1
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Choi JY, Owusu-Ayim M, Dawe R, Ibbotson S, Fleming C, Foerster J. Narrowband ultraviolet B phototherapy is associated with a reduction in topical corticosteroid and clinical improvement in atopic dermatitis: a historical inception cohort study. Clin Exp Dermatol 2021; 46:1067-1074. [PMID: 33837558 DOI: 10.1111/ced.14676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Despite decades of use, the magnitude of efficacy of narrowband ultraviolet B (NB-UVB) phototherapy for atopic dermatitis (AD) beyond industry-sponsored trials remains unclear. AIM To evaluate the clinical efficacy of NB-UVB in AD under real-world conditions. METHODS We conducted a historical inception cohort study using automated recording of dispensed drugs to provide an objective treatment outcome in a large population catchment of 420 000 people over 15 years. We analysed clinical treatment outcomes, recorded multicentre and prospectively over 15 years, of a large AD treatment cohort (n = 844), along with the drugs dispensed to this cohort. RESULTS The majority (70%) of patients with AD received significantly fewer topical corticosteroids (TCS) during the 12-month window after finishing NB-UVB compared with the 12-month window before starting the treatment (median reduction from 37.5 to 19.7 g/month). The number of patients dispensed with oral corticosteroids and antihistamines also dropped significantly (from 20% to 10% and from 69% to 31%, respectively), while all AD-unrelated drugs dispensed remained unchanged. Clinically, NB-UVB treatment achieved a 'clear' or 'almost clear' status in 48.7% of patients, while 20.4% achieved 'moderate clearance'. Treatment outcomes scores were validated by a strong correlation with reduction in AD-specific drug treatment. CONCLUSION Our data confirm the significant efficacy of NB-UVB for AD under conditions of routine care.
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Affiliation(s)
- J Y Choi
- University of Dundee, Medical School, Dundee, UK
| | - M Owusu-Ayim
- University of Dundee, Medical School, Dundee, UK
| | - R Dawe
- University of Dundee, Medical School, Dundee, UK.,National Managed Clinical Network for Phototherapy (Photonet), NHS Tayside, UK
| | - S Ibbotson
- University of Dundee, Medical School, Dundee, UK
| | - C Fleming
- University of Dundee, Medical School, Dundee, UK
| | - J Foerster
- University of Dundee, Medical School, Dundee, UK
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2
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Butt S, Dawe R, Blair R, Ibbotson S. A new approach to actinic folliculitis: prophylactic narrowband ultraviolet B phototherapy. Clin Exp Dermatol 2021; 46:675-679. [PMID: 33215732 DOI: 10.1111/ced.14518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND We have observed an increasing number of patients referred to the Scottish Photobiology Service (SPS), who were later diagnosed with actinic folliculitis (AF) and had positive phototesting results. Treatment options for AF are limited, with only a few reports in the literature. The use of prophylactic narrowband ultraviolet B (NB-UVB) phototherapy for AF has not previously been described, and we report on this for the first time. AIM To analyse the clinical characteristics, phototesting results and responses to treatment for patients with AF diagnosed by the SPS. METHODS We undertook a retrospective review over 10 years of all case notes of patients who were assessed and diagnosed with AF through the SPS, based at the Photobiology Unit, Dundee, UK. RESULTS All 10 patients were women. Mean age of onset was 25 years and mean time to referral for investigation was 7 years. The commonest site involved was the face, with the main clinical feature being monomorphic pustules appearing after sunlight exposure. The eruption could be provoked with iterative doses of broadband UVA irradiation in five patients. All patients were offered photoprotective advice and prophylactic NB-UVB phototherapy. Five patients proceeded with phototherapy; four of these completed the desensitization course and all four reported either a delay in symptom onset or total prevention of rash induction, with complete efficacy of desensitization maintained for 3 years in one patient. CONCLUSION We demonstrate the successful use of UVA provocation testing as a diagnostic tool in AF. Additionally, we recommend the use of prophylactic NB-UVB phototherapy in AF as an effective and well-tolerated approach.
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Affiliation(s)
- S Butt
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - R Dawe
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - R Blair
- Dermatology Department, Royal Alexandra Hospital, Paisley, UK
| | - S Ibbotson
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
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3
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Choi J, Dawe R, Ibbotson S, Fleming C, Doney A, Foerster J. 湿疹患者使用多少润肤剂和类固醇乳膏,以及抑郁症和类固醇乳膏使用之间的联系. Br J Dermatol 2020. [DOI: 10.1111/bjd.18929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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4
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Choi J, Dawe R, Ibbotson S, Fleming C, Doney A, Foerster J. How much emollient and steroid cream do eczema patients use, and the link between depression and steroid cream use. Br J Dermatol 2020. [DOI: 10.1111/bjd.18910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Barnard I, Eadie E, McMillan L, Moseley H, Brown T, Wood K, Dawe R. Could psoralen plus ultraviolet A1 (‘
PUVA
1’) work? Depth penetration achieved by phototherapy lamps. Br J Dermatol 2019; 182:813-814. [DOI: 10.1111/bjd.18561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- I.R.M. Barnard
- Scottish Universities Physics Alliance School of Physics and Astronomy University of St Andrews St Andrews U.K
| | - E. Eadie
- Photobiology Unit NHS Tayside Ninewells Hospital Dundee U.K
| | - L. McMillan
- Scottish Universities Physics Alliance School of Physics and Astronomy University of St Andrews St Andrews U.K
| | - H. Moseley
- Photobiology Unit NHS Tayside Ninewells Hospital Dundee U.K
| | - T. Brown
- Scottish Universities Physics Alliance School of Physics and Astronomy University of St Andrews St Andrews U.K
| | - K. Wood
- Scottish Universities Physics Alliance School of Physics and Astronomy University of St Andrews St Andrews U.K
| | - R. Dawe
- Photobiology Unit NHS Tayside Ninewells Hospital Dundee U.K
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6
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Choi JY, Dawe R, Ibbotson S, Fleming C, Doney A, Foerster J. Quantitative analysis of topical treatments in atopic dermatitis: unexpectedly low use of emollients and strong correlation of topical corticosteroid use both with depression and concurrent asthma. Br J Dermatol 2019; 182:1017-1025. [PMID: 31257575 DOI: 10.1111/bjd.18265] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Despite decades of use, the actual amounts of topical corticosteroids (TCS) and emollients used in moderate-to-severe atopic dermatitis (AD) under real-world conditions are unknown. Thus, it remains unclear whether inadequate use is widespread. OBJECTIVES To quantify the use of TCS and emollients in moderate-to-severe AD. METHODS Double-blinded drug prescribing was recorded prospectively at the point of drug dispensing within a catchment area of approximately 450 000 people over a 31-year period in a population-based cohort marked by failure of disease control in primary care (n = 844). For each patient, prescribing was recorded over a 12-month period in order to minimize fluctuations. RESULTS This approach resulted in a near-complete dataset, which was essentially free of reporting bias and recording bias. Atopic comorbidities matched expected frequencies. Median use of TCS was statistically significantly higher in juvenile patients (age < 16 years) compared with adult patients (49·2 vs. 38·1 g per month), in male vs. female patients (46·8 vs. 29·7 g per month) and in patients receiving concurrent asthma treatment (40·4 vs. 26·7 g per month). TCS use was strongly associated with antidepressant treatment. Emollient use was unexpectedly low with a median of 9·6 g per day (range 1·4-30·1). Results were replicated in an independent validation cohort. CONCLUSIONS Deficient use of emollients may be a factor contributing to AD severity. Our analysis showed that the use of TCS does not exceed current guidelines. Accurate quantification of topical treatments provides a widely accessible strategy to measure the real-world impact of novel AD treatments. What's already known about this topic? Both emollient and topical corticosteroid (TCS) use have been a mainstay of atopic dermatitis (AD) treatment for over 60 years. The actual quantities used by patients under real-world conditions are unknown. What does this study add? The real-world use of emollients is fourfold lower than the amount recommended in current guidelines. Underuse of emollients may be a significant factor in disease exacerbation. The use of TCS is significantly higher in male patients and is higher in patients with AD who also have asthma. The use of TCS is strongly associated with concurrent antidepressant treatment.
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Affiliation(s)
- J Y Choi
- School of Medicine, University of Dundee, Dundee, U.K
| | - R Dawe
- School of Medicine, University of Dundee, Dundee, U.K
| | - S Ibbotson
- School of Medicine, University of Dundee, Dundee, U.K
| | - C Fleming
- School of Medicine, University of Dundee, Dundee, U.K
| | - A Doney
- School of Medicine, University of Dundee, Dundee, U.K
| | - J Foerster
- School of Medicine, University of Dundee, Dundee, U.K
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7
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Lydon E, Dawe R, Ibbotson S. Factors influencing pain and efficacy of topical photodynamic therapy: a retrospective study. Br J Dermatol 2018; 180:205-206. [DOI: 10.1111/bjd.17204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- E. Lydon
- Photobiology Unit, Dermatology Department University of Dundee, Ninewells Hospital and Medical School Dundee DD1 9SY U.K
| | - R.S. Dawe
- Photobiology Unit, Dermatology Department University of Dundee, Ninewells Hospital and Medical School Dundee DD1 9SY U.K
| | - S.H. Ibbotson
- Photobiology Unit, Dermatology Department University of Dundee, Ninewells Hospital and Medical School Dundee DD1 9SY U.K
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8
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Hausdorff J, Dawe R, Leurgans S, Yu L, Barnes L, Giladi N, Bennett D, Buchman A. DO UNIQUE SIGNATURES OF MOBILITY PREDICT DISTINCT ADVERSE HEALTH OUTCOMES IN OLDER ADULTS? PROSPECTIVE FINDINGS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - R Dawe
- Rush University Medical Center, Chicago, IL, USA
| | | | - L Yu
- Rush University Medical Center
| | | | - N Giladi
- Tel Aviv Sourasky Medical Center
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9
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Hausdorff J, Geffen N, Gazit E, Dawe R, Mirelman A, Curran T, Buchman A. THINKING ABOUT WALKING: A NEW APPROACH TO QUANTIFYING GAIT INITIATION USING A WEARABLE SENSOR. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - N Geffen
- Tel Aviv Sourasky Medical Center
| | - E Gazit
- Tel Aviv Sourasky Medical Center
| | - R Dawe
- Rush University Medical Center, Chicago, IL USA
| | - A Mirelman
- Tel Aviv Medical Center, Tel Aviv University
| | - T Curran
- Rush University Medical Center, Chicago, IL USA
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10
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Boswell K, Cameron H, West J, Fleming C, Ibbotson S, Dawe R, Foerster J. Cost of narrowband ultraviolet B for psoriasis. Br J Dermatol 2018. [DOI: 10.1111/bjd.17210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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11
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Boswell K, Cameron H, West J, Fleming C, Ibbotson S, Dawe R, Foerster J. 窄波 UVB 用于银屑病治疗的费用. Br J Dermatol 2018. [DOI: 10.1111/bjd.17224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Harkins C, McAleer M, Bennett D, McHugh M, Fleury O, Pettigrew K, Oravcová K, Parkhill J, Proby C, Dawe R, Geoghegan J, Irvine A, Holden M. Topical antimicrobial resistance in S. aureus
from patients with AD. Br J Dermatol 2018. [DOI: 10.1111/bjd.17167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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13
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Harkins C, McAleer M, Bennett D, McHugh M, Fleury O, Pettigrew K, Oravcová K, Parkhill J, Proby C, Dawe R, Geoghegan J, Irvine A, Holden M. 来自 AD 患者的 金黄色葡萄球菌的
局部抗生素耐药性. Br J Dermatol 2018. [DOI: 10.1111/bjd.17178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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14
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Boswell K, Cameron H, West J, Fleming C, Ibbotson S, Dawe R, Foerster J. Narrowband ultraviolet B treatment for psoriasis is highly economical and causes significant savings in cost for topical treatments. Br J Dermatol 2018; 179:1148-1156. [PMID: 29901862 DOI: 10.1111/bjd.16716] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Narrowband ultraviolet B (NB-UVB) treatment for psoriasis is considered expensive. However, existing data are based on estimates and do not consider indirect cost savings. OBJECTIVES To define the actual costs of NB-UVB incurred by the service provider, as well as treatment-associated cost savings. METHODS We performed data linkage of (i) comprehensive treatment records and (ii) prescribing data for all NB-UVB treatment episodes spanning 6 years in a population of 420 000. We minimized data fluctuation by compiling data from four independent treatment sites, and using drug prescriptions unrelated to psoriasis as a negative control. RESULTS National Health Service Tayside spent an average of £257 per NB-UVB treatment course (mean 257 ± 63, range 150-286, across four independent treatment sites), contrasting sharply with the estimate of £1882 used by the U.K. National Institute for Health and Care Excellence. The cost of topical treatments averaged £128 per patient in the 12 months prior to NB-UVB, accounting for 42% of the overall drug costs incurred by these patients. This was reduced by 40% to £53 per patient over the 12-month period following NB-UVB treatment, while psoriasis-unrelated drug prescription remained unchanged, suggesting disease-specific effects of NB-UVB. The data were not due to site-specific factors, as confirmed by highly similar results observed between treatment sites operated by distinct staff. Finally, we detail all staff hours directly and indirectly involved in treatment, allowing direct translation of cost into other healthcare systems. CONCLUSIONS NB-UVB is a low-cost treatment; cost figures currently used in health technology appraisals are an overestimate based on the data presented here. Creating or extending access to NB-UVB is likely to offer additional savings by delaying or avoiding costly third-line treatments for many patients.
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Affiliation(s)
- K Boswell
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
| | - H Cameron
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
| | - J West
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
| | - C Fleming
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
| | - S Ibbotson
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
| | - R Dawe
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K.,National Managed Clinical Network for Phototherapy (Photonet), NHS Scotland, Dundee, U.K
| | - J Foerster
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
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15
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Dawe R. Maintenance therapy with psoralen-ultraviolet A for mycosis fungoides: in the absence of evidence sitting on the fence is appropriate. Br J Dermatol 2017; 177:337-338. [DOI: 10.1111/bjd.15673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R.S. Dawe
- Photobiology Unit; Department of Dermatology; Ninewells Hospital and Medical School; Dundee DD1 9SY U.K
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16
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Dawe R. Further evidence for carotenoid antioxidants in photoprotection. Br J Dermatol 2017; 176:1120-1121. [DOI: 10.1111/bjd.15487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R.S. Dawe
- Ninewells Hospital and Medical School; Photobiology Unit; Department of Dermatology; Dundee DD1 9SY U.K
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17
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Dawe R. Freely available meteorological data can be used to predict population vitamin D levels. Br J Dermatol 2016; 174:960. [DOI: 10.1111/bjd.14597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R.S. Dawe
- Department of Dermatology; Photobiology Unit; Ninewells Hospital and Medical School; Dundee DD1 9SY U.K
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18
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West J, Ogston S, Palmer C, Fleming C, Dawe R, Kumar V, Waterston S, Foerster J. Methotrexate in psoriasis under real‐world conditions: long‐term efficacy and tolerability. Br J Dermatol 2016; 174:1407-10. [DOI: 10.1111/bjd.14452] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. West
- Medical School University of Dundee Dundee U.K
| | - S. Ogston
- Medical School University of Dundee Dundee U.K
| | - C. Palmer
- Medical School University of Dundee Dundee U.K
| | - C. Fleming
- Department of Dermatology and Photobiology University of Dundee Dundee U.K
| | - R. Dawe
- Department of Dermatology and Photobiology University of Dundee Dundee U.K
| | - V. Kumar
- Department of Rheumatology University of Dundee Dundee U.K
| | - S. Waterston
- Department of Dermatology and Photobiology University of Dundee Dundee U.K
| | - J. Foerster
- Medical School University of Dundee Dundee U.K
- Department of Dermatology and Photobiology University of Dundee Dundee U.K
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Ling T, Clayton T, Crawley J, Exton L, Goulden V, Ibbotson S, McKenna K, Mohd Mustapa M, Rhodes L, Sarkany R, Dawe R, McHenry P, Hughes J, Griffiths M, McDonagh A, Buckley D, Nasr I, Swale V, Duarte Williamson C, Levell N, Leslie T, Mallon E, Wakelin S, Hunasehally P, Cork M, Ungureanu S, Donnelly J, Towers K, Saunders C, Davis R, Brain A, Exton L, Mohd Mustapa M. British Association of Dermatologists and British Photodermatology Group guidelines for the safe and effective use of psoralen–ultraviolet A therapy 2015. Br J Dermatol 2016; 174:24-55. [DOI: 10.1111/bjd.14317] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2015] [Indexed: 01/28/2023]
Affiliation(s)
- T.C. Ling
- Dermatology Centre Faculty of Medical and Human Sciences Salford Royal NHS Foundation Trust Salford Manchester M6 8HD U.K
| | - T.H. Clayton
- Dermatology Centre Faculty of Medical and Human Sciences Salford Royal NHS Foundation Trust Salford Manchester M6 8HD U.K
| | - J. Crawley
- Department of Dermatology University College Hospital 235 Euston Road London NW1 2BU U.K
| | - L.S. Exton
- British Association of Dermatologists Willan House 4 Fitzroy Square London W1T 5HQ U.K
| | - V. Goulden
- Department of Dermatology Leeds Teaching Hospitals NHS Trust Leeds LS7 4SA U.K
| | - S. Ibbotson
- Department of Dermatology Ninewells Hospital and Medical School University of Dundee Dundee DD1 9SY U.K
| | - K. McKenna
- Department of Dermatology Belfast City Hospital Belfast BT9 7AB U.K
| | - M.F. Mohd Mustapa
- British Association of Dermatologists Willan House 4 Fitzroy Square London W1T 5HQ U.K
| | - L.E. Rhodes
- Dermatology Research Centre Faculty of Medical and Human Sciences Salford Royal NHS Foundation Trust Salford Manchester M6 8HD U.K
| | - R. Sarkany
- Department of Dermatology University College Hospital 235 Euston Road London NW1 2BU U.K
| | - R.S. Dawe
- Department of Dermatology Ninewells Hospital and Medical School University of Dundee Dundee DD1 9SY U.K
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20
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Affiliation(s)
- R.S. Dawe
- Photobiology Unit; Department of Dermatology; Ninewells Hospital and Medical School; Dundee DD1 9SY U.K
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21
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Dawe R. A new way of targeting phototherapy to body sites where it is needed. Br J Dermatol 2015; 172:563-4. [DOI: 10.1111/bjd.13663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- R.S. Dawe
- Photobiology Unit; Department of Dermatology; Ninewells Hospital and Medical School; Dundee U.K
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22
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Affiliation(s)
- M. Sivaramakrishnan
- Scottish Cutaneous Porphyria Service; Department of Dermatology and Photobiology; Ninewells Hospital and Medical School; Dundee DD1 9SY U.K
| | - J. Woods
- Scottish Cutaneous Porphyria Service; Department of Dermatology and Photobiology; Ninewells Hospital and Medical School; Dundee DD1 9SY U.K
| | - R. Dawe
- Scottish Cutaneous Porphyria Service; Department of Dermatology and Photobiology; Ninewells Hospital and Medical School; Dundee DD1 9SY U.K
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23
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Fenton L, Dawe R, Ibbotson S, Ferguson J, Silburn S, Moseley H. Impact assessment of energy-efficient lighting in patients with lupus erythematosus: a pilot study. Br J Dermatol 2014; 170:694-8. [DOI: 10.1111/bjd.12719] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2013] [Indexed: 11/30/2022]
Affiliation(s)
- L. Fenton
- The Photobiology Unit; Ninewells Hospital and Medical School; Dundee DD1 9SY U.K
| | - R. Dawe
- The Photobiology Unit; Ninewells Hospital and Medical School; Dundee DD1 9SY U.K
| | - S. Ibbotson
- The Photobiology Unit; Ninewells Hospital and Medical School; Dundee DD1 9SY U.K
| | - J. Ferguson
- The Photobiology Unit; Ninewells Hospital and Medical School; Dundee DD1 9SY U.K
| | - S. Silburn
- Rheumatology; Ninewells Hospital and Medical School; Dundee DD1 9SY U.K
| | - H. Moseley
- The Photobiology Unit; Ninewells Hospital and Medical School; Dundee DD1 9SY U.K
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24
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Yule S, Sanyal S, Ibbotson S, Moseley H, Dawe R. Self-administration of hospital-based narrowband ultraviolet B (TL-01) phototherapy: a feasibility study in an outpatient setting. Br J Dermatol 2013; 169:464-8. [DOI: 10.1111/bjd.12312] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2013] [Indexed: 11/26/2022]
Affiliation(s)
- S. Yule
- Photobiology Unit; Department of Dermatology; Ninewells Hospital and Medical School; University of Dundee; Dundee DD1 9SY U.K
| | - S. Sanyal
- Photobiology Unit; Department of Dermatology; Ninewells Hospital and Medical School; University of Dundee; Dundee DD1 9SY U.K
| | - S. Ibbotson
- Photobiology Unit; Department of Dermatology; Ninewells Hospital and Medical School; University of Dundee; Dundee DD1 9SY U.K
| | - H. Moseley
- Photobiology Unit; Department of Dermatology; Ninewells Hospital and Medical School; University of Dundee; Dundee DD1 9SY U.K
| | - R.S. Dawe
- Photobiology Unit; Department of Dermatology; Ninewells Hospital and Medical School; University of Dundee; Dundee DD1 9SY U.K
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Tierney P, Ferguson J, Ibbotson S, Dawe R, Eadie E, Moseley H. Nine out of 10 sunbeds in England emit ultraviolet radiation levels that exceed current safety limits. Br J Dermatol 2013; 168:602-8. [PMID: 23330641 DOI: 10.1111/bjd.12181] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Exposure to ultraviolet (UV) radiation from sunlight is recognized as the principal cause of skin cancer. Moreover, sunbeds have been classified as carcinogenic by the International Agency for Research on Cancer. Despite this, there is a shortage of objective data on UV exposure levels in sunbeds in England. OBJECTIVES We set out to measure UV emission levels in sunbeds at sites around England, and to compare these levels with both current standards and natural sunlight. METHODS Between October 2010 and February 2011, UV spectra were measured on site from a total of 402 artificial tanning units in England. Measurement instrumentation was calibrated, traceable to the National Physical Laboratory. Compliance with the relevant British and European standard was determined, and a skin-cancer weighting factor was used to compare the carcinogenic potential of sunbeds with that of sunlight. RESULTS For compliance with the European standard, erythemal-effective irradiance should not exceed 0·3 W m(-2). The values that we measured ranged between 0·10 and 1·32 W m(-2) with a mean of 0·56 ± 0·21 W m(-2) . Only 10% of sunbeds surveyed were within the recommended limit. Application of the skin-cancer weighting factor produced values that varied from 0·17 to 2·52 W m(-2) with a mean of 0·99 ± 0·41 W m(-2). The comparable value for Mediterranean noon day sun was 0·43 W m . CONCLUSIONS Nine out of 10 sunbeds surveyed throughout England emitted levels of UV radiation that exceed the maximum levels contained within the European standard. Moreover, the skin cancer risk for comparable times of exposure was up to six times higher than that for Mediterranean sunlight. This situation is unacceptable and stricter control measures must be put in place.
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Affiliation(s)
- P Tierney
- The Photobiology Unit, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
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Ibbotson S, Dawe R, Dinkova-Kostova A, Weidlich S, Farr P, Ferguson J, Wolf C, Smith G. Glutathione S-transferase genotype is associated with sensitivity to psoralen-ultraviolet A photochemotherapy. Br J Dermatol 2012; 166:380-8. [DOI: 10.1111/j.1365-2133.2011.10661.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Fumaric acid esters (FAE) have been used in the treatment of psoriasis for many years. In general, they are regarded as relatively safe compared with other antipsoriatic systemic treatments, with the most notable adverse effects being gastrointestinal upset, lymphopenia and transient flushing. Renal toxicity has only rarely been reported, and was not found in two independent prospective trials nor in a large retrospective evaluation of almost 1000 patients treated for a median of 44 months. We report three patients developing reversible proteinuria during FAE treatment. One of these displayed the same pattern upon repeated drug administration, thereby clearly indicating FAE treatment to be the causal trigger. The presented cases highlight proteinuria as a clinical concern in FAE treatment. Furthermore, as the novel FAE agent dimethylfumaric (DMF) ester (contained in BG00012/Panaclar) has previously been shown to be effective in psoriasis in a phase III trial and not shown renal toxicity in a large trial for multiple sclerosis, the current report suggests that market introduction of DMF for psoriasis should be pursued.
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Affiliation(s)
- S Ogilvie
- Department of Dermatology, Ninewells Hospital, Dundee, UK
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Dawe R. Using ‘number needed to treat’ to express the magnitudes of benefit of ultraviolet B phototherapy and of antitumour necrosis factor-α therapies for psoriasis. Br J Dermatol 2009; 162:456-7. [DOI: 10.1111/j.1365-2133.2009.09555.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kerr A, Dawe R, Nathwani D, Evans A, Ferguson J. Presentation of leishmaniasis (Leishmania infantum) in the skin of a patient with severe atopic dermatitis. Br J Dermatol 2009; 161:202-3. [DOI: 10.1111/j.1365-2133.2009.09201.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hearn R, Kerr A, Rahim K, Ferguson J, Dawe R. Incidence of skin cancers in 3867 patients treated with narrow-band ultraviolet B phototherapy. Br J Dermatol 2008; 159:931-5. [DOI: 10.1111/j.1365-2133.2008.08776.x] [Citation(s) in RCA: 224] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dawe R, Russell S, Ferguson J. Borrowing from museums and industry: two photoprotective devices. Br J Dermatol 2008. [DOI: 10.1111/j.1365-2133.1996.tb07410.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bianchi J, Zamiri M, Loney M, McIntosh H, Dawe R, Douglas W. Pulse oximetry index: a simple arterial assessment for patients with venous disease. J Wound Care 2008; 17:253-4, 256-8, 260. [DOI: 10.12968/jowc.2008.17.6.29585] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J. Bianchi
- Glasgow Caledonian University, Scotland, UK; Department of Dermatology, Monklands Hospital, Glasgow, UK
| | - M. Zamiri
- Western Infirmary, Glasgow, Scotland, UK
| | - M. Loney
- Department of Dermatology, Monklands Hospital, Glasgow, UK
| | - H. McIntosh
- Department of Dermatology, Monklands Hospital, Glasgow, UK
| | - R.S. Dawe
- Ninewells Hospital, Dundee, Scotland, UK
| | - W.S. Douglas
- Department of Dermatology, Monklands Hospital, Glasgow, UK
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Hearn R, Dawe R, Kerr A, Rahim K, Ibbotson S, Ferguson J. Abstract No. 3
Is there a skin cancer risk with narrowband ultraviolet B phototherapy? Preliminary data from the second phase of the Dundee follow-up study. Br J Dermatol 2006. [DOI: 10.1111/j.1365-2133.2006.07477_3.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Clark C, Bryden A, Dawe R, Moseley H, Ferguson J, Ibbotson SH. Topical 5-aminolaevulinic acid photodynamic therapy for cutaneous lesions: outcome and comparison of light sources. Photodermatol Photoimmunol Photomed 2003; 19:134-41. [PMID: 12914598 DOI: 10.1034/j.1600-0781.2003.00024.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Topical 5-aminolaevulinic acid (ALA) photodynamic therapy (PDT) is increasingly used for superficial non-melanoma skin cancers and their precursors. METHODS We report our 3-year experience of topical ALA-PDT, with a preliminary comparison of the effects of broadband and laser light sources. RESULTS We performed 688 treatments on 483 lesions in 207 patients. Complete clearance was achieved in 222/239 lesions of Bowen's disease (BD), superficial basal cell carcinoma (sBCC) and actinic keratosis (AK) (93%) - 117/129 BD (91%), 84/87 sBCC (97%) and 21/23 AK (91%), with a median follow up of 48 weeks. Broadband and laser light sources were of similar efficacy. Recurrences have occurred in 10.3% BD, 4.8% sBCC and 4.8% AK. Adverse effects from PDT were uncommon but included pigmentary change (2%) and minor scarring (2%). How-ever, severe pain was experienced in 16-21% of treatments using the high-output broadband and laser sources, but in only 2% with the low-output xenon arc source. CONCLUSION Topical ALA-PDT is effective for BD, sBCC and AK and has been an invaluable addition to our dermatology service. Efficacy is similar for broadband and laser light sources, although treatment at higher surface irradiance may be painful, and excellent cosmetic results can be achieved.
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Affiliation(s)
- C Clark
- Department of Dermatology, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
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Moseley H, Cameron H, MacLeod T, Clark C, Dawe R, Ferguson J. New sunscreens confer improved protection for photosensitive patients in the blue light region. Br J Dermatol 2001; 145:789-94. [PMID: 11736903 DOI: 10.1046/j.1365-2133.2001.04429.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Some patients with photosensitivity disorders are sensitive to visible radiation. As current commercial sunscreens do not significantly absorb in this region, there is a lack of effective topical photoprotection. To meet this need a new range of sunscreens has been developed incorporating zinc oxide and pigmentary grade titanium dioxide as active ingredients. OBJECTIVES To determine the effectiveness of the new sunscreens in providing protection for patients with visible radiation photosensitivity. METHODS In the first part of this study, an in vitro transmission spectrum was obtained. The properties of the new sunscreens, as well as a range of commercial agents, were compared, and a new parameter, photosensitivity protection factor (PPF), was developed. This was used to predict the likely degree of protection the various sunscreens would provide for patients with photosensitivity extending into the visible region. In the second in vivo part of the study, patients with known visible (blue) light photosensitivity were tested using light at 430 +/- 30 nm and the protection factor (PF) at this wavelength was determined. RESULTS Mean +/- SD PPFs for the new sunscreens were between 5.4 +/- 0.3 and 9.6 +/- 0.3, compared with 4.1 +/- 0.1 for Sun E45 (sun protection factor, SPF 25) and 4.2 +/- 0.1 for RoC Total (SPF 25). The derived in vivo PF for Sun E45 ranged between 1 and 4 (median 2). For the new sunscreens the range was 3 to > 10 (median 8). CONCLUSIONS This study demonstrates that the new sunscreens do provide protection for patients with sensitivity to visible light (blue light region).
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Affiliation(s)
- H Moseley
- The Photobiology Unit, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
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McMorris TC, Yu J, Lira R, Dawe R, MacDonald JR, Waters SJ, Estes LA, Kelner MJ. Structure-activity studies of antitumor agent irofulven (hydroxymethylacylfulvene) and analogues. J Org Chem 2001; 66:6158-63. [PMID: 11529745 DOI: 10.1021/jo010458z] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Many analogues of the antitumor agent irofulven have been readily prepared by replacing the allylic hydroxyl with a variety of nucleophiles. Analogues of acylfulvene (the precursor to irofulven) were also prepared by Michael reaction with acrolein. The toxicity of the analogues was determined, as well as preclinical antitumor activity. Several analogues exhibited good activity in mouse xenografts. Structural requirements for activity are discussed.
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Affiliation(s)
- T C McMorris
- Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, California 92093-0506, USA.
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Abstract
A new sesquiterpene, omphadiol (4), has been isolated from cultures of Omphalotus illudens. Several known compounds, including illudosin (1), were also obtained. Structures were determined using MS, NMR, and X-ray techniques.
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Affiliation(s)
- T C McMorris
- Department of Chemistry and Biochemistry and Department of Pathology, University of California, San Diego, La Jolla, California 92093-0506, USA
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Abstract
Skin photosensitizing reactions have been reported during treatment with fluoroquinolone antibiotics. The incidence and severity of such reactions, however, appear to differ between agents. The photosensitizing effect of grepafloxacin 400 and 600 mg once daily was compared with that of ciprofloxacin 500 mg bd and placebo in a double-blind trial involving 32 healthy subjects. Skin photosensitivity, expressed as the minimal erythemal dose (MED), was measured before treatment and towards the end of the 7 day treatment period. Grepafloxacin showed a mild photosensitizing effect comparable to that of ciprofloxacin, with significant reductions in MED at 335+/-30 and 365+/-30 nm. However, few subjects showed MEDs outside the normal range, and MEDs consistently returned to baseline values within 1 week of stopping treatment. No significant differences between the effects of grepafloxacin and ciprofloxacin could be observed. It is concluded that grepafloxacin has a weak, UVA-dependent and rapidly reversible photosensitizing effect.
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Affiliation(s)
- J Ferguson
- Department of Dermatology, Ninewells Hospital, Dundee, UK
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Hatcliffe S, Dawe R. How patients see symptoms. Nurs Times 1996; 92:61-3. [PMID: 8710614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
This article outlines the response of a palliative care unit to the targets set out in A Vision for the Future (DoH/NHSME 1992). The authors explain how the unit has evaluated the existing service, using audit and quality assurance techniques, and how changes have been implemented to the benefit of staff and patients alike.
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Guckian M, Jones CD, Vestey JP, Cooper EJ, Dawe R, Gibbs NK, Norval M. Immunomodulation at the initiation of phototherapy and photochemotherapy. Photodermatol Photoimmunol Photomed 1995; 11:163-9. [PMID: 8850250 DOI: 10.1111/j.1600-0781.1995.tb00160.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The numbers and function of circulating lymphocyte subsets are within normal ranges in patients with psoriasis and are not affected by 4 weeks of ultraviolet (UV) therapy, except for a suppression in natural killer (NK) cell activity. However, it is possible that immunomodulation might occur at the initiation of phototherapy with a return to control values on more prolonged UV exposure. Thus, in this study the responses of 15 patients with chronic plaque psoriasis undergoing broad-band UVB therapy, 10 narrow-band (311-313 nm) UVB therapy and 10 PUVA therapy were compared. In each case, samples were taken immediately before starting treatment and 1 week later. Broad-band UVB and PUVA therapy had no effect on NK activity, but a significant reduction was found in the group receiving narrow-band UVB. In vitro lymphoproliferative responses to mitogens and to herpes simplex virus antigens did not alter with therapy, except there was a significant increase in mitogen responses (at optimal mitogen concentrations only) in the narrow-band UVB group. Generally no alterations in overall percentages of circulating mononuclear cells were found in any group. Samples were taken from the epidermis of the forearm and back of the patients receiving narrow-band UVB for the quantification of urocanic acid (UCA) isomers. The total UCA concentration remained unchanged after 1 week of therapy, while the percentage of cis-UCA increased significantly at both sites in the majority of patients. However, this rise did not correlate with the decrease in NK cell activity and the two parameters may not be related causally.
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Affiliation(s)
- M Guckian
- Department of Medical Microbiology, Edinburgh University Medical School, United Kingdom
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Pearson FC, Bohon J, Lee W, Bruszer G, Sagona M, Jakubowski G, Dawe R, Morrison D, Dinarello C. Characterization of Limulus amoebocyte lysate-reactive material from hollow-fiber dialyzers. Appl Environ Microbiol 1984; 48:1189-96. [PMID: 6517586 PMCID: PMC241708 DOI: 10.1128/aem.48.6.1189-1196.1984] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Hollow-fiber hemodialyzers containing cellulose-based membranes have been shown to produce positive results with the Limulus amoebocyte lysate test. This study was undertaken to determine whether endotoxin was causing the reaction. Rinses from 45 parallel-plate and hollow-fiber dialyzers from eight different manufacturers were tested before and after treatment with cellulase, using three lysates and four Limulus amoebocyte lysate methods. In addition, four in vitro cellular methods--human leukocytic pyrogen, lymphocytic activating factor, peritoneal macrophage, and arginase release--were used to evaluate endotoxin activity. The substance causing the reaction was identified by chromatographic methods. Results indicate that the Limulus amoebocyte lysate reactive material is cellulose derived and not pyrogenic.
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