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Park C, Korman AM, Dulmage BL. An overview of the efficacy of phototherapy in oncodermatology. Support Care Cancer 2022; 30:5591-5600. [PMID: 35107598 DOI: 10.1007/s00520-022-06841-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 01/17/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cutaneous adverse events (AEs) following cancer immunotherapy, targeted therapy, and chemotherapy have been well-documented in the literature. A number of case reports have identified phototherapy, a form of light therapy that mimics sunlight exposure, as a noninvasive treatment modality for these cutaneous toxicities. By inducing local suppression of the immune system, phototherapy is a skin-directed treatment with minimal effect on tumor response. Phototherapy may therefore be a viable treatment option for cutaneous AEs from cancer therapies. METHODS We reviewed the literature for patients treated with phototherapy for cutaneous AEs following cancer immunotherapy, targeted therapy, or chemotherapy. We also included three previously unpublished cases from our own institution. RESULTS We identified 24 patients (80% male, mean age 67 years, range 49-75 years). Patients received the following phototherapy types: NB-UVB (n = 17), PUVA (n = 6), or PDT (n = 1). A topical steroid was used in conjunction with phototherapy in seven patients. At phototherapy onset, cancer treatment was either continued, temporarily discontinued, or discontinued (n = 9, 6, 7, respectively; in two cases, the cancer treatment course was unknown). Improvement of cutaneous AEs was observed in 96% of patients. CONCLUSIONS Phototherapy resulted in full or partial improvement in all but one patient. A topical steroid was used in nearly a third of patients, suggesting some oncodermatologists co-administer topicals to further boost response. Continuation of cancer therapy in the majority of patients highlights an additional advantage of phototherapy. We believe phototherapy may be an effective adjunctive treatment to topical steroids when treating these cutaneous toxicities.
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Affiliation(s)
- Candice Park
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Abraham M Korman
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
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2
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Kutlu O, Ozdemir Cetinkaya P, Karaosmanoglu N, Karaaslan E, Kiratli Nalbant E, Eksioglu M. The effect of narrowband ultraviolet B phototherapy on antinuclear antibody status: A case-control study. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2020; 36:470-475. [PMID: 32810337 DOI: 10.1111/phpp.12601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/10/2020] [Accepted: 08/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Narrowband ultraviolet B (NB-UVB) phototherapy has become a widely used, standard treatment modality in dermatology. The effect of 8-methoxypsoralen plus ultraviolet A on antinuclear antibody (ANA) formation has been investigated extensively, but there are very scarce data about the potential risk of NB-UVB phototherapy inducing production of ANAs. The aims of this study were evaluation of ANA status before and after NB-UVB treatment and comparison of ANA status with the healthy control group. METHODS Phototherapy unit database was used to identify patients who had received whole body NB-UVB treatment. Analyses of ANA were performed twice in the study group that were before initiation of the NB-UVB phototherapy and after cessation of the therapy. Also, ANAs were screened in the control group. RESULTS A total of 95 patients (50 males and 45 females; mean age: 43.03 ± 13.40) treated with NB-UVB radiation and 90 age- and sex-matched controls were included in the study. Thirteen patients (13.7%) were found to develop ANAs at the end of the treatment. ANA positivity was significantly more common in patients after phototherapy than in patients before phototherapy and than in the control group. None of the patients in the positive ANA group was diagnosed with any connective tissue diseases. CONCLUSION This study revealed that ANA positivity increased after NB-UVB phototherapy. However, it did not provide evidence for increased connective tissue disease risk. Therefore, ANA might not need to be routinely checked before treatment unless the patients have signs and symptoms indicating autoimmune diseases.
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Affiliation(s)
- Omer Kutlu
- Department of Dermatology and Venereology, Uşak University Medical Faculty, Uşak, Turkey
| | | | - Nermin Karaosmanoglu
- Department of Dermatology and Venereology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Engin Karaaslan
- Department of Dermatology and Venereology, Nusaybin State Hospital, Mardin, Turkey
| | - Esra Kiratli Nalbant
- Department of Dermatology and Venereology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Meral Eksioglu
- Department of Dermatology and Venereology, Ankara Training and Research Hospital, Ankara, Turkey
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3
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Torres AE, Lyons AB, Hamzavi IH, Lim HW. Role of phototherapy in the era of biologics. J Am Acad Dermatol 2020; 84:479-485. [PMID: 32339702 PMCID: PMC7194984 DOI: 10.1016/j.jaad.2020.04.095] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 12/20/2022]
Abstract
Phototherapy is a safe and effective treatment for many dermatologic conditions. With the advent of novel biologics and small molecule inhibitors, it is important to critically evaluate the role of phototherapy in dermatology. Surveys have shown that many dermatology residency programs do not dedicate time to teaching residents how to prescribe or administer phototherapy. Limitations of phototherapy include access to a center, time required for treatments, and insurance approval. Home phototherapy, a viable option, is also underused. However, it should be emphasized that modern phototherapy has been in use for over 40 years, has an excellent safety profile, and does not require laboratory monitoring. It can be safely combined with many other treatment modalities, including biologics and small molecule inhibitors. In addition, phototherapy costs significantly less than these novel agents. Dermatologists are the only group of physicians who have the expertise and proper training to deliver this treatment modality to our patients. Therefore, to continue to deliver high-quality, cost-effective care, it is imperative that phototherapy be maintained as an integral part of the dermatology treatment armamentarium.
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Affiliation(s)
- Angeli Eloise Torres
- Manila, Philippines; Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, Michigan
| | - Alexis B Lyons
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, Michigan
| | - Iltefat H Hamzavi
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, Michigan
| | - Henry W Lim
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, Michigan.
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Slowly Repaired Bulky DNA Damages Modulate Cellular Redox Environment Leading to Premature Senescence. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:5367102. [PMID: 32104534 PMCID: PMC7035574 DOI: 10.1155/2020/5367102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/23/2020] [Indexed: 11/17/2022]
Abstract
Treatments on neoplastic diseases and cancer using genotoxic drugs often cause long-term health problems related to premature aging. The underlying mechanism is poorly understood. Based on the study of a long-lasting senescence-like growth arrest (10-12 weeks) of human dermal fibroblasts induced by psoralen plus UVA (PUVA) treatment, we here revealed that slowly repaired bulky DNA damages can serve as a “molecular scar” leading to reduced cell proliferation through persistent endogenous production of reactive oxygen species (ROS) that caused accelerated telomere erosion. The elevated levels of ROS were the results of mitochondrial dysfunction and the activation of NADPH oxidase (NOX). A combined inhibition of DNA-PK and PARP1 could suppress the level of ROS. Together with a reduced expression level of BRCA1 as well as the upregulation of PP2A and 53BP1, these data suggest that the NHEJ repair of DNA double-strand breaks may be the initial trigger of metabolic changes leading to ROS production. Further study showed that stimulation of the pentose phosphate pathway played an important role for NOX activation, and ROS could be efficiently suppressed by modulating the NADP/NADPH ratio. Interestingly, feeding cells with ribose-5-phosphate, a precursor for nucleotide biosynthesis that produced through the PPP, could evidently suppress the ROS level and prevent the cell enlargement related to mitochondrial biogenesis. Taken together, these results revealed an important signaling pathway between DNA damage repair and the cell metabolism, which contributed to the premature aging effects of PUVA, and may be generally applicable for a large category of chemotherapeutic reagents including many cancer drugs.
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5
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Karaosmanoglu N, Ozdemir Cetinkaya P, Kutlu O, Karaaslan E, Imren IG, Kiratli Nalbant E, Eksioglu M. A cross-sectional analysis of skin cancer risk in patients receiving narrow-band ultraviolet B phototherapy: an evaluation of 100 patients. Arch Dermatol Res 2019; 312:249-253. [PMID: 31729594 DOI: 10.1007/s00403-019-02007-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/20/2019] [Accepted: 11/05/2019] [Indexed: 01/14/2023]
Abstract
Narrow-band ultraviolet B (NB-UVB) phototherapy is an effective and widely used treatment modality for psoriasis and other inflammatory skin diseases. The carcinogenic effect of PUVA treatment has been investigated extensively, but there is very scarce data about the role of NB-UVB in the development of skin cancer. The aim of this study was to investigate the potential carcinogenic risk of NB-UVB therapy in various skin disorders. In this cross-sectional study, we evaluated 100 patients who had received whole-body NB-UVB treatment and 100 age- and sex-matched controls. Phototherapy unit database was used to identify patients. A total of 100 patients (53 males and 47 females) treated with NB-UVB and 100 controls were included in the study. The patient group revealed no cases of melanoma or non-melanoma skin cancer, while ten of them were found to have solar lentigines. Basal cell carcinoma in a patient and nine patients with solar lentigines were detected in the control group. There was no statistically significant difference between patient and control groups in terms of skin cancer and solar lentigines. This study does not provide evidence for an increased skin cancer risk in patients treated with NB-UVB phototherapy. However, we have detected the occurence of 10 cases of solar lentigines. Still, definitive prospective longitudinal studies with a greater number of patients and prolonged follow-up are required to specifically address skin cancer risk in relation to NB-UVB phototherapy.
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Affiliation(s)
- Nermin Karaosmanoglu
- Dermatology and Venereology, Ankara Training and Research Hospital, Ankara, Turkey
| | | | - Omer Kutlu
- Dermatology and Venereology, Develi Hatice Muammer Kocatürk State Hospital, Kayseri, Turkey
| | - Engin Karaaslan
- Dermatology and Venereology, Nusaybin State Hospital, Mardin, Turkey
| | - Işıl Göğem Imren
- Dermatology and Venereology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Esra Kiratli Nalbant
- Dermatology and Venereology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Meral Eksioglu
- Dermatology and Venereology, Ankara Training and Research Hospital, Ankara, Turkey
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Hansson Mild K, Lundström R, Wilén J. Non-Ionizing Radiation in Swedish Health Care-Exposure and Safety Aspects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1186. [PMID: 30987016 PMCID: PMC6479478 DOI: 10.3390/ijerph16071186] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/26/2019] [Accepted: 03/28/2019] [Indexed: 12/13/2022]
Abstract
The main aim of the study was to identify and describe methods using non-ionizing radiation (NIR) such as electromagnetic fields (EMF) and optical radiation in Swedish health care. By examining anticipated exposure levels and by identifying possible health hazards we also aimed to recognize knowledge gaps in the field. NIR is mainly used in health care for diagnosis and therapy. Three applications were identified where acute effects cannot be ruled out: magnetic resonance imaging (MRI), transcranial magnetic stimulation (TMS) and electrosurgery. When using optical radiation, such as class 3 and 4 lasers for therapy or surgical procedures and ultra-violet light for therapy, acute effects such as unintentional burns, photo reactions, erythema and effects on the eyes need to be avoided. There is a need for more knowledge regarding long-term effects of MRI as well as on the combination of different NIR exposures. Based on literature and after consulting staff we conclude that the health care professionals' knowledge about the risks and safety measures should be improved and that there is a need for clear, evidence-based information from reliable sources, and it should be obvious to the user which source to address.
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Affiliation(s)
- Kjell Hansson Mild
- Department of Radiation Sciences, Umeå University, S-90185 Umeå, Sweden.
| | - Ronnie Lundström
- Department of Radiation Sciences, Umeå University, S-90185 Umeå, Sweden.
| | - Jonna Wilén
- Department of Radiation Sciences, Umeå University, S-90185 Umeå, Sweden.
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Extra-adrenal glucocorticoid synthesis at epithelial barriers. Genes Immun 2019; 20:627-640. [PMID: 30692606 DOI: 10.1038/s41435-019-0058-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 01/02/2019] [Indexed: 01/08/2023]
Abstract
Epithelial barriers play an important role in the exchange of nutrients, gases, and other signals between our body and the outside world. However, they protect it also from invasion by potential pathogens. Defective epithelial barriers and associated overshooting immune responses are the basis of many different inflammatory disorders of the skin, the lung, and the intestinal mucosa. The anti-inflammatory activity of glucocorticoids has been efficiently used for the treatment of these diseases. Interestingly, epithelia in these tissues are also a rich source of endogenous glucocorticoids, suggesting that local glucocorticoid synthesis is part of a tissue-specific regulatory circuit. In this review, we summarize current knowledge about the extra-adrenal glucocorticoid synthesis at the epithelial barriers of the intestine, lung and the skin, and discuss their relevance in the pathogenesis of inflammatory diseases and as therapeutic targets.
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Grandi V, Fava P, Rupoli S, Alberti Violetti S, Canafoglia L, Quaglino P, Berti E, Pimpinelli N. Standardization of regimens in Narrowband UVB and PUVA in early stage mycosis fungoides: position paper from the Italian Task Force for Cutaneous Lymphomas. J Eur Acad Dermatol Venereol 2018; 32:683-691. [DOI: 10.1111/jdv.14668] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 10/16/2017] [Indexed: 11/29/2022]
Affiliation(s)
- V. Grandi
- Dermatology Unit; Department of Surgery and Translational Medicine; University of Florence Medical School; Florence Italy
| | - P. Fava
- Department of Medical Sciences; Dermatologic Clinic; University of Turin; Turin Italy
| | - S. Rupoli
- Clinic of Hematology; United Ancona Hospitals; Polytechnic University of Marche; Ancona Italy
| | - S. Alberti Violetti
- Dermatology Unit; IRCCS Ca’ Granda - Ospedale Maggiore Policlinico; Milan Italy
| | - L. Canafoglia
- Clinic of Hematology; United Ancona Hospitals; Polytechnic University of Marche; Ancona Italy
| | - P. Quaglino
- Department of Medical Sciences; Dermatologic Clinic; University of Turin; Turin Italy
| | - E. Berti
- Dermatology Unit; IRCCS Ca’ Granda - Ospedale Maggiore Policlinico; Milan Italy
| | - N. Pimpinelli
- Dermatology Unit; Department of Surgery and Translational Medicine; University of Florence Medical School; Florence Italy
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9
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Howell ST, Cardwell LA, Feldman SR. A Review and Update of Phototherapy Treatment Options for Psoriasis. CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0211-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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10
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Miolo G, Sturaro G, Cigolini G, Menilli L, Tasso A, Zago I, Conconi MT. 4,6,4'-trimethylangelicin shows high anti-proliferative activity on DU145 cells under both UVA and blue light. Cell Prolif 2018; 51:e12430. [PMID: 29318693 DOI: 10.1111/cpr.12430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/01/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Furocoumarins (psoralens and angelicins) have been already used under ultraviolet A light (UVA) for the treatment of skin diseases and cutaneous T-cell lymphoma. Besides their high anti-proliferative activity, some severe long-term side effects have been observed, for example genotoxicity and mutagenicity, likely strictly related to the formation of crosslinks. It has been demonstrated that blue light (BL) activation of 8-methoxypsoralen, an FDA-approved drug, leads to less mutagenic monoadducts in the DNA. So far, in this work the less toxic and more penetrating BL is proposed to activate 4,6,4'-trimethylangelicin (TMA), an already known UVA photoactivatable compound. MATERIALS AND METHODS Photocleavage, crosslink formation and oxidative damage were detected in pBR322 plasmid DNA treated with 300.0 μmol/L TMA activated with various exposures of BL. Anti-proliferative activity, reactive oxygen species (ROS) formation and activation status of some signalling pathways involved in cell growth and apoptosis were verified on DU145 cells treated with 5.0 μmol/L TMA plus 2.0 J/cm2 of BL. RESULTS Under BL-TMA, no mutagenic crosslinks, no photocleavage and neither photooxidative lesions were detected on isolated plasmid DNA. TMA showed high anti-proliferative activity on DU145 cells through induction of apoptosis. Besides ROS generation, the proapoptotic effect seemed to be related to activation of p38 and inhibition of p44/42 phosphorylation. Interestingly, the decrease in nuclear β-catenin was coupled with a significant dropping of CD44-positive cells. CONCLUSION Overall, our results indicate that TMA can be activated by BL and may be considered for targeted phototherapy of prostate cancer lesions.
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Affiliation(s)
- G Miolo
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - G Sturaro
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - G Cigolini
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - L Menilli
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - A Tasso
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - I Zago
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - M T Conconi
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
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11
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Pacifico A, Leone G, Damiani G, Ferraro C, Iacovelli P, Paro Vidolin A, Muscardin L. Indeterminate cell histiocytosis: A case treated with ultraviolet B narrow band phototherapy (NB UVB). PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2017; 33:329-333. [DOI: 10.1111/phpp.12327] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/23/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - Giovanni Leone
- San Gallicano Dermatological Institute; IRCCS; Rome Italy
| | - Giovanni Damiani
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti; Unità Operativa di Dermatologia; IRCCS Fondazione Cà Granda; Ospedale Maggiore Policlinico; Università degli Studi di Milano; Milano Italy
| | | | | | | | - Luca Muscardin
- San Gallicano Dermatological Institute; IRCCS; Rome Italy
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12
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Toutfaire M, Bauwens E, Debacq-Chainiaux F. The impact of cellular senescence in skin ageing: A notion of mosaic and therapeutic strategies. Biochem Pharmacol 2017; 142:1-12. [PMID: 28408343 DOI: 10.1016/j.bcp.2017.04.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/07/2017] [Indexed: 02/07/2023]
Abstract
Cellular senescence is now recognized as one of the nine hallmarks of ageing. Recent data show the involvement of senescent cells in tissue ageing and some age-related diseases. Skin represents an ideal model for the study of ageing. Indeed, skin ageing varies between individuals depending on their chronological age but also on their exposure to various exogenous factors (mainly ultraviolet rays). If senescence traits can be detected with ageing in the skin, the senescent phenotype varies among the various skin cell types. Moreover, the origin of cellular senescence in the skin is still unknown, and multiple origins are possible. This reflects the mosaic of skin ageing. Senescent cells can interfere with their microenvironment, either via the direct secretion of factors (the senescence-associated secretory phenotype) or via other methods of communication, such as extracellular vesicles. Knowledge regarding the impact of cellular senescence on skin ageing could be integrated into dermatology research, especially to limit the appearance of senescent cells after photo(chemo)therapy or in age-related skin diseases. Therapeutic approaches include the clearance of senescent cells via the use of senolytics or via the cooperation with the immune system.
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Affiliation(s)
- Marie Toutfaire
- URBC, NAmur Research Institute for LIfe Science (NARILIS), University of Namur, Namur, Belgium
| | - Emilie Bauwens
- URBC, NAmur Research Institute for LIfe Science (NARILIS), University of Namur, Namur, Belgium
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Maiorino A, De Simone C, Perino F, Caldarola G, Peris K. Melanoma and non-melanoma skin cancer in psoriatic patients treated with high-dose phototherapy. J DERMATOL TREAT 2016; 27:443-7. [PMID: 26822468 DOI: 10.3109/09546634.2015.1133882] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The carcinogenic effect of plus ultraviolet A (PUVA)-therapy in psoriatic patients has been widely demonstrated, while data on the safety of narrow band (311 nm) ultraviolet B (nb-UVB) are scarce. We investigated the occurrence of melanoma and non-melanoma skin cancer (NMSC) in psoriatic patients treated with nb-UVB or PUVA-therapy. METHODS This retrospective study included patients affected by psoriasis, who had been treated with nb-UVB or PUVA-therapy. Clinical data and phenotypic risk factors were collected and a total body examination was performed at a routine appointment during the study period. RESULTS We examined 92 patients (60 males and 32 females; mean age: 53.5 years, range: 20-83 years) treated with PUVA-therapy (42/92, 45%) or with nb-UVB (50/92, 55%) for 1-28 years (mean: 7.1 years). Among patients treated with PUVA, nine skin tumors (one melanoma, seven basal cell carcinoma (BCCs) and one squamous cell carcinoma (SCC)) were detected in 2/42 (4.7%) patients, while in the nb-UVB group, 14 skin tumors including two melanomas, four BCCs, and eight SCCs were diagnosed in 6/50 (12%) patients. CONCLUSIONS A noteworthy number of NMSC were diagnosed in this Mediterranean population of patients exposed to high-dose UV treatment. A thorough risk-benefit evaluation should always be done before UV treatment and patients should be carefully monitored for skin cancer during and after treatment discontinuation.
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Affiliation(s)
- Alessia Maiorino
- a Institute of Dermatology, Catholic University of the Sacred Heart , Rome , Italy
| | - Clara De Simone
- a Institute of Dermatology, Catholic University of the Sacred Heart , Rome , Italy
| | - Francesca Perino
- a Institute of Dermatology, Catholic University of the Sacred Heart , Rome , Italy
| | - Giacomo Caldarola
- a Institute of Dermatology, Catholic University of the Sacred Heart , Rome , Italy
| | - Ketty Peris
- a Institute of Dermatology, Catholic University of the Sacred Heart , Rome , Italy
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14
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Laner-Plamberger S, Lener T, Schmid D, Streif DA, Salzer T, Öller M, Hauser-Kronberger C, Fischer T, Jacobs VR, Schallmoser K, Gimona M, Rohde E. Mechanical fibrinogen-depletion supports heparin-free mesenchymal stem cell propagation in human platelet lysate. J Transl Med 2015; 13:354. [PMID: 26554451 PMCID: PMC4641400 DOI: 10.1186/s12967-015-0717-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/29/2015] [Indexed: 01/10/2023] Open
Abstract
Background Pooled human platelet lysate (pHPL) is an efficient alternative to xenogenic supplements for ex vivo expansion of mesenchymal stem cells (MSCs) in clinical studies. Currently, porcine heparin is used in pHPL-supplemented medium to prevent clotting due to plasmatic coagulation factors. We therefore searched for an efficient and reproducible medium preparation method that avoids clot formation while omitting animal-derived heparin. Methods We established a protocol to deplete fibrinogen by clotting of pHPL in medium, subsequent mechanical hydrogel disruption and removal of the fibrin pellet. After primary culture, bone-marrow and umbilical cord derived MSCs were tested for surface markers by flow cytometry and for trilineage differentiation capacity. Proliferation and clonogenicity were analyzed for three passages. Results The proposed clotting procedure reduced fibrinogen more than 1000-fold, while a volume recovery of 99.5 % was obtained. All MSC types were propagated in standard and fibrinogen-depleted medium. Flow cytometric phenotype profiles and adipogenic, osteogenic and chondrogenic differentiation potential in vitro were independent of MSC-source or medium type. Enhanced proliferation of MSCs was observed in the absence of fibrinogen but presence of heparin compared to standard medium. Interestingly, this proliferative response to heparin was not detected after an initial contact with fibrinogen during the isolation procedure. Conclusions Here, we present an efficient, reproducible and economical method in compliance to good manufacturing practice for the preparation of MSC media avoiding xenogenic components and suitable for clinical studies. Electronic supplementary material The online version of this article (doi:10.1186/s12967-015-0717-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sandra Laner-Plamberger
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria. .,Department of Blood Group Serology and Transfusion Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Lindhofstrasse 20-22, 5020, Salzburg, Austria.
| | - Thomas Lener
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria. .,Department of Blood Group Serology and Transfusion Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Lindhofstrasse 20-22, 5020, Salzburg, Austria.
| | - Doris Schmid
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria. .,Department of Blood Group Serology and Transfusion Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Lindhofstrasse 20-22, 5020, Salzburg, Austria.
| | - Doris A Streif
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria. .,Department of Blood Group Serology and Transfusion Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Lindhofstrasse 20-22, 5020, Salzburg, Austria.
| | - Tina Salzer
- Department of Blood Group Serology and Transfusion Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Lindhofstrasse 20-22, 5020, Salzburg, Austria.
| | - Michaela Öller
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria. .,Department of Blood Group Serology and Transfusion Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Lindhofstrasse 20-22, 5020, Salzburg, Austria.
| | | | - Thorsten Fischer
- Department of Gynecology and Obstetrics, Paracelsus Medical University, Salzburg, Austria.
| | - Volker R Jacobs
- Department of Gynecology and Obstetrics, Paracelsus Medical University, Salzburg, Austria.
| | - Katharina Schallmoser
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria. .,Department of Blood Group Serology and Transfusion Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Lindhofstrasse 20-22, 5020, Salzburg, Austria.
| | - Mario Gimona
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria. .,Department of Blood Group Serology and Transfusion Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Lindhofstrasse 20-22, 5020, Salzburg, Austria.
| | - Eva Rohde
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria. .,Department of Blood Group Serology and Transfusion Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Lindhofstrasse 20-22, 5020, Salzburg, Austria.
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15
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Olsen EA, Hodak E, Anderson T, Carter JB, Henderson M, Cooper K, Lim HW. Guidelines for phototherapy of mycosis fungoides and Sézary syndrome: A consensus statement of the United States Cutaneous Lymphoma Consortium. J Am Acad Dermatol 2015; 74:27-58. [PMID: 26547257 DOI: 10.1016/j.jaad.2015.09.033] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ultraviolet light (UVL) is a long established treatment for mycosis fungoides (MF) and Sézary syndrome (SS), subtypes of cutaneous T-cell lymphoma (CTCL). Treatments have traditionally included broadband, narrowband ultraviolet B light (UVB) and psoralen plus ultraviolet A light photochemotherapy (PUVA), but more recently, treatment options have expanded to include UVA1 and excimer laser. UVL is used either as monotherapy or as an adjuvant to systemic therapy, demonstrating efficacy in many cases that equal or surpass systemic medications. Despite its utility and duration of use, the current practice of using UVL guidelines for psoriasis to treat patients with MF/SS is problematic because the goals of prolonging survival and preventing disease progression are unique to CTCL compared to psoriasis. OBJECTIVES We sought to develop separate guidelines for phototherapy for MF/SS for both clinical practice and for clinical trials. METHODS Literature review and cutaneous lymphoma expert consensus group recommendations. RESULTS This paper reviews the published literature for UVB and UVA/PUVA in MF/SS and suggests practical standardized guidelines for their use. LIMITATIONS New standardization of phototherapy. CONCLUSIONS These guidelines should allow the comparison of results with phototherapy in MF/SS across different stages of patients, centers, and in combination with other agents in practice and in clinical trials.
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Affiliation(s)
- Elise A Olsen
- Departments of Dermatology and Medicine, Duke University Medical Center, Durham, North Carolina.
| | - Emilia Hodak
- Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Thomas Anderson
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - Joi B Carter
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Marsha Henderson
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Kevin Cooper
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
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16
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Vangipuram R, Feldman SR. Ultraviolet phototherapy for cutaneous diseases: a concise review. Oral Dis 2015; 22:253-9. [PMID: 26464123 DOI: 10.1111/odi.12366] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 08/13/2015] [Indexed: 01/05/2023]
Abstract
Phototherapy is the use of non-ionizing radiation, primarily in the ultraviolet spectrum, to treat disease. In dermatology, ultraviolet (UV) phototherapy remains an established, lower cost, and often preferred option for many common skin conditions, despite the introduction of newer potent biologics. This article introduces a principal therapeutic modality in the treatment of psoriasis, atopic dermatitis (eczema), vitiligo, and morphea among other diseases where oral manifestations may be present, providing basic information about the use of UVA, UVB, and PUVA. Practical considerations and side effects of phototherapy are described. Phototherapy is an effective treatment for many illnesses and carries a relatively benign side-effect profile.
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Affiliation(s)
- R Vangipuram
- University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - S R Feldman
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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17
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Nisar MF, Parsons KSG, Bian CX, Zhong JL. UVA irradiation induced heme oxygenase-1: a novel phototherapy for morphea. Photochem Photobiol 2014; 91:210-20. [PMID: 25207998 DOI: 10.1111/php.12342] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 08/21/2014] [Indexed: 12/21/2022]
Abstract
Long wave UVA radiation (340-400 nm) causes detrimental as well as beneficial effects on human skin. Studies of human skin fibroblasts irradiated with UVA demonstrate increased expression of both antifibrotic heme oxygenase-1 (HO-1) and matrix metalloproteinase 1 (MMP-1). The use of UVA-induced MMP-1 is well-studied in treating skin fibrotic conditions such as localized scleroderma, now called morphea. However, the role that UVA-induced HO-1 plays in phototherapy of morphea has not been characterized. In the present manuscript, we have illustrated and reviewed the biological function of HO-1 and the use of UVA1 wavebands (340-400 nm) for phototherapy; the potential use of HO-1 induction in UVA therapy of morphea is also discussed.
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Affiliation(s)
- Muhammad Farrukh Nisar
- The Base of "111 Project" for Biomechanics & Tissue Repair Engineering, Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing, China
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18
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Miolo G, Salvador A, Mazzoli A, Spalletti A, Marzaro G, Chilin A. Photochemical and photobiological studies on furoquinazolines as new psoralen analogs. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2014; 138:43-54. [DOI: 10.1016/j.jphotobiol.2014.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 04/29/2014] [Accepted: 05/05/2014] [Indexed: 10/25/2022]
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19
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Abstract
UV phototherapy has a long history of use for the treatment of select diseases in dermatology. Its use has evolved into more effective and targeted modalities, including psoralen + UV-A photochemotherapy, narrowband UV-B, excimer laser, and UV-A1 phototherapy. With its proven record of efficacy and safety, UV phototherapy is an excellent option in the treatment of an ever-growing number of skin conditions.
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Affiliation(s)
- Mariam B Totonchy
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Melvin W Chiu
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, 52-121 Center for the Health Sciences, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
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20
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Abstract
Atopic dermatitis (AD) continues to present significant therapeutic challenges, especially in severe cases. Navigating the line between risk and benefit can be difficult for more powerful medications such as immunosuppressants, but non-pharmacologic treatments are often overlooked and underutilized. Creative application of these more physical therapies can serve to minimize the pharmacologic treatments and their side effects, and possibly even create synergy between modalities, to maximize benefit to the patient.
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Affiliation(s)
- Peter A Lio
- Clinical Dermatology & Pediatrics, Northwestern University Feinberg School of Medicine, 1455 N. Milwaukee Ave, 2nd Floor, Chicago, IL, 60622, USA,
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21
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Richard EG, Hönigsmann H. Phototherapy, psoriasis, and the age of biologics. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2013; 30:3-7. [PMID: 24313462 DOI: 10.1111/phpp.12088] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 11/26/2022]
Abstract
Over 10 years have passed since the first approval of a biologic agent for the treatment of psoriasis. No one can argue that the arrival of this entirely new, highly effective class of medications has not forever changed the therapeutic landscape for psoriasis. Traditional treatments such as phototherapy, however, remain both viable and effective therapies, both as standalone treatments and in combination with biologics. In general, synergistic effects are noted for combinations utilizing phototherapy; however, the long-term impact of these combinations on skin cancer development has yet to be fully determined. Increasing financial pressures for cost-effective therapies augment the appeal of phototherapy and other traditional treatments as compared with the more costly biologics. Phototherapy also remains strong outside the realm of psoriasis, in the management of atopic dermatitis, vitiligo, and cutaneous T-cell lymphoma, among other conditions. Phototherapy will remain a cornerstone in the management of psoriasis as well as nonpsoriatic skin conditions, as its efficacy is well known, its financial cost is reasonable, it is readily compatible with other therapeutics, and its utility is historically proven.
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22
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Bellavista S, D' Antuono A, Infusino SD, Trimarco R, Patrizi A. Pruritic papular eruption in HIV: a case successfully treated with NB-UVB. Dermatol Ther 2013; 26:173-5. [PMID: 23551375 DOI: 10.1111/j.1529-8019.2013.01545.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pruritic papular eruption (PPE) is a skin disease characterized by the eruption of itching papules on the extremities, face, and trunk; it is quite frequent in HIV-positive patients especially during the advanced immunosuppressive stage. PPE usually improves or heals when antiretroviral therapy restores the immune system function, but in some cases, it can take several months, and a symptomatic treatment for PPE is required. Systemic antihistamines, topical steroids, topical tacrolimus, itraconazole, pentoxyphilline, and ultraviolet B phototherapy have been proposed in cases of persisting PPE, but an elective treatment has not yet been found. We describe the case of a black patient affected by PPE, nonimproving with antiretroviral treatment, and resistant to topical steroids and oral antihistamines; a satisfactory and speedy result was achieved with narrow-band ultraviolet B phototherapy.
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Affiliation(s)
- Sara Bellavista
- Section of Dermatology and Venereology, Department of Internal Medicine, Geriatrics and Nephrology, University of Bologna, Bologna, Italy.
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23
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Antitumor activity of Mn(III) complexes in combination with phototherapy and antioxidant therapy. Biometals 2013; 26:439-46. [DOI: 10.1007/s10534-013-9626-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 04/06/2013] [Indexed: 11/26/2022]
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24
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Abstract
Skin is a model of choice in studies on aging. Indeed, skin aging can be modulated by internal and external factors, reflecting its complexity. Two types of skin aging have been identified: intrinsic, mainly genetically determined and extrinsic—also called "photo-aging"—resulting on the impact of environmental stress and more precisely of UV rays. Simplified in vitro models, based on cellular senescence, have been developed to study the relationship between UV and aging. These models vary on the cell type (fibroblasts or keratinocytes, normal or immortalized) and the type of UV used (UVA or UVB).
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25
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Ong WK, Chen HF, Tsai CT, Fu YJ, Wong YS, Yen DJ, Chang TH, Huang HD, Lee OKS, Chien S, Ho JHC. The activation of directional stem cell motility by green light-emitting diode irradiation. Biomaterials 2012; 34:1911-20. [PMID: 23261211 DOI: 10.1016/j.biomaterials.2012.11.065] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 11/29/2012] [Indexed: 01/08/2023]
Abstract
Light-emitting diode (LED) irradiation is potentially a photostimulator to manipulate cell behavior by opsin-triggered phototransduction and thermal energy supply in living cells. Directional stem cell motility is critical for the efficiency and specificity of stem cells in tissue repair. We explored that green LED (530 nm) irradiation directed the human orbital fat stem cells (OFSCs) to migrate away from the LED light source through activation of extracellular signal-regulated kinases (ERK)/MAP kinase/p38 signaling pathway. ERK inhibitor selectively abrogated light-driven OFSC migration. Phosphorylation of these kinases as well as green LED irradiation-induced cell migration was facilitated by increasing adenosine triphosphate (ATP) production in OFSCs after green LED exposure, and which was thermal stress-independent mechanism. OFSCs, which are multi-potent mesenchymal stem cells isolated from human orbital fat tissue, constitutionally express three opsins, i.e. retinal pigment epithelium-derived rhodopsin homolog (RRH), encephalopsin (OPN3) and short-wave-sensitive opsin 1 (OPN1SW). However, only two non-visual opsins, i.e. RRH and OPN3, served as photoreceptors response to green LED irradiation-induced OFSC migration. In conclusion, stem cells are sensitive to green LED irradiation-induced directional cell migration through activation of ERK signaling pathway via a wavelength-dependent phototransduction.
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Affiliation(s)
- Wei-Kee Ong
- Center for Stem Cell Research, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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26
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Chiu YE, Vora S, Kwon EKM, Maheshwari M. A significant proportion of children with morphea en coup de sabre and Parry-Romberg syndrome have neuroimaging findings. Pediatr Dermatol 2012; 29:738-48. [PMID: 23106674 PMCID: PMC3490222 DOI: 10.1111/pde.12001] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
En coup de sabre (ECDS) and Parry-Romberg syndrome (PRS) are variants of linear morphea on the head and neck that can be associated with neurologic manifestations. Intracranial abnormalities on computed tomography (CT) and magnetic resonance imaging (MRI) are present in a significant proportion of individuals with these conditions. We describe 32 children from our institution with ECDS or PRS; neuroimaging was performed in 21 cases. We also review 51 additional cases from the literature. Nineteen percent of the children at our institution with ECDS or PRS had intracranial abnormalities on MRI, half of whom were asymptomatic. Hyperintensities on T2-weighted sequences were the most common finding, present in all children with intracranial abnormalities on MRI. Seizures (13%) and headaches (9%) were the most common neurologic symptom. Neurologic symptoms were not correlated with neuroimaging abnormalities, with two asymptomatic children having marked MRI findings and only two of nine symptomatic children having an abnormal MRI. Similarly the severity of the superficial disease did not predict neurologic involvement; a child with subtle skin involvement had striking MRI findings and seizures, whereas another with a bony defect had no brain parenchymal involvement. Neurologic symptoms and neuroimaging abnormalities are found in a surprisingly substantial percentage of children with ECDS and PRS. Early recognition of neurologic involvement is necessary because it affects treatment choices. Because clinical predictors of intracranial abnormalities are poor, strong consideration should be given to obtaining an MRI before treatment initiation to assist in management decisions and establish a baseline examination.
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Affiliation(s)
- Yvonne E Chiu
- Division of Pediatric Dermatology, Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
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Juzeniene A, Moan J. Beneficial effects of UV radiation other than via vitamin D production. DERMATO-ENDOCRINOLOGY 2012; 4:109-17. [PMID: 22928066 PMCID: PMC3427189 DOI: 10.4161/derm.20013] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Most of the positive effects of solar radiation are mediated via ultraviolet-B (UVB) induced production of vitamin D in skin. However, several other pathways may exist for the action of ultraviolet (UV) radiation on humans as focused on in this review. One is induction of cosmetic tanning (immediate pigment darkening, persistent pigment darkening and delayed tanning). UVB-induced, delayed tanning (increases melanin in skin after several days), acts as a sunscreen. Several human skin diseases, like psoriasis, vitiligo, atopic dermatitis and localized scleroderma, can be treated with solar radiation (heliotherapy) or artificial UV radiation (phototherapy). UV exposure can suppress the clinical symptoms of multiple sclerosis independently of vitamin D synthesis. Furthermore, UV generates nitric oxide (NO), which may reduce blood pressure and generally improve cardiovascular health. UVA-induced NO may also have antimicrobial effects and furthermore, act as a neurotransmitter. Finally, UV exposure may improve mood through the release of endorphins.
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