Phototherapy: Theory and practice

Phototherapy as an alternative in the treatment of chronic spontaneous urticaria

Chronic spontaneous urticaria (CSU) is defined as the occurrence of hives, angioedema, or both, lasting for more than 6 weeks. The treatment is based on the use of antihistamines, omalizumab, and/or cyclosporine following a stepwise algorithm recommended by international guidelines with a high level of evidence. Nevertheless, management can be challenging as some patients do not respond to the suggested drugs or have difficulties accessing them for various reasons. In such cases, phototherapy has been reported as a potential treatment option. The evidence on the effectiveness of phototherapy is limited. Most studies have methodological limitations and involve small numbers of patients. A systematic review and meta-analysis of four studies in 2020 concluded that, despite the limited number of randomized controlled trials and the low level of evidence, considering overall efficacy, risk/benefit balance, and costs, narrow band ultraviolet B therapy (NB-UVB) may be a useful adjunct therapy for CSU. Other studies have suggested that the effectiveness of combined antihistamine and phototherapy appears to be more effective than antihistamine alone, although this is based on very low-quality evidence. Additionally, the risk of recurrence was lower with the combination therapy. The objective of this review was to evaluate the role of phototherapy in the treatment of CSU. While randomized studies with a larger number of participants providing a high level of evidence are still needed, we consider phototherapy to be a valuable tool in specific clinical contexts, such as a bridge to the initiation of other medications or until spontaneous remission of the condition occurs.

Nonsteroidal Approaches for Atopic Dermatitis®: A Clinical Update

Topical corticosteroids (TCSs) are the most widely used treatment for atopic Dermatitis® (AD), but they can have adverse effects such as skin atrophy, telangiectasias, and hypopigmentation, especially with prolonged use of higher potency steroids. Many patients also have a fear of using TCSs, known as "corticophobia." With the development of biologics and Janus kinase inhibitors, a nonsteroidal approach to the treatment of AD may be possible and may be preferred by certain patients. Given what is known about these nonsteroidal therapies, we propose a structured treatment ladder and action plan that can guide clinicians and patients on the use of these therapies for the treatment of AD. The ladder divides nonsteroidal medication classes into treatments for exacerbation versus maintenance therapies in an escalating order of increasing potential for adverse effects, both real and perceived. This treatment algorithm proposal paves the way for a potential nonsteroidal approach to managing AD.

Psoriasis and Seasonality: Exploring the Genetic and Epigenetic Interactions

Psoriasis is a multifactorial, chronic, and inflammatory disease that severely impacts patients' quality of life. The disease is caused by genetic irregularities affected by epigenetic and environmental factors. Some of these factors may include seasonal changes, such as solar radiation, air pollution, and humidity, and changes in circadian rhythm, especially in the temporal and polar zones. Thus, some psoriasis patients report seasonal variability of symptoms. Through a comprehensive review, we aim to delve deeper into the intricate interplay between seasonality, environmental factors, and the genetic and epigenetic landscape of psoriasis. By elucidating these complex relationships, we strive to provide insights that may inform targeted interventions and personalized management strategies for individuals living with psoriasis.

Tolerability of Narrow-band Ultraviolet-B Phototherapy for Different Dermatological Diseases in Relation to Co-medications

Phototherapy is an efficient therapy for a variety of skin diseases. Various drugs can cause photosensitivity and impact tolerability of phototherapy. The tolerability was investigated of narrowband ultraviolet-B 311 nm therapy in dependence on the underlying disease and long-term co-medication. A total of 534 narrowband ultraviolet-B therapy courses were examined. Compared with psoriasis, adverse events were observed more frequently in eczematous diseases and, in some cases, other indications. About two-thirds of all courses were carried out in patients taking at least one photosensitising drug, according to the summaries of product characteristics. Phototherapy was more frequently associated with adverse events when medication was taken concomitantly. When considering the tolerability of phototherapy in dependence on individual substances or drug classes, no statistically significant result was shown after adjustment.