UVB phototherapy is an effective treatment for pruritus in patients infected with HIV

Phototherapy in Skin of Color

Phototherapy in skin of color requires special consideration. Pigmented skin is an efficient ultraviolet filter. Hence, higher doses of ultraviolet radiation are generally more effective and well tolerated in skin of color. An objective and practical system has not yet been established to determine optimal phototherapy dosing in skin of color. The authors recommend obtaining a detailed history of each individual patient's response to sun exposure before prescribing a phototherapy dosing regimen. In addition, providers should consider the role of socioeconomic factors and their impact on phototherapy-related outcomes, including barriers to access and compliance.

Pruritic papular eruption in HIV: a case successfully treated with NB-UVB

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.

Pruritus: management algorithms and experimental therapies

Pruritus (itch) is a major symptom in many dermatologic as well as systemic diseases and has a dramatic impact on the quality of life in these patients. The symptom of itch has to be treated on the basis of its pathophysiology and its underlying disease. In daily practice, a "quick" diagnosis of the underlying disease is often difficult, although a rapid relief of the itch is desired. We often treat patients on the basis of the symptomatology. A rational therapeutic ladder for a symptomatic therapy is useful until the final diagnosis has been confirmed. There are probably many subtypes of pruritus, just as there are many diseases that cause itch. The pathophysiology in many subtypes of pruritus is still poorly understood, hindering a rapid and targeted treatment strategy. An extensive diagnostic workup is often required to determine the final cause(s) of the itch. Thus, in daily life, physicians often start with a more or less rational therapeutic strategy to combat the debilitating itch. We present possible therapeutic ladders that form the basis for effective therapeutic itch strategies in various diseases. On the basis of our current knowledge about the different pathophysiologies of itch, on clinical trials or case reports, and our own clinical experience, we aim to present therapeutic ladders for the rapid as well as long-term management of itch. Finally, we summarize current exciting developments of experimental strategies in itch research and in clinical development for itch therapy.

Indolent systemic mastocytosis treated with narrow-band UVB phototherapy: study of five cases

BACKGROUND

Mastocytoses represent a heterogeneous group of stem cell disorders marked by an abnormal hyperplasia and accumulation of mast cells in one or more tissues, including bone marrow, gastrointestinal tract, liver, spleen, lymph nodes and skin. Indolent systemic mastocytosis (ISM) is characterized by red-brownish and pruriginous maculopapular lesions, a bone marrow infiltration without functional impairment and an indolent clinical course with a good prognosis. In particular, the most common cutaneous symptoms are urticarial rash and mild-to-high pruritus.

OBJECTIVES

This study analyses the clinical outcome of patients affected by ISM with prevalent pruriginous cutaneous symptoms and a scarce response to anti-histamines treated using narrowband ultraviolet B (NB-UVB) phototherapy.

METHODS

Narrowband ultraviolet B phototherapy was administered in a UV-irradiation cabin equipped with fluorescent UVB lamps with a peak emission at 311-313 nm. The perception of pruritus severity was assessed using the Visual Analogue Scale (VAS) before starting the treatment and at each control.

RESULTS

A complete remission of the cutaneous lesions and pruritus was documented in all patients after a median of 40.3 UV treatments and a median cumulative dose of 51.4 J/cm(2), with a lasting remission over a 6-month follow-up. The median VAS score at the beginning of the treatment was 86.6 (SD=6.64), whereas it decreased to 6.66 (SD=3.75) after 3 months of therapy.

CONCLUSIONS

Our work provides evidence that NB-UVB phototherapy is useful for the treatment of the cutaneous symptoms and pruritus in ISM.

Fototerapia: aplicações clínicas

Fototerapia é a modalidade terapêutica que aplica exposições repetidas e controladas de radiação ultravioleta para alterar a fisiologia cutânea de modo a induzir a regressão ou controlar a evolução de diversas dermatoses. Este texto apresenta uma visão geral das práticas correntes que utilizam a radiação ultravioleta isolada ou em combinação com fotossensibilizantes ou outras medicações. Serão ainda discutidos os mecanismos de ação de cada modalidade, as indicações mais aceitas, seus esquemas de prescrição, efeitos adversos e cuidados especiais.

Pustular skin disorders: diagnosis and treatment

The differential diagnosis for pustular skin disorders is extensive. The distribution of the lesions and the age of the patient are characteristics that may provide strong clues to the etiology of cutaneous pustular eruptions. In adults, generalized pustular dermatoses include pustular psoriasis, Reiter's disease and subcorneal pustular dermatosis. Medications can cause generalized pustular eruptions, such as in the case of acute generalized exanthematous pustulosis; or more localized reactions, such as acneiform drug eruptions, which usually involve the face, chest and back. Localized pustular eruptions are seen on the hands and feet in adults with pustulosis palmaris et plantaris and acrodermatitis continua (both of which may be variants of psoriasis); on the face in patients with acne vulgaris, rosacea, and perioral dermatitis; and on the trunk and/or extremities in patients with folliculitis. A separate condition known as eosinophilic folliculitis occurs in individuals with advanced human immunodeficiency disease. Severely pruritic, sterile, eosinophilic pustules are found on the chest, proximal extremities, head and neck. Elevated serum immunoglobulin E and eosinophilia are often concurrently found. In neonates, it is especially important to make the correct diagnosis with respect to pustular skin disorders, since pustules can be a manifestation of sepsis or other serious infectious diseases. Generalized pustular eruptions in neonates include erythema toxicum neonatorum and transient neonatal pustular melanosis, both of which are non-infectious. Pustules are seen in infants with congenital cutaneous candidiasis, which may or may not involve disseminated disease. Ofuji's syndrome is an uncommon generalized pustular dermatosis of infancy with associated eosinophilia. As in adults, neonates and infants may develop acne or scabies infestations. In this article, we review the most common pustular dermatoses and offer a systematic approach to making a diagnosis. We also report the most up-to-date information on the treatment of these various cutaneous pustular conditions.

HIV and AIDS in inpatient dermatology. Approach to the consultation

In the inpatient setting, the dermatologic consultant is called on to address the whole spectrum of cutaneous disease seen in HIV/AIDS patients, with severity varying from severe life-threatening to less serious conditions that dramatically affect quality of life. Rather than reviewing a "laundry list" of conditions associated with HIV/AIDS or the most severe conditions, this article aims to demonstrate a systematic approach to inpatient dermatology consultation in HIV/AIDS patients and to briefly review several common and interesting topics frequently addressed in the inpatient setting (e.g., medications issues, and phototherapy in HIV-infected patients).

Phototherapy and photochemotherapy: an update

Three types of phototherapy and 2 forms of photochemotherapy are now available for treatment of more than 40 diseases of the skin. Broadband ultraviolet B (UVB) phototherapy and oral psoralen photochemotherapy (PUVA) therapy are most widely available while there has been increased interest in topical PUVA therapy. Narrow-band UVB phototherapy and UVA-1 phototherapy offer potential for the future.