[Complications of corneal cross-linking]

BACKGROUND

More than 10 years after the clinical introduction of corneal cross-linking (CXL) the indications and contraindications are still not yet defined. Fundamental for such a list is the incidence of complications.

METHODS

A PubMed search for complications of corneal crosslinking published up to March 2013 was carried out.

RESULTS

The published complication rates ranged from 1 % to 10 % depending on the stage of keratoconus. Early postoperative complications were transient stromal haze, sterile infiltrates, endothelium decompensation, delayed epithelial healing and infectious keratitis. Stromal opacity can be a delayed postoperative event.

CONCLUSIONS

Complications after corneal cross-linking treatment for keratoconus are rare but the management of these complications may need keratoplasty.

Rate of acute adverse events for narrow-band UVB and Psoralen-UVA phototherapy

BACKGROUND

Ultraviolet (UV) radiation therapies are commonly used to treat a wide range of dermatological conditions. However, no published data exist regarding the rate of acute adverse events occurring within the different UV therapy modalities.

AIM

The aim of this study was to determine the rate of acute adverse events experienced by patients receiving narrow-band UVB or photochemotherapy in 3 neighboring dermatology units.

METHOD

Standardized adverse event forms from all 3 units were retrospectively analysed over a 12-month period between October 2003 and September 2004. The treatments included were narrow-band UVB and systemic, bath and hand/foot PUVA.

RESULTS

A total of 8784 treatments were given over the study period. The total number of acute adverse events recorded for all phototherapy treatments was 70 (0.8%). The rates of acute adverse events for each treatment modality were 0.6% for narrow-band UVB, 1.3% for systemic PUVA, 1.3% for bath PUVA and 0.8% for hand/foot PUVA. Adverse events were due to patient non-compliance with standard operating procedures in 15 cases (21%) and operator error in 2 (3%). Only 4 of the acute adverse events were considered to be severe, accounting for 0.05% of all treatments.

CONCLUSIONS

The rates of acute adverse events with phototherapy in this analysis were low, in particular the rate of severe adverse events. The highest rate was seen with both systemic and bath PUVA. The number of adverse events resulting from operator error was low. These published rates for adverse events associated with narrow-band UVB and PUVA may help other units when analyzing their own rate of adverse events.

[The influence of vitamin D deficiency on cancers and autoimmune diseases development]

There is a growing number of diseases which prevalence can be associated with vitamin D deficiency. The link between low cholecalciferol concentration and bone diseases is well established, however there is also data suggesting that it may influence development and progression of different cancers and autoimmune diseases. The in vitro studies proved that the active vitamin D metabolite--1,25(OH)(2)D(3) may arrest the cell cycle progression, induce apoptosis as well as regulate T cells and antigen presenting cells function. Results of the in vivo experiments suggest that vitamin D deficiency accelerates development of autoimmune diseases and cancers in animals. Epidemiological studies imply that the vitamin D deficiency is also associated with the increased incidence of autoimmune diseases and cancers in people. The main determinant of vitamin D serum concentration in a human body is skin synthesis. The changes in the lifestyle, air pollution as well as a common use of sun screens caused that the contemporary European receives little sunlight compared to his ancestors. According to the recent epidemiological studies, the vitamin D concentrations in serum of people who live in high latitudes (above 34 degrees N/S), including Poland, is far from being sufficient. This paper reviews results of the recent studies concerning the potential role of the vitamin D in the development of cancers and autoimmune diseases, as well as provides guidelines for vitamin D supplementation.

The utility of a data-logging device for measuring adherence to home phototherapy

BACKGROUND

Treatment adherence to home phototherapy is not well characterized.

PURPOSE

To develop an accurate measure of home phototherapy unit usage.

METHODS

We tested a commercially available data logger containing a photo-sensor on two home phototherapy units.

RESULTS

The data logger accurately recorded actual usage and did not record stray light sources over the study period.

CONCLUSION

A data logger can accurately capture usage patterns for a home phototherapy unit. These devices could potentially be used in clinical trials to measure adherence to home phototherapy treatment regimens.

UVA1 phototherapy for cutaneous diseases: an experience of 92 cases in the United States

BACKGROUND

The efficacy and safety of UVA1 (340-400 nm) phototherapy were established by studies from European countries.

PURPOSE

Evaluate experience with UVA1 phototherapy for patients with cutaneous diseases in the United States.

METHODS

A retrospective analysis of 92 cases of UVA1-treated cutaneous conditions from four medical centers in the United States was performed.

RESULTS

Two-third of the patients showed a fair to good response (26-100% improvement) and one-third of the patients showed a poor response (0-25% improvement). Diseases with a moderate to good response (51-100% improvement) included scleredema adultorum, hand or foot dermatitis, atopic dermatitis, morphea (medium or medium- to high-dose UVA1), systemic sclerosis, and urticaria pigmentosa. Besides tanning, other adverse effects were found in 15% of patients, which include pruritus, erythema, tenderness, and burning sensation. Patients with skin types I-III responded better that those with a darker skin type.

CONCLUSION

UVA1 phototherapy is a useful and well-tolerated treatment option for a variety of skin conditions.

The challenge resulting from positive and negative effects of sunlight: How much solar UV exposure is appropriate to balance between risks of vitamin D deficiency and skin cancer?

There is no doubt that solar ultraviolet (UV) exposure is the most important environmental risk factor for the development of non-melanoma skin cancer. Therefore, sun protection is of particular importance to prevent these malignancies, especially in risk groups. However, 90% of all requisite vitamin D has to be formed in the skin through the action of the sun-a serious problem, for a connection between vitamin D deficiency and a broad variety of independent diseases including various types of cancer, bone diseases, autoimmune diseases, hypertension and cardiovascular disease has now been clearly indicated in a large number of epidemiologic and laboratory studies. An important link that improved our understanding of these new findings was the discovery that the biologically active vitamin D metabolite 1,25(OH)(2)D is not exclusively produced in the kidney, but in many other tissues such as prostate, colon, skin and osteoblasts. Extra-renally produced 1,25(OH)(2)D is now considered to be an autocrine or paracrine hormone, regulating various cellular functions including cell growth. We and others have shown that strict sun protection causes vitamin D deficiency in risk groups. In the light of new scientific findings that convincingly demonstrate an association of vitamin D deficiency with a variety of severe diseases including various cancers, the detection and treatment of vitamin D deficiency in sun-deprived risk groups is of high importance. It has to be emphasized that in groups that are at high risk of developing vitamin D deficiency (e.g., nursing home residents or patients under immunosuppressive therapy), vitamin D status has to be monitored. Vitamin D deficiency should be treated, e.g., by giving vitamin D orally. Dermatologists and other clinicians have to recognize that there is convincing evidence that the protective effect of less intense solar UV radiation outweighs its mutagenic effects. Although further work is necessary to define an adequate vitamin D status and adequate guidelines for solar UV exposure, it is at present mandatory that public health campaigns and recommendations of dermatologists on sun protection consider these facts. Well-balanced recommendations on sun protection have to ensure an adequate vitamin D status, thereby protecting people against adverse effects of strict sun protection without significantly increasing the risk of developing UV-induced skin cancer.

Does sunlight have a beneficial influence on certain cancers?

Apperly [1941. The relation of solar radiation to cancer mortality in North America. Cancer Research 1, 191-195] first proposed that increased mortality from cancer in the north than in the south of the USA might be due to the south to north decrease in ambient solar radiation. This inverse association between ambient solar radiation and cancer mortality has been subsequently reported for cancers of the colon, breast, ovary and prostate. While the evidence that sunlight might be related to lower incidence or more favourable outcomes from cancer came initially from ecological studies, case-control and cohort studies have now shown a similar association of sun exposure with risks of colon, breast and prostate cancers in individuals, and other studies in individuals have found that serum and dietary vitamin D levels are associated with reduced risks of colorectal cancer and, less certainly, prostate cancer. Studies in individuals have recently also suggested an effect of sun exposure to reduce risk of non-Hodgkin lymphoma and to increase survival after a diagnosis of melanoma. Data on variation in survival from cancer by season of diagnosis suggest that sun exposure may also improve outcome from cancers of the breast, colon and prostate and Hodgkin lymphoma.

Dermatologists’ Views and Opinions about Photo(chemo)therapy and Conventional Systemic Psoriasis Therapies: Results from a Belgian Survey

BACKGROUND

Experts' opinions about old and new psoriasis therapies are well documented.

OBJECTIVES

To document the views and opinions of a large, diverse group of dermatologists about psoriasis treatment.

PARTICIPANTS/METHODS

A survey was conducted among Belgian dermatologists. In addition to demographic and professional characteristics, the questionnaire assessed the self-rated level of experience, frequency of use, preference and considerations regarding UVB, PUVA, methotrexate (MTX), cyclosporin (CsA) and acitretin. Multivariate logistic regression analyses were performed to investigate predictors of these dermatologist-based outcomes.

RESULTS

Of the 628 contacted dermatologists, 310 responded (response rate of 49.3%). The dermatologists were significantly more experienced with photo(chemo)therapy than with systemic agents (p < or = 0.02); about half reported none or little experience with MTX and CsA. Also, photo(chemo)therapies were significantly more frequently used than systemic drugs (p < or = 0.01). In the last year, almost 40% had not used and less than 10% had used MTX or CsA more than 10 times. Despite the limitations of PUVA, it was preferred to UVB, followed by acitretin (+/- phototherapy), and MTX and CsA were considered final options by most dermatologists. After adjusting for confounding variables, age, years in practice, seeing and treating more patients, residency programme and/or access to UV therapy were significantly associated with limited experience, regular use and/or preference of studied therapies.

CONCLUSION

Either a substantial proportion of the dermatologists does not need or wish to use conventional systemic psoriasis therapies or they may need better and more uniform training during and after their residency. This may improve patient care and patient selection for other treatments.

Home ultraviolet B phototherapy for psoriasis: discrepancy between literature, guidelines, general opinions and actual use. Results of a literature review, a web search, and a questionnaire among dermatologists

BACKGROUND

Home ultraviolet B (UVB) phototherapy is a debated treatment. It is currently being prescribed for patients with psoriasis, although literature on the subject is scarce. Despite the apparent contradiction between clinical practice and literature, no systematic study of either has been conducted.

OBJECTIVES

To assess and compare the available publications and guidelines about home UVB phototherapy for psoriasis with the actual opinions and use of this therapy.

METHODS

The literature and guidelines were searched using databases, search engines and e-mail. A postal survey of 343 Dutch dermatologists and 142 dermatologists from 32 other countries was carried out; 255 and 102 dermatologists respectively responded. Outcome measures were the reported advantages, drawbacks and prescription rates of home UVB phototherapy.

RESULTS

Fourteen publications (nonrandomized) and six guidelines concerning home UVB phototherapy for psoriasis were identified. Most were reticent about the use of this treatment. Publications describing nonclinical research (7/14) reported most of the drawbacks mentioned (24/31). Home UVB phototherapy was prescribed to 5% (median) of all patients with psoriasis in The Netherlands who required UVB. However, 28% (68/244) of the Dutch dermatologists prescribed home UVB in 20 to 100% of their cases. Dermatologists from other countries reported that 0-10% of UVB treatments were offered at home. For both Dutch and other dermatologists, the most important reasons for prescribing home UVB concerned time and travel distance (80%, i.e. 163 of 205 and 75%, i.e. 33 of 44). Therapy-related drawbacks (such as poor service and equipment) were the objections mentioned most often (55%, i.e. 103 of 186 and 63%, i.e. 57 of 91). Concerns about the medicolegal liability of home UVB were rarely expressed by individual respondents, but frequently mentioned in the various reports.

CONCLUSIONS

A discrepancy exists between the actual use of home UVB phototherapy and the general opinions found in publications. The treatment is prescribed for a considerable number of patients despite the fact that literature and guidelines advise caution. Personal and nonevidence-based opinions on this therapy are widespread while randomized clinical studies have thus far not been conducted.

Management of neonatal hyperbilirubinemia: pediatricians' practices and educational needs

Background

Early detection and treatment of neonatal hyperbilirubinemia is important in the prevention of bilirubin-induced encephalopathy. In this study, we evaluated the New Jersey pediatricians' practices and beliefs regarding the management of neonatal hyperbilirubinemia and their compliance with the recommendations made by the American Academy of Pediatrics (AAP) in 1994.

Methods

A survey questionnaire was mailed to a random sample of 800 pediatricians selected from a list of 1623 New Jersey Fellows of the AAP initially in October 2003 and then in February 2004 for the non-respondents. In addition to the physicians' demographic characteristics, the questionnaire addressed various aspects of neonatal hyperbilirubinemia management including the diagnosis, treatment, and follow up as well as the pediatricians' beliefs regarding the significance of risk factors in the development of severe hyperbilirubinemia.

Results

The adjusted response rate of 49.1% (n = 356) was calculated from the 725 eligible respondents. Overall, the practicing pediatricians reported high utilization (77.9%) of the cephalocaudal progression of jaundice and low utilization (16.1%) of transcutaneous bilirubinometry for the quantification of the severity of jaundice. Most of the respondents (87.4%) identified jaundice as an indicator for serum bilirubin (TSB) testing prior to the neonate's discharge from hospital, whereas post-discharge, only 57.7% felt that a TSB was indicated (P < 0.01). If the neonate's age was under 72 hours, less than one-third of the respondents reported initiation of phototherapy at TSB levels lower than the treatment parameters recommended by the AAP in 1994, whereas if the infant was more than 72 hours old, almost 60% were initiating phototherapy at TSB lower than the 1994 AAP guidelines. Most respondents did not regard neonatal jaundice noted after discharge and gestational ages 37–38 weeks as being significant in the development of severe hyperbilirubinemia. However, the majority did recognize the importance of jaundice presenting within the first 24 hours and Rh/ABO incompatibility.

Conclusion

The pediatricians' practices regarding the low utilization of laboratory diagnosis for the quantification of jaundice after discharge and underestimation of risk factors that contribute to the development of severe hyperbilirubinemia are associated with initiation of phototherapy at lower than AAP recommended treatment parameters and recognition of neonatal hyperbilirubinemia as an important public health concern.

Considering the potential benefits as well as adverse effects of sun exposure: can all the potential benefits be provided by oral vitamin D supplementation?

Exposure to ultraviolet radiation (UVR) is associated with both adverse and beneficial health effects. While many of the adverse effects of excessive exposure are well known, the adverse effects of insufficient UVR exposure are less clear-cut, but may include a heightened risk of several cancers and autoimmune disorders as well as of bone diseases such as rickets, osteomalacia and osteoporosis. Although some of the postulated beneficial effects of UVR exposure may occur through the maintenance of adequate levels of vitamin D, it is not clear that this can account for all of these effects. We briefly review the epidemiological literature with respect to vitamin D, UVR exposure and autoimmune diseases. We further outline alternative pathways, whereby UVR could alter the risk of development of some cancers and autoimmune disorders, independent of effects on vitamin D synthesis. Recognition of the beneficial effects of UVR exposure has led to a reconsideration of sun avoidance policies. It is important to recognize that all of the beneficial effects of UVR exposure may not occur only through UVR-induced vitamin D synthesis. Thus maintaining current sun avoidance policies while supplementing food with vitamin D may not be sufficient to avoid the risks of insufficient exposure to UVR.

[Health economic aspects of psoriasis therapy. Is inpatient topical treatment of plaque-type psoriasis in this age of biologics still appropriate from both medical and economic viewpoints?]

BACKGROUND

We tried to clarify whether the treatment of plaque psoriasis as an inpatient with dithranol and narrow band UV-B 311 nm is still appropriate and economical when compared to biologics such as efalizumab.

PATIENTS AND METHODS

In a 15 month period, all patients admitted to the hospital after unsuccessful outpatient treatment of psoriasis were evaluated prospectively according to medical and economical criteria.

RESULTS

PASI-score was reduced by 89% in 74 patients. The direct cost to improve one in-patient by 75% in PASI score (PASI-75) was 4342.27 EUR; the total costs for employed patients were 7441.81 EUR. Direct costs of treatment with efalizumab would come to 15048.89 EUR per patient with PASI-75 in a 12 weeks period.

CONCLUSION

Topical inpatient therapy for plaque psoriasis is well tolerated and a less expensive option than biologics in those who fail ambulatory treatment.

[Therapy of hand eczema. What can we learn from the published clinical studies?]

Hand eczema is a very common skin disease, which can be induced by different causes. Although many interventions ranging from topical corticosteroids and UV therapy to oral cyclosporine and retinoids are available, the treatment of hand eczema can be very difficult and frustrating. The objective of our study was to assess the external evidence of different treatment modalities for hand eczema. Electronic databases (Cochrane, MEDLINE, Embase, Pascal, Jicst-Eplus, Amed) were systematically searched for clinical trials on therapy for hand eczema. Additionally, four general medical journals (BMJ, JAMA, Lancet, NEJM) and 17 specialists dermatological journals were hand searched from 1977 to August 2004. A total of 100 studies were found and 31 identified as randomised clinical trials (RCTs) dealing with different interventions. Due to the poor quality of most of these RCTs, they are inadequate as a guide to clinical practice. There is a need for high-quality RCTs on therapy for hand eczema regarding established as well as new treatment options taking different subgroups of hand eczema into consideration.

An automated dosimetry system for testing whole-body ultraviolet phototherapy cabinets

A new technique is described for automated ultraviolet dosimetry within whole-body phototherapy cabinets. A dual-head detector system has been designed, permitting simultaneous assessment of irradiance levels and radiant intensities from individual lamps. One detector is used in combination with a diffuser/filter system for the measurement of irradiance and the other is mounted at the end of a slit collimator to provide a measurement which can be related to the radiant intensities of the individual lamps. These quantities are derived from 800 separate measurements made during rotation of the detector head around a 360 degrees circle at a fixed height and position within the cabinet under remote computer software control. The device has advantages compared with standard techniques, enabling measurements to be made without the need for a person to be present in the cabinet. A full set of measurements is made with minimal switching of the power supply to the lamps. This simplifies the assessment and reduces the uncertainty from variation in output after the lamps are switched on. Variations in irradiance with orientation for the smaller phototherapy cabinets are clearly demonstrated. Plots of data from the collimated detector show peaks corresponding to the lamps and the surrounding reflectors. The plots enable failed lamps to be detected and peak values can be related to radiant intensities of individual lamps.

Lack of consensus among experts on the choice of UV therapy for psoriasis

CONTEXT

Each year tens of thousands of patients in the United States are treated with UV-B radiation or psoralen plus UV-A radiation (PUVA) for a variety of skin disorders. Although PUVA is generally considered more effective, it is also more toxic and more expensive. The degree of consensus among experts in prescribing these alternative treatments has not been quantified.

OBJECTIVES

To quantify variation among specialty clinics in the type of ultraviolet therapy used to treat specific skin conditions and assess factors associated with the use of specific treatments.

DESIGN

Survey conducted during two 2-week periods in the late fall of 1994 and early spring of 1995.

SETTING

Thirty-nine specialty clinics in 17 US geographic areas in 14 states and Washington, DC.

PARTICIPANTS

A total of 3401 patients treated with UV radiation one or more times.

OUTCOME MEASURES

Type of UV therapy used and indications for treatment, age, sex, number of patients treated, and geographic location of each clinic.

RESULTS

The proportion of patients at each center treated with PUVA ranged from 0% to 93% (mean, 41%). Clinic size and geographic location, demographic characteristics of the patients, and diagnosis did not explain these large intercenter differences.

CONCLUSIONS

Among specialized clinics, there is little consistency in the use of alternative therapies, which differ substantially in safety and cost, but whose relative efficacy is not well quantified. There is a lack of consensus among experts about the circumstances in which the greater risks and costs of PUVA are outweighed by its possibly greater efficacy, especially in the treatment of psoriasis.

A population-based survey on the use of artificial tanning devices in the Province of Québec, Canada

BACKGROUND

The suntanning industry has grown up over the last decade in North America, mainly because tanned skin is socially desirable and artificial tanning is perceived as a "safe tan." However, exposure to UV radiation is known to cause adverse health effects.

OBJECTIVE

The purpose of this study was to estimate the prevalence of use of tanning equipment in the Province of Québec and to characterize people who reported using these devices.

METHODS

In 1996, a telephone survey was carried out among adults from the two most densely populated regions (Montréal, Québec) of the Province of Québec. The final sample included 1003 white persons 18 to 60 years old. Interviewers used a standardized questionnaire to document the characteristics of the participant, skin phototype, and exposure habits to artificial UV radiation sources.

RESULTS

During the last 5 years before the survey, 20.2% of the respondents reported they had used, at least once, a tanning device in a commercial tanning salon. The rate of use during the last 12 months before the study was 11.1%. A significantly higher proportion of female, young people (18 to 34 years old) and single persons was found among tanning bed users. Twenty-six percent of users experienced one or more acute adverse health effects from the artificial UV irradiation. Most of these were cases of skin burns. A high proportion (77.5%) of those who used tanning equipment during the last year before the study said they would return to tanning salons. The intention of returning to a tanning salon was not influenced by the occurrence of the acute adverse health effects. The most prevalent reason given for using tanning equipment was "to improve their appearance by a tan." Most people (60.4%) who used a tanning bed during the last 5 years before the study believe that tanning salons are not dangerous.

CONCLUSION

This survey indicates that tanning bed use is very prevalent in the Province of Québec, mainly among young women. The high rate of acute adverse health effects related to artificial tanning, particularly skin burns, is of concern. Finally, our results underline the importance of changing attitudes and beliefs in the population regarding artificial tanning.

[The intracorporeal ultraviolet irradiation of the blood and its effect on the immune status in patients with a surgical infection]

A dynamic investigation was done of the immunologic status in 75 patients with purulent surgical lesions of soft tissues. Applied in the complex of therapeutic measures was intracorporeal irradiation of blood with ultraviolet light under control of partial pressure of oxygen and carbon dioxide. The above irradiation was found out to make for a more rapid and marked stabilization of bodily immunologic status.

[The clinico-pathogenetic validation of intravascular laser therapy in the combined treatment of salmonellosis in young infants]

The clinico-laboratory study of the effectiveness of the intravascular ultraviolet laser therapy (IUVLT) in the complex treatment of 25 young children with prolonged severe salmonellosis was made. The study revealed that under the action of IUVLT the main symptoms of salmonellosis (intoxication and diarrhea) disappeared at a shorter period than after treatment by traditional methods. The pathogenetic basis of the effectiveness of IUVLT was the induction of the enzymes of the monooxygenase system of the liver and an increase in the activity of the enzymes of antiradical protection.

Ten-year experience of phototherapy in Yonsei Medical Center

Phototherapy with PUVA or UVB has been used to treat a wide variety of diseases such as psoriasis, vitiligo, atopic dermatitis and mycosis fungoides, etc. The present study was performed to investigate the pattern of phototherapy in the phototherapy clinic of Yonsei Medical Center. One thousand six hundred ninety two patients who received PUVA or UVB phototherapy were included in this study. We analyzed the protocols for phototherapy between 1985 and 1994. The number of phototherapy per year increased sharply until 1991 and thereafter it has remained relatively constant. The most common age group at the start of phototherapy was the third decade. The most common indications for PUVA and UVB phototherapy were vitiligo and psoriasis, respectively. Most patients had received less than 50 treatments of PUVA and less than 200 J/cm2 of cumulative UVA. Most patients had received less than 50 treatments with UVB and cumulative UVB doses were variable. We had not found any malignancy in the skin. Since the maximum safe cumulative doses of UVA or UVB have not yet been established, it is difficult to decide when phototherapy should be discontinued. The data presented in this study needs to be further analyzed in correlation with photoaging and cancer development for the safe usage of phototherapy.

Neonatal jaundice and molecular mutations in glucose-6-phosphate dehydrogenase deficient newborn infants

Molecular mutations of the glucose-6-phosphate dehydrogenase (G6PD) gene and clinical manifestations of neonatal jaundice in 112 male and 50 female Chinese neonates with G6PD deficiency were studied. In the 112 males, the nucleotide (nt) 1376 (G-->T) mutation was the dominant type (50.0%), followed by nt 1388 (G-->A) (16.1%), nt 493 (A-->G) (8.0%), nt 1024 (C-->T) (6.2%), nt 95 (A-->G) (5.4%), nt 392 (G-->T) (1.8%), nt 487 (G-->A) (1.8%), nt 871 (G-->A) (0.9%), and nt 1360 (C-->T) (0.9%). The nt 871 variant has not been reported in Taiwan before. The occurrence rates for nt 1376, nt 1388, nt 493, nt 95, and nt 1024 mutations in the 50 females were 44.0%, 18.0%, 12.0%, 6.0%, and 6.0%, respectively. The type of G6PD mutation in 10 male and 7 female neonates has not been identified yet. Although G6PD deficient neonates had higher frequency of phototherapy than G6PD normal neonates in both sexes, a significant difference in the prevalence of hyperbilirubinemia (peak bilirubin > or = 15.0 mg/dl) between G6PD deficient and normal neonates was found only in males. Further analysis showed that duration of phototherapy was longer in G6PD deficient male neonates than in the control group, while the outcome of phototherapy was better in subjects with non-nt 1376 mutations than subjects with the nt 1376 mutation. Most (78.3%) of the 23 G6PD deficient neonates who subsequently suffered from neonatal hyperbilirubinemia carried the nt 1376 mutation. The results of this study indicate that the nucleotide substitution at 1376 is the most common and important mutation for G6PD deficiency in Chinese neonates in Taiwan.

UVB phototherapy for pityriasis rosea: a bilateral comparison study

BACKGROUND

Pityriasis rosea is a common self-limiting disease. UV light has been mentioned as helpful, but only a few studies substantiate this possibility.

OBJECTIVE

Our purpose was to evaluate the clinical efficacy of UVB phototherapy in pityriasis rosea and the course of the disease after treatment.

METHODS

Seventeen patients with extensive pityriasis rosea were treated with unilateral UVB phototherapy in a bilateral comparison study. One joule of UVA was used as a "placebo" on the untreated side. The treatments were given five times per week for 2 weeks. The rate of clearing was monitored by estimation of the severity score.

RESULTS

Ten daily erythemogenic exposures of UVB resulted in substantially decreased severity of disease, greater than that on the untreated side in 15 of 17 patients. The overall reduction of severity score showed a significant difference after the third treatment; the UVB irradiation was superior. However, during the follow-up period the two sides were indistinguishable in regard to severity score (p = 0.6784). No significant difference in pruritus was noted between the two sides (p > 0.1638). The duration of disease did not relate to the success of UVB phototherapy.

CONCLUSION

During the treatment period UVB phototherapy resulted in decreased severity of disease. However, the itching and the course of the disease were unchanged.

The practice of ultraviolet phototherapy in the United Kingdom

A survey, using a postal questionnaire, was carried out to examine the current practice of UVB phototherapy in dermatology centres in the U.K. The questionnaire was sent to 115 dermatology departments, and sought information regarding the type and age of each machine used for ultraviolet B (UVB) phototherapy, methods of prescribing, recording and terminating patient exposure, and the skin conditions treated. Completed questionnaires were received from 87 of the 115 centres, giving a response rate of 76%. The survey showed that an appreciable number of U.K. phototherapy centres are using equipment which is both old, and suboptimal in producing a therapeutic response. There appeared to be a wide variation in the approach to phototherapy, both in terms of prescribing initial and incremental exposure, and in terminating treatment. The findings suggest that effectiveness and efficiency might be improved, and the risk/benefit ratio of phototherapy further reduced, by some rationalization of treatment protocols.

[Immunogenetic methods in the prognosis of the efficacy of using a method of transfusing extracorporeally irradiated autologous blood for treating patients with rheumatoid arthritis]

HLA antigens distribution among subgroups of rheumatoid arthritis (RA) patients was compared with reference to the results achieved after the treatment with transfusion of extracorporeally irradiated autologous blood (TEIB). The treatment efficacy was found to be in general 66% and to depend on HLA phenotype, age of the patients, the RA activity. The analysis of associations of clinical significance exhibited by clinical, laboratory and immunogenetic signs made it possible to derive a formula for individual prognostic criterion capable of raising TEIB efficacy to 89%.