Charles R. Taylor

Photoaging/photodamage and photoprotection

Exposure to sunlight can produce both acute and long-term effects. Acute changes include erythema, photosensitivity, and immunologic alterations. Long-term consequences include carcinogenesis and photoaging. All effects can be minimized by photoprotection. This article reviews the adverse effects of sun exposure and strategies to reduce photodamage.

Medium-dose 308-nm excimer laser for the treatment of psoriasis.

BACKGROUND The excimer laser can deliver high-intensity ultraviolet B (UVB) energy at 308 nm, a wavelength similar to that used in narrow-band UVB phototherapy. OBJECTIVE The goal of this investigation was to evaluate the role of high-dose single treatments with the excimer 308-nm laser in stable plaque-type psoriasis. METHODS Eighteen volunteers were enrolled in the study. Two plaques were selected and half of each plaque was held as a control while the other half was treated with a single dose of either 8 or 16 times the minimal erythema dose. RESULTS Sixteen subjects completed the study. Two patients signed up but never actually participated because of scheduling problems. Eleven showed significant improvement within 1 month, and 5 still demonstrated persistent areas of clearing at 4 months. CONCLUSION As little as one high-dose excimer laser treatment can be effective for localized plaque-type psoriasis. Multiple treatments or other irradiation schedules with this innovative device may prove even more efficacious.

Familial Dysalbuminemic Hyperthyroxinemia

Abstract We investigated 15 euthyroid patients from eight families with a recently recognized syndrome, familial dysalbuminemic hyperthyroxinemia (FDH), that could be mistaken for thyrotoxicosis. T...

TREATMENT OF BENIGN PIGMENTED EPIDERMAL LESIONS BY Q-SWITCHED RUBY LASER

Background. Disorders of cutaneous pigmentation are a common problem, which can cause substantial cosmetic morbidity. Traditional treatments are often ineffective and sometimes associated with further hyperpigmentation, hypo‐pigmentation, or scarring. Because the Q‐switched ruby laser has proven useful for the treatment of tattoos and, in a small number of cases, benign disorders of the epidermal melanin, we decided to apply this modality systematically to additional benign pigmented lesions.

Wood’s light in dermatology

Wood’s lampwas invented in 1903 by a Baltimore physicist, Robert W. Wood (1868–1955).1 The familiar long-wave ultraviolet (UV) light, known as Wood’s lamp, has become an invaluable tool in the practice of medicine. The first reported use of this lamp in dermatology occurred in 1925, being recommended for the detection of fungal infection of the hair.2 Unlike many other medical devices, which have tended to lose their popularity over time, Wood’s lamp has maintained its usefulness not only in dermatology, but also in ceramics where it can be used to determine repairs.

PUVA treatment of alopecia areata partialis, totalis and universalis: audit of 10 years' experience at St John's Institute of Dermatology.

Our 10‐year experience with PUVA treatment for alopecia areata. partialis, totalis and universalis was retrospectively reviewed using charts and follow‐up questionnaires for 70 patients at St Johns Institute of Dermatology. In all cases, several previous therapies were judged to be unsatisfactory prior to starting PUVA, and many cases were already deemed clinically refractory prior to referral for PUVA. If cases of vellus hair growth are excluded, and those who lost their PUVA‐induced regrowth rapidly on follow‐up, the effective success rate was at best 6·3% for alopecia areata partialis, 12·5% for alopecia areata totalis and 13·3% for alopecia areata universalis. We affirm that PUVA is generally not an effective treatment for alopecia areata.

308‐nm excimer laser for the treatment of localized vitiligo

Background and Objective Vitiligo is commonly treated with PUVA, and more recently, narrow‐band UVB (NBUVB) phototherapy. Given the proximity of the wavelengths of NBUVB (311 nm) and the excimer laser (308 nm), we undertook a clinical trial to test the efficacy of this device.

Treatment of nevus of Ota by Q-switched ruby laser

BACKGROUND There are few reports on therapy for nevus of Ota. Moreover, traditional treatments are largely palliative or risk permanent pigmentary changes and/or scarring. OBJECTIVE The efficacy of the Q-switched ruby laser (694 nm, 40 nsec) as a therapy for nevus of Ota was investigated. METHODS Nine nevi or portions thereof were irradiated up to six times with 4.5 and/or 7.5 J/cm2 at a mean exposure interval of 3 weeks. Sequential skin biopsy specimens were processed for light microscopy, immunohistochemistry, and electron microscopy. RESULTS Cosmetic improvement occurred at both doses in the irradiated parts of the six nevi available for follow-up. No appreciable difference was noted between single and multiple treatments. There was no gross scarring. Light microscopy revealed dose-related immediate injury with more melanophages and fewer dermal melanocytes after irradiation in comparison with control areas. Electron microscopic distinction between dermal melanocytes and melanin-laden macrophages was difficult. A monoclonal antibody to human melanosome-specific antigen type 1 (HMSA-1) was used to distinguish between the two cell populations. CONCLUSION Our findings suggest that the Q-switched ruby laser is useful for treating nevus of Ota.

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.

Characterization of photosensitivity in the Smith-Lemli-Opitz syndrome: a new congenital photosensitivity syndrome.

Photosensitivity has recently been reported as a feature of the Smith–Lemli–Opitz syndrome (SLO). The aim of this study was to establish the photobiological features of this disorder and to examine the hypothesis that the photosensitivity is caused by the high levels of 7‐dehydrocholesterol found in SLO. All known cases of SLO in the U.K. were reviewed and clinical details of photosensitivity were recorded in detail. The action spectrum of the photosensitive eruption was defined by monochromator light testing. Thirteen of the 23 subjects (57%) had severe photosensitivity, and in 10 there was no photosensitivity. No correlation was identified between levels of 7‐dehydrocholesterol and severity of photosensitivity, suggesting that the photosensitivity in SLO is not caused by a direct phototoxic effect mediated by 7‐dehydrocholesterol. A novel pattern of photosensitivity was observed, with onset of a sunburn‐like erythema on sun‐exposed skin within minutes of sun exposure, which persisted in most cases for up to 24–48 h before fading. Monochromator light testing in three subjects showed an ultraviolet (UV) A‐mediated photosensitivity eruption with greatest photosensitivity at 350 nm. Photosensitivity is a common and prominent feature of SLO and appears to be UVA‐mediated. Elucidation of its biochemical basis may provide insight into normal cutaneous protective mechanisms against UVA‐induced photodamage, and also sun sensitivity in general.