated papular GA, and atypical generalized GA), subcutaneous, and perforating GA, providing for a wide spectrum of clinical lesions. The etiology of GA remains unknown and several systemic associations have been proposed but not proven, including diabetes mellitus, malignancy, thyroid disease, and dyslipidemia. The diagnosis of GA relies on clinicopathological correlation, with a skin biopsy confirming the histological features of the disease, including palisading granulomas, collagen degeneration, mucin, and a lymphohistiocytic infiltrate. Localized GA is often asymptomatic and self-limited within 2 years; however, the patient may desire treatment for cosmetic reasons, with topical and intralesional corticosteroids as the mainstays of therapy. When GA is generalized, disseminated, or atypical, a more thorough medical workup for underlying diseases may be considered depending on the physical examination, a thorough review of systems, comorbidities, and clinical suspicion. Treatment is often challenging for generalized GA, especially because of its recalcitrant nature and a lack of evidence-based therapy. Over 30 different treatments have been described for GA with variable results; however, the majority of these have been single case reports, small case series, or retrospective studies. Reported treatments for GA include topical, intralesional, intramuscular, and oral medications (steroidal vs. non-steroidal); biologic agents; surgical interventions; phototherapy; and laser treatments. When selecting a systemic therapy for a patient with GA, multiple variables must be considered, such as baseline blood evaluations, comorbidities, drug interactions, compliance, adverse effect profiles, prior treatments, and reproductive status. This evidence-based review will focus on the advances made in the twenty-first century regarding the etiology, diagnosis, and therapeutic management of GA.
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Affiliation(s)
- Laura A Thornsberry
- Department of Dermatology, University of Pittsburgh, 200 Lothrop St., Presby South Tower Suite 3880, Pittsburgh, PA 15213, USA
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Poppe H, Poppe LM, Goebeler M, Trautmann A. Treatment of Disseminated Granuloma Annulare with Oral Vitamin E: Primum Nil Nocere'. Dermatology 2013; 227:83-8. [DOI: 10.1159/000353528] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 06/04/2013] [Indexed: 11/19/2022] Open
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Luo S, Zheng Y, Peng Z, Jiang J, Gondokaryono S, Wang G, Ikeda S. Effects of narrow-band ultraviolet B and tazarotene therapy on keratinocyte proliferation and TIG3 expression. J Dermatol 2008; 35:651-7. [PMID: 19017044 DOI: 10.1111/j.1346-8138.2008.00538.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Tazarotene plus narrow-band ultraviolet B (NB-UVB) therapy has been shown to enhance the efficacy in treating patients with psoriasis, while the mechanism is not clear. The present study aims to investigate the alteration of cell proliferation and TIG3 in cultured normal human keratinocytes after NB-UVB and/or tazarotene treatment. Keratinocytes were exposed to NB-UVB, then incubated with or without tazarotene, and then cell proliferation was detected by methyl thiazoleterazolium colorimetric assay and TIG3 mRNA expression and protein production was examined by real-time reverse transcription polymerase chain reaction and immunocytochemistry, respectively. The results show that keratinocyte proliferation was inhibited and TIG3 mRNA expression and protein production were elevated by tazarotene at a dose higher than 0.1 micromol/L. In NB-UVB single irradiating groups, only 200 mJ/cm2 NB-UVB inhibited keratinocyte proliferation, and none of the irradiated groups had an effect on TIG3 expression. Moreover, tazarotene plus NB-UVB have stronger effects than those separately. These results indicate NB-UVB plus tazarotene may have synergistic effects on inhibiting keratinocyte proliferation and elevating TIG3 expression, which may have some implications for the understanding of how to treat psoriasis patients with tazarotene plus NB-UVB.
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Affiliation(s)
- Suju Luo
- Department of Dermatology, Second Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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