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Ju HJ, Bae JM. Bridging Molecular Mechanism and Clinical Practice in Vitiligo Treatment: An Updated Review. Dermatology 2024; 240:474-486. [PMID: 38417409 DOI: 10.1159/000537810] [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: 08/02/2022] [Accepted: 02/11/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Treatment of vitiligo seeks to achieve three goals: cessation of disease progression, regeneration of pigmentation, and prevention of recurrence. SUMMARY Number of nonsurgical interventions are available that suppress the autoimmune response and regenerate the melanocytes from the reservoir: phototherapy including psoralen and ultraviolet A, narrowband ultraviolet B, and 308-nm excimer and 311-nm Titanium:Sapphire lasers; topical agents including topical calcineurin inhibitors, topical corticosteroids, and topical 5-fluorouracil; and systemic agents including corticosteorids, mycophenolate mofetil, cyclosporine, methotrexate, minocycline, afamelanotide, and antioxidants. In recent years, a great advance has been made in the understanding of pathogenesis of vitiligo, and JAK inhibitors are being investigated as a new treatment. Minimally invasive procedures such as fractional lasers or microneedling can help achieve the optimal treatment outcome when used properly. KEY MESSAGES Our review describes various treatment modalities for vitiligo based on their molecular mechanism of action. Bridging the gap between molecular mechanisms and therapeutic options would be a valuable reference for physicians in clinical practice.
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Affiliation(s)
- Hyun Jeong Ju
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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The effects of UVB irradiance on aberrant epidermal proliferation: Novel insights on how to improve currently available sunscreens. Life Sci 2022; 288:120181. [PMID: 34843737 DOI: 10.1016/j.lfs.2021.120181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 11/12/2021] [Accepted: 11/21/2021] [Indexed: 11/23/2022]
Abstract
AIMS Sunscreen use, which prolonged the time required to develop sunburn by reducing the irradiance (mW/cm2) of the UVB radiation, is thought to protect the skin from developing cancers. Recently, in addition to fluence (mJ/cm2), irradiance of the UVB radiation was demonstrated to play an important role leading to photocarcinogenesis of the skin. After equivalent fluence of UVB exposure, enhanced aberrant keratinocyte proliferation contributes significantly to the photocarcinogenic capacity of low irradiance (LI) UVB as compared to its high irradiance (HI) UVB counterpart. However, the mechanism involved remains unclear. MAIN METHODS Relevant cell and animal models were employed to investigate the effects of equivalent UVB fluence administered at HI or LI on keratinocyte proliferation. Additionally, the mechanisms involved were also explored. KEY FINDINGS We found that at equivalent fluence, LIUVB induces significantly higher reactive oxidative species (ROS) production, cell proliferation, as well as phosphorylated AKT (pAKT) expression in both cell and animal models as compare to its HIUVB counterpart. Pretreating cultured keratinocytes with antioxidant or AKT inhibitor significantly reduced the UVB-induced ROS, cell proliferation, and pAKT expression. Additionally, these pretreatments abrogate the difference between the LI and HIUVB treated keratinocytes. Similar findings were noted using animal model treated with AKT inhibitor. SIGNIFICANCE In summary, at equivalent fluence, LIUVB induces significantly more aberrant epidermal proliferation via enhanced ROS and pAKT signaling. Reducing UVB-induced AKT phosphorylation presents a novel strategy to improve the protective capacity of the currently available sunscreens.
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Zhilova MB, Gorodnichev PV. Narrow-band phototherapy in the treatment of atopic dermatitis: mechanisms of action, methodology of implementation. VESTNIK DERMATOLOGII I VENEROLOGII 2021. [DOI: 10.25208/vdv1293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Phototherapy is widely used to treat various chronic skin diseases. One of the most effective methods of treatment is narrow-band medium-wave ultraviolet radiation with a wavelength of 311 nm (UVB-311). UVB-311 is used for such immune-mediated diseases as atopic dermatitis, psoriasis, vitiligo, mycosis fungoides and others. Despite the fact that the method was developed more than 30 years ago, the exact mechanism of its therapeutic action remains insufficiently studied. To date, most of the effects of UVB-311 are explained by its effect on the immune cells of the skin. This review examines data on the effects on the main molecular targets, including T-lymphocytes, keratinocytes, Langerhans cells, cytokine profile, epidermal barrier proteins. Data on the features of the pathogenetic effect of UVB-311 on the immune mechanisms of pathogenesis in atopic dermatitis were obtained. The issues of dosing by determining the minimum erythemic dose (MED) or skin phototype, methodology of procedures are discussed. Prospects for further study of photobiological aspects of UVB-311 action are determined.
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Effectiveness of a combined 308-nm excimer lamp and topical mid-potent steroid treatment for facial vitiligo: a preliminary, randomized double-blinded controlled study. Lasers Med Sci 2020; 35:2023-2029. [DOI: 10.1007/s10103-020-03048-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 05/22/2020] [Indexed: 11/26/2022]
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Hodge MX, Reece SW, Madenspacher JH, Gowdy KM. In Vivo Assessment of Alveolar Macrophage Efferocytosis Following Ozone Exposure. J Vis Exp 2019. [PMID: 31710036 DOI: 10.3791/60109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Ozone (O3) is a criteria air pollutant that exacerbates and increases the incidence of chronic pulmonary diseases. O3 exposure is known to induce pulmonary inflammation, but little is known regarding how exposure alters processes important to the resolution of inflammation. Efferocytosis is a resolution process, whereby macrophages phagocytize apoptotic cells. The purpose of this protocol is to measure alveolar macrophage efferocytosis following O3-induced lung injury and inflammation. Several methods have been described for measuring efferocytosis; however, most require ex vivo manipulations. Described in detail here is a protocol to measure in vivo alveolar macrophage efferocytosis 24 h after O3 exposure, which avoids ex vivo manipulation of macrophages and serves as a simple technique that can be used to accurately represent perturbations in this resolution process. The protocol is a technically non-intensive and relatively inexpensive method that involves whole-body O3 inhalation followed by oropharyngeal aspiration of apoptotic cells (i.e., Jurkat T cells) while under general anesthesia. Alveolar macrophage efferocytosis is then measured by light microscopy evaluation of macrophages collected from bronchoalveolar (BAL) lavage. Efferocytosis is finally measured by calculating an efferocytic index. Collectively, the outlined methods quantify efferocytic activity in the lung in vivo while also serving to analyze the negative health effects of O3 or other inhaled insults.
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Affiliation(s)
- Myles X Hodge
- Department of Pharmacology and Toxicology, East Carolina University
| | - Sky W Reece
- Department of Pharmacology and Toxicology, East Carolina University
| | | | - Kymberly M Gowdy
- Department of Pharmacology and Toxicology, East Carolina University;
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Ly K, Smith MP, Thibodeaux QG, Beck KM, Liao W, Bhutani T. Beyond the Booth: Excimer Laser for Cutaneous Conditions. Dermatol Clin 2019; 38:157-163. [PMID: 31753188 DOI: 10.1016/j.det.2019.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The excimer laser has emerged as an efficacious treatment modality for many dermatologic diseases. The excimer laser is an alternative to standard narrowband ultraviolet B (NBUVB) phototherapy treatment in patients with limited disease. In comparison to standard NBUVB, the excimer laser requires fewer treatment sessions, has reduced treatment duration, requires a lower cumulative UVB dose, and limits UVB exposure to lesional skin. This review addresses the mechanism, safety, application, and efficacy of the excimer laser for the treatment of these conditions.
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Affiliation(s)
- Karen Ly
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA 94118, USA
| | - Mary P Smith
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA 94118, USA
| | - Quinn G Thibodeaux
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA 94118, USA
| | - Kristen M Beck
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA 94118, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA 94118, USA
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA 94118, USA.
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Kemény L, Varga E, Novak Z. Advances in phototherapy for psoriasis and atopic dermatitis. Expert Rev Clin Immunol 2019; 15:1205-1214. [PMID: 31575297 DOI: 10.1080/1744666x.2020.1672537] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: Phototherapy has long been used for the treatment of inflammatory skin diseases, such as psoriasis and atopic dermatitis. The most frequent treatment approach utilizes ultraviolet (UV) light, however, recently, different lasers and low-level light therapies (LLLT) emitting wavelengths in the spectrum of the visible light have also been tried for the treatment of inflammatory skin diseases with variable success.Areas covered: This review provides an update on the different forms of phototherapy used for the treatment of psoriasis and atopic dermatitis. The proposed mechanism of action of the different phototherapeutical approaches are covered, including the immunosuppressive effect of UV light, the anti-inflammatory effect of vascular lasers and the LLLT induced photobiomodulation. The clinical efficacy of the different treatment options is also discussed.Expert opinion: Based on the efficacy and safety, NB-UVB represents the gold standard for treating psoriasis and atopic dermatitis. The UVB excimer laser and excimer lamp might be the best option for clearing localized therapy-resistant lesions. Home UV phototherapy systems might promote treatment adherence and better compliance of the patients. Vascular lasers, IPLs and LLLT, however, can not currently be recommended for the treatment of inflammatory skin diseases because of the lack of well-controlled studies.
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Affiliation(s)
- Lajos Kemény
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.,MTA-SZTE Dermatological Research Group, University of Szeged, Szeged, Hungary.,HCEMM-USZ Skin Research Group, Szeged, Hungary
| | - Emese Varga
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Zoltan Novak
- Department of Gynaecology, National Insitute of Oncology, Budapest, Hungary
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Lai HC, Lin CS, Wu CS, Lan CCE. The impact of irradiance on UVB-induced cutaneous immunosuppression: Implications on administering most efficient phototherapy. J Dermatol Sci 2019; 93:116-122. [PMID: 30709685 DOI: 10.1016/j.jdermsci.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/26/2018] [Accepted: 01/08/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Ultraviolet B (UVB) is commonly used for treating dermatologic conditions. Recently, high irradiance UVB (HIUVB) has been suggested to be more effective for treating skin conditions as compared to its low irradiance (LI) counterpart. The biological impact of UVB radiation emitted at different irradiance on cutaneous immunity remains obscure. OBJECTIVE This study aimed to explore the impacts of UVB radiation administered at equivalent fluence (mJ/cm2) but different irradiance (mW/cm2) on cutaneous immune response. METHODS Cultured bone marrow derived dendritic cell (BMDC) were treated with equivalent fluence of UVB radiation with HIUVB or LIUVB. The phenotypic and functional alterations of BMDCs were documented. Animal models were used to validate the in vitro results in vivo and explore the mechanisms involved. RESULTS After equivalent fluence of UVB radiation, the HIUVB treated BMDC showed significantly lower MHCII and CD86 expressions, reduced capacity to stimulate T cell proliferation, and enhanced activation of aryl hydrocarbon receptor (AhR)-activated genes as compared to control while their LIUVB treated counterpart showed no significant change. Using animal model, the HIUVB induced significantly higher immune suppressive effect in mice as compared to their LIUVB counterpart after equivalent fluence of UVB treatment. The superior immune suppressive effect of HIUVB over LIUVB radiation was not observed when similar experiments were performed using AhR-deficient mice. CONCLUSION We propose irradiance played an important role modulating UVB-induced cutaneous immune suppression. Future works on UVB phototherapy, both clinical and research, should incorporate this important parameter into consideration.
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Affiliation(s)
- Hsiao-Chi Lai
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chang-Shen Lin
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Shuang Wu
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Che E Lan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Dermatology, Kaohsiung Medical University Hospital and Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Esmat S, Hegazy RA, Shalaby S, Hu SCS, Lan CCE. Phototherapy and Combination Therapies for Vitiligo. Dermatol Clin 2017; 35:171-192. [PMID: 28317527 DOI: 10.1016/j.det.2016.11.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Vitiligo is a disease characterized by disappearance of melanocytes from the skin. It can negatively influence the physical appearance of affected individuals, and may profoundly affect a person's psychosocial function and quality of life. Therefore, vitiligo should not be considered as merely a condition that affects a patient's appearance, but needs to be actively treated in patients who seek medical help. Phototherapy has been used as the main treatment modality for patients with vitiligo. Different forms of phototherapy for vitiligo include broadband UVB, narrowband UVB, excimer light and excimer laser, and psoralen plus UVA.
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Affiliation(s)
- Samia Esmat
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Rehab A Hegazy
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Suzan Shalaby
- Phototherapy Unit, Dermatology Department, Faculty of Medicine, Cairo University, Egypt
| | - Stephen Chu-Sung Hu
- Department of Dermatology, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No 100, Tzyou 1st Road, Kaohsiung 807, Taiwan
| | - Cheng-Che E Lan
- Department of Dermatology, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No 100, Tzyou 1st Road, Kaohsiung 807, Taiwan.
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10
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Irradiance-dependent UVB Photocarcinogenesis. Sci Rep 2016; 6:37403. [PMID: 27869214 PMCID: PMC5116611 DOI: 10.1038/srep37403] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/27/2016] [Indexed: 01/08/2023] Open
Abstract
Ultraviolet B (UVB) radiation from the sun may lead to photocarcinogenesis of the skin. Sunscreens were used to protect the skin by reducing UVB irradiance, but sunscreen use did not reduce sunburn episodes. It was shown that UVB-induced erythema depends on surface exposure but not irradiance of UVB. We previously showed that irradiance plays a critical role in UVB-induced cell differentiation. This study investigated the impact of irradiance on UVB-induced photocarcinogenesis. For hairless mice receiving equivalent exposure of UVB radiation, the low irradiance (LI) UVB treated mice showed more rapid tumor development, larger tumor burden, and more keratinocytes harboring mutant p53 in the epidermis as compared to their high irradiance (HI) UVB treated counterpart. Mechanistically, using cell models, we demonstrated that LI UVB radiation allowed more keratinocytes harboring DNA damages to enter cell cycle via ERK-related signaling as compared to its HI UVB counterpart. These results indicated that at equivalent exposure, UVB radiation at LI has higher photocarcinogenic potential as compared to its HI counterpart. Since erythema is the observed sunburn at moderate doses and use of sunscreen was not found to associate with reduced sunburn episodes, the biological significance of sunburn with or without sunscreen use warrants further investigation.
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Bella Z, Kiricsi Á, Viharosné ÉDR, Dallos A, Perényi Á, Kiss M, Koreck A, Kemény L, Jóri J, Rovó L, Kadocsa E. Rhinophototherapy in persistent allergic rhinitis. Eur Arch Otorhinolaryngol 2016; 274:1543-1550. [PMID: 27864672 DOI: 10.1007/s00405-016-4358-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
Abstract
Previous published results have revealed that Rhinolight® intranasal phototherapy is safe and effective in intermittent allergic rhinitis. The present objective was to assess whether phototherapy is also safe and effective in persistent allergic rhinitis. Thirty-four patients with persistent allergic rhinitis were randomized into two groups; twenty-five subjects completed the study. The Rhinolight® group was treated with a combination of UV-B, UV-A, and high-intensity visible light, while the placebo group received low-intensity visible white light intranasal phototherapy on a total of 13 occasions in 6 weeks. The assessment was based on the diary of symptoms, nasal inspiratory peak flow, quantitative smell threshold, mucociliary transport function, and ICAM-1 expression of the epithelial cells. All nasal symptom scores and nasal inspiratory peak flow measurements improved significantly in the Rhinolight® group relative to the placebo group and this finding persisted after 4 weeks of follow-up. The smell and mucociliary functions did not change significantly in either group. The number of ICAM-1 positive cells decreased non-significantly in the Rhinolight® group. No severe side-effects were reported during the treatment period. These results suggest that Rhinolight® treatment is safe and effective in persistent allergic rhinitis.
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Affiliation(s)
- Zsolt Bella
- Department of Otorhinolarygology and Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt 111, Szeged, 6725, Hungary.
| | - Ágnes Kiricsi
- Department of Otorhinolarygology and Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt 111, Szeged, 6725, Hungary
| | - Éva Dósa-Rácz Viharosné
- Department of Dermatology and Allergology, Faculty of Medicine, University of Szeged, Korányi fasor 6, Szeged, 6720, Hungary
| | - Attila Dallos
- Department of Dermatology and Allergology, Faculty of Medicine, University of Szeged, Korányi fasor 6, Szeged, 6720, Hungary
| | - Ádám Perényi
- Department of Otorhinolarygology and Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt 111, Szeged, 6725, Hungary
| | - Mária Kiss
- Department of Dermatology and Allergology, Faculty of Medicine, University of Szeged, Korányi fasor 6, Szeged, 6720, Hungary
| | - Andrea Koreck
- Department of Dermatology and Allergology, Faculty of Medicine, University of Szeged, Korányi fasor 6, Szeged, 6720, Hungary
| | - Lajos Kemény
- Department of Dermatology and Allergology, Faculty of Medicine, University of Szeged, Korányi fasor 6, Szeged, 6720, Hungary
| | - József Jóri
- Department of Otorhinolarygology and Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt 111, Szeged, 6725, Hungary
| | - László Rovó
- Department of Otorhinolarygology and Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt 111, Szeged, 6725, Hungary
| | - Edit Kadocsa
- Department of Otorhinolarygology and Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt 111, Szeged, 6725, Hungary
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Higgins E, Ralph N, Ryan S, Koik N, Honari B, Lally A, Collins P. A randomised half body prospective study of low and medium dose regimens using the 308 nm excimer laser in the treatment of localised psoriasis. J DERMATOL TREAT 2016; 28:8-13. [DOI: 10.3109/09546634.2016.1170758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Eleanor Higgins
- The Charles Centre, Department of Dermatology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Nicola Ralph
- The Charles Centre, Department of Dermatology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Sheila Ryan
- The Charles Centre, Department of Dermatology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Nicola Koik
- The Charles Centre, Department of Dermatology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Bahman Honari
- Centre for Support and Training in Analysis and Research (CSTAR), Department of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Aoife Lally
- The Charles Centre, Department of Dermatology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Paul Collins
- The Charles Centre, Department of Dermatology, St. Vincent’s University Hospital, Dublin, Ireland
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Soliman M, Samy NA, Abo Eittah M, Hegazy M. Comparative study between excimer light and topical antioxidant versus excimer light alone for treatment of vitiligo. J COSMET LASER THER 2016; 18:7-11. [PMID: 26052813 DOI: 10.3109/14764172.2015.1052510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Vitiligo is an acquired idiopathic cutaneous disease characterized by pearly white patches of variable shapes and sizes. Various medical and surgical therapeutic options have been proposed to achieve repigmentation; phototherapy is one of the most efficient options. Topical therapies have been a mainstay of vitiligo treatment, with or without phototherapy. AIM OF THE WORK To compare the efficacy of combined topical antioxidant hydrogel and excimer light versus excimer light alone in treating vitiligo. PATIENTS AND METHODS Thirty patients were included in this comparative, prospective, randomized study. For each patient, at least 2-4 vitiliginous macules were randomly selected and treated while an untreated vitiliginous macule served as control. Lesions were divided into two groups: Group A received combination therapy of daily topical antioxidant plus excimer light, while Group B received only excimer light. Lesions were treated twice a week for a maximum of 24 sessions. Initial fluencies were adjusted individually according to the minimal erythema dose in vitiliginous skin. Efficacy based on repigmentation percentages were blindly evaluated by two independent physicians. RESULTS Group A lesions showed significant efficacy than group B (p < 0.001), specially on treating UV-sensitive lesions with no side effects. CONCLUSION Topical antioxidant and excimer light represents a valuable, effective therapy for localized vitiligo.
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Affiliation(s)
- Mona Soliman
- a National Institute of Laser Enhanced Sciences, Cairo University , Egypt
| | - Nevien Ahmed Samy
- a National Institute of Laser Enhanced Sciences, Cairo University , Egypt
| | - Maha Abo Eittah
- a National Institute of Laser Enhanced Sciences, Cairo University , Egypt
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15
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Lan CCE, Yu HS, Lu JH, Wu CS, Lai HC. Irradiance, but not fluence, plays a crucial role in UVB-induced immature pigment cell development: new insights for efficient UVB phototherapy. Pigment Cell Melanoma Res 2013; 26:367-76. [PMID: 23398671 DOI: 10.1111/pcmr.12077] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 02/04/2013] [Indexed: 01/28/2023]
Abstract
Light exposure modulates development of living organisms. In the field of medicine, light has frequently been used for regenerative purposes. Excimer light (308 nm) has demonstrated superior efficacy in treating vitiligo, a condition requiring development of melanoblasts and a model for studying nerve cell regeneration, as compared to narrow-band ultraviolet B (NBUVB; 311 nm). Using mouse-derived melanoblast cells to examine the pro-differentiation effects of these two light sources, we demonstrated that at equivalent fluence, excimer light induces melanoblast differentiation, while NBUVB failed to so. Mechanistically, activation of aryl hydrocarbon receptor pathway and nuclear translocation of epidermal growth factor receptor are involved in pro-differentiation effects of excimer light. Reduction in irradiance by filter abrogated the effects of excimer light in melanoblasts, even when equivalent fluence was delivered by the same light source. As ultraviolet B (UVB) irradiation is closely associated pigment cell development, future therapy employing UVB for pigmentation purposes should incorporate irradiance as a crucial specification.
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Affiliation(s)
- Cheng-Che E Lan
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Kagen M, Cao LY, Oyetakin-White P, Tacastacas JD, Yan C, McCormick TS, Cooper KD. Single administration of lesion-limited high-dose (TURBO) ultraviolet B using the excimer laser: clinical clearing in association with apoptosis of epidermal and dermal T cell subsets in psoriasis. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2012; 28:293-8. [DOI: 10.1111/j.1600-0781.2012.00692.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mark Kagen
- Department of Dermatology; University Hospitals Case Medical Center; Cleveland; OH; USA
| | - Lauren Y. Cao
- Case Western Reserve University School of Medicine; Cleveland; OH; USA
| | | | - Joselin D. Tacastacas
- Department of Dermatology; University Hospitals Case Medical Center; Cleveland; OH; USA
| | - Chunlin Yan
- Department of Dermatology; University Hospitals Case Medical Center; Cleveland; OH; USA
| | - Thomas S. McCormick
- Department of Dermatology; University Hospitals Case Medical Center; Cleveland; OH; USA
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Cheng YP, Chiu HY, Jee SH, Tsai TF. Excimer light photototherapy of segmental and non-segmental vitiligo: experience in Taiwan. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2011; 28:6-11. [DOI: 10.1111/j.1600-0781.2011.00628.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Yu-Pin Cheng
- Department of Dermatology; National Taiwan University Hospital; Taipei; Taiwan
| | - Hsien-Yi Chiu
- Department of Dermatology; National Taiwan University Hospital; Taipei; Taiwan
| | - Shiou-Hwa Jee
- Department of Dermatology; National Taiwan University Hospital; Taipei; Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology; National Taiwan University Hospital; Taipei; Taiwan
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Pacifico A, Leone G. Photo(chemo)therapy for vitiligo. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2011; 27:261-77. [DOI: 10.1111/j.1600-0781.2011.00606.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Carrascosa J, López-Estebaranz J, Carretero G, Daudén E, Ferrándiz C, Vidal D, Belinchón I, Sánchez-Regaña M, Puig L. Documento de consenso de fototerapia en psoriasis del Grupo Español de Psoriasis: ultravioleta B de banda estrecha (UVBBE), láser y fuentes monocromáticas de excímeros y terapia fotodinámica. ACTAS DERMO-SIFILIOGRAFICAS 2011; 102:175-86. [DOI: 10.1016/j.ad.2010.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 11/10/2010] [Indexed: 01/22/2023] Open
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20
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Carrascosa J, López-Estebaranz J, Carretero G, Daudén E, Ferrándiz C, Vidal D, Belinchón I, Sánchez-Regaña M, Puig L. Narrowband UV-B, Monochromatic Excimer Laser, and Photodynamic Therapy in Psoriasis: A Consensus Statement of the Spanish Psoriasis Group. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1578-2190(11)70782-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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21
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Verhaeghe E, Lodewick E, van Geel N, Lambert J. Intrapatient Comparison of 308-nm Monochromatic Excimer Light and Localized Narrow-Band UVB Phototherapy in the Treatment of Vitiligo: A Randomized Controlled Trial. Dermatology 2011; 223:343-8. [DOI: 10.1159/000335272] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 11/22/2011] [Indexed: 11/19/2022] Open
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22
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Patel N, O'Haver J, Hansen RC. Vitiligo therapy in children: a case for considering excimer laser treatment. Clin Pediatr (Phila) 2010; 49:823-9. [PMID: 20308196 DOI: 10.1177/0009922810363169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nirav Patel
- University of Arizona College of Medicine, Phoenix, AZ, USA.
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Bella Z, Kadocsa E, Kemény L, Koreck A. Narrow-band UVB phototherapy of nasal polyps: results of a pilot study. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2010; 100:123-7. [PMID: 20566294 DOI: 10.1016/j.jphotobiol.2010.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Revised: 04/22/2010] [Accepted: 05/26/2010] [Indexed: 10/19/2022]
Abstract
Nasal polyposis (NP) is characterized by high recurrence rate despite medical and/or surgical treatment. The major mechanism of action of ultraviolet B light (UVB) is induction of apoptosis in inflammatory cells. Therefore phototherapy may represent a new therapeutic approach in NP. A pilot feasibility study was performed to assess the tolerability and clinical efficacy of UVB phototherapy in NP. Thirteen subjects with bilateral grade 1-3 NP were enrolled in an open-labeled prospective pilot study. Patients were exposed to gradually increasing doses of UVB light over a 12 week period (3 exposures/week). Subjects rated their nasal obstruction symptom scores weekly on a visual analogue scale from 0 to 6. The NOSE quality of life questionnaire was used at baseline and end of treatment period. Adverse events were monitored by endoscopy. Ten subjects completed the study. Nasal obstruction symptom scores and quality of life (NOSE) improved at end of treatment compared to baseline. Treatments were well tolerated and no device related adverse events were reported. The results suggest that phototherapy may represent a potential new treatment option in nasal polyps.
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Affiliation(s)
- Zsolt Bella
- Department of Otolaryngology, Head and Neck Surgery, University of Szeged, Hungary
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Kemény L, Csoma Z, Bagdi E, Banham A, Krenács L, Koreck A. Targeted phototherapy of plaque-type psoriasis using ultraviolet B-light-emitting diodes. Br J Dermatol 2010; 163:167-73. [DOI: 10.1111/j.1365-2133.2010.09763.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Brehmer D. Endonasal phototherapy with Rhinolight for the treatment of allergic rhinitis. Expert Rev Med Devices 2010; 7:21-6. [PMID: 20021238 DOI: 10.1586/erd.09.56] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Allergic rhinitis, although not life threatening, significantly affects the quality of the patient's daily life. The three major steps in the treatment of the condition are avoidance of allergens, treatment of symptoms (in particular, antihistaminics and topical nasal corticosteroids) and specific immunotherapy. Avoidance of the allergen is usually not possible and symptom relief is often limited, despite the availability of a number of pharmacological options. Specific immunotherapy demands a high level of cooperation on the part of the patient for at least 3 years. Endonasal phototherapy with the Rhinolight device (Rhinolight Ltd, Szeged, Hungary) for the treatment of immunoglobulin E-mediated allergic rhinitis is a new option that utilizes the immunosuppressive effects of UV radiation. The method directs a combination of UV-B (5%), UV-A (25%) and visible light (70%) into the nasal cavity, and its effectiveness has been demonstrated in one double-blind, placebo-controlled study. The results of additional studies have been presented at various medical conferences and in abstracts. Reports in the literature confirm that phototherapy is a well-established and successful treatment of atopic dermatitis and other skin diseases.
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Affiliation(s)
- Detlef Brehmer
- University of Witten/Herdecke, Faculty of Medicine, Friedrichstrasse 3/4, 37073 Goettingen, Germany.
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26
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Kinyó A, Kiss-László Z, Hambalkó S, Bebes A, Kiss M, Széll M, Bata-Csörgo Z, Nagy F, Kemény L. COP1 contributes to UVB-induced signaling in human keratinocytes. J Invest Dermatol 2009; 130:541-5. [PMID: 19741714 DOI: 10.1038/jid.2009.286] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
UVB irradiation has been shown to trigger a broad range of changes in gene expression in human skin; however, factors governing these events are still not well understood. In this study, we show that human constitutive photomorphogenic protein-1 (huCOP1), an E3 ligase, contributes to the orchestration of UVB response of keratinocytes. Accordingly, our data show that (i) huCOP1 protein is expressed both in the nucleus and in the cytoplasm of cultured keratinocytes, (ii) UVB reduces the levels of the huCOP1 mRNA and protein, and (iii) induces changes in the subcellular localization of huCOP1. Finally, we show that gene-specific silencing of huCOP1 induces the accumulation of the tumor suppressor p53 protein, which is further increased after UVB irradiation.
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Affiliation(s)
- Agnes Kinyó
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.
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27
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UVB radiation induced effects on cells studied by FTIR spectroscopy. EUROPEAN BIOPHYSICS JOURNAL: EBJ 2009; 39:929-34. [DOI: 10.1007/s00249-009-0446-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 03/10/2009] [Accepted: 03/16/2009] [Indexed: 10/21/2022]
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28
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Gattu S, Rashid RM, Wu JJ. 308-nm excimer laser in psoriasis vulgaris, scalp psoriasis, and palmoplantar psoriasis. J Eur Acad Dermatol Venereol 2009; 23:36-41. [DOI: 10.1111/j.1468-3083.2008.02942.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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29
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Kemény L, Koreck A. Ultraviolet light phototherapy for allergic rhinitis. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2007; 87:58-65. [PMID: 17329119 DOI: 10.1016/j.jphotobiol.2007.01.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Revised: 01/09/2007] [Accepted: 01/09/2007] [Indexed: 11/28/2022]
Abstract
Phototherapy has a profound immunosuppressive effect and is widely used for the treatment of immune mediated skin diseases. Phototherapy is able to inhibit immediate type hypersensitivity reaction in the skin. Intranasal phototherapy is a new approach for treatment of allergic rhinitis. In two open studies, 308 nm excimer laser and topical PUVA therapy efficiently inhibited clinical symptoms of allergic rhinitis. In a randomized, double-blind study combined low dose UVB, low dose UVA and visible light proved to be effective in reducing symptom scores for sneezing, rhinorrhea, nasal itching and the total nasal score in ragweed allergic patients. Mechanism of action of phototherapy is complex, it reduces the antigen presenting capacity of dendritic cells, induces apoptosis of immune cells and inhibits synthesis and release of pro-inflammatory mediator from several cell types. Therefore, intranasal phototherapy may represent an alternative treatment of allergic rhinitis and other inflammatory and immune mediated mucosal diseases.
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Affiliation(s)
- Lajos Kemény
- Department of Dermatology and Allergology, University of Szeged, Koranyi fasor 6, 6720 Szeged, Hungary.
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Aufiero BM, Talwar H, Young C, Krishnan M, Hatfield JS, Lee HK, Wong HK, Hamzavi I, Murakawa GJ. Narrow-band UVB induces apoptosis in human keratinocytes. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2005; 82:132-9. [PMID: 16309917 DOI: 10.1016/j.jphotobiol.2005.08.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Revised: 08/30/2005] [Accepted: 08/30/2005] [Indexed: 01/03/2023]
Abstract
Narrow-band ultraviolet (NB-UVB) phototherapy emits mostly 311/312 nm light and is commonly used in the treatment of inflammatory skin disorders. As a source of UVB irradiation, NB-UVB causes apoptosis in T lymphocytes but its effects on keratinocytes are unknown. Herein, we have investigated the ability of NB-UVB to induce apoptosis in keratinocytes. Two types of human keratinocytes, primary and immortalized, were exposed to NB-UVB and broad-band UVB (BB-UVB; 315-280 nm) and tested for apoptosis. Both UVB light sources induced apoptosis in keratinocytes as determined by the presence of DNA ladders, although NB-UVB required approximately ten fold higher doses; NB-UVB (1000 mJ/cm2) and BB-UVB (125 mJ/cm2). By comparison, lower doses of NB-UVB (750 mJ/cm2) induced apoptosis in T lymphocytes, suggesting cell type specificity for NB-UVB induced apoptosis. Approximately, 50% or more of the cells underwent apoptosis when exposed to NB-UVB or BB-UVB as revealed by TUNEL assay. Electron micrographs showed that NB-UVB irradiated keratinocytes contained marked chromatin condensation, extensive cytoplasmic vacuolization and fragmentation of the nuclear envelope. Furthermore, Western blot analysis confirmed the presence of activated products of caspase 3 in keratinocytes that received apoptotic doses of NB-UVB. This study defines conditions by which NB-UVB irradiation causes apoptosis in keratinocytes.
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Affiliation(s)
- Barbara M Aufiero
- Department of Dermatology, Wayne State University School of Medicine, Detroit, MI, USA
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