H. Cameron

A randomized, observer‐blinded trial of twice vs. three times weekly narrowband ultraviolet B phototherapy for chronic plaque psoriasis

Summary Background The optimum treatment frequency for narrowband (TL‐01) ultraviolet B (NB‐UVB) in psoriasis is not yet known. We have previously found three times weekly to be preferable to five times weekly treatment in our population.

A randomized controlled trial of narrowband ultraviolet B vs bath-psoralen plus ultraviolet A photochemotherapy for psoriasis.

Summary Background  In 1991, consensus guidelines recommended psoralen plus ultraviolet A photochemotherapy (PUVA) for those requiring second‐line therapy for psoriasis. Narrowband (TL‐01) UVB has since become more widely available, replacing the less effective broadband sources.

Taking treatment to the patient: development of a home TL-01 ultraviolet B phototherapy service

Summary Background While most patients requiring phototherapy can attend for hospital‐based out‐patient ultraviolet (UV) B therapy, a significant number cannot attend because of geographical, work, economic and other reasons.

New sunscreens confer improved protection for photosensitive patients in the blue light region

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.

A randomized controlled comparison of the efficacy of Dead Sea salt balneophototherapy vs. narrowband ultraviolet B monotherapy for chronic plaque psoriasis.

Background  Dead Sea (DS) salt solution soaks are used in combination with narrowband ultraviolet B (NB‐UVB) to treat psoriasis in many centres, particularly in continental Europe. No previously published controlled study has assessed DS salt + NB‐UVB balneophototherapy.

A Randomized Comparison of Methods of Selecting Narrowband UV-B Starting Dose to Treat Chronic Psoriasis

OBJECTIVES To compare narrowband UV-B (TL-01 lamp) phototherapy for psoriasis with individual patient starting doses based on minimal erythemal dose (MED) determination vs a standard fixed starting dose and to compare the efficacy of 70% of MED vs 50% of MED starting dose regimens. DESIGN Single-center, randomized, double-blind, clinical trial. SETTING Department of Dermatology, Ninewells Hospital and Medical School, Dundee, Scotland. PATIENTS A total of 210 adult patients (207 of skin phototypes I to III) referred for narrowband UV-B to treat chronic psoriasis. The study was designed to have 90% power to detect a difference of 3 or more treatments to clearance and/or minimal residual activity (MRA) between groups. INTERVENTIONS Narrowband UV-B phototherapy was given according to 3 standard regimens, differing only by starting dose selection method. The randomly allocated starting doses were (1) a fixed starting dose, (2) 70% of individual MED, and (3) 50% of individual MED. All patients were MED tested to ensure blinding and for safety reasons. MAIN OUTCOME MEASURES The number of treatments to clearance and/or MRA of psoriasis was the primary efficacy outcome measure, with changes in Psoriasis Area and Severity Index and Psoriasis Disability Index scores as secondary measures. Adverse effects were recorded. RESULTS There were no significant differences in the number of treatments to clearance and/or MRA across all 3 groups or in the percentages achieving clearance in each group. More uncomfortable erythemas occurred in the 50% of MED starting dose group (39%) than in the 70% of MED starting dose group (24%) or the fixed starting dose group (24%) (P=.07). CONCLUSIONS The methods of determining the starting dose in this predominantly skin phototype I and II population, treated 3 times weekly, with a 20% followed by 10% incremental reduction in dose, did not significantly influence the effectiveness of treatment. Had there been a clinically important difference in efficacy, we would have expected to identify this. Thus, basing starting dose on individual MED assessments may not influence the treatments efficacy in a skin phototype I to III population, although it remains important for patient safety. It remains possible that in populations containing individuals with a broader range of erythemal sensitivity, basing the starting dose on MED testing could have an important impact on treatment effectiveness. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN84614024.

A randomised, blinded, controlled study of the clinical relevance of matching pulse duration to thermal relaxation time when treating facial telangiectasia

The theory of selective photo-thermolysis (SP) suggests the occurrence of optimal damage when the laser pulse duration (PD) equals the target thermal relaxation time (Tr). This study examines the clinical relevance of this theory. The study design and methods consisted of prospective, randomised, blinded, controlled study of KTP 532-nm laser treatment of 28 telangiectatic facial vessels. The PD varied from 0.13 to 1.71 times Tr (factor of 13). All vessels achieved marked improvement or clearance. The analysis of proportions reaching clearance over marked improvement for small and large calibre vessels shows a better outcome when the PD is nearer to the Tr (86% vs 57%; P=0.09, 95% CI for difference −3% to 60%). Logistic regression analysis shows that, as the ratio of PD to Tr increases (PD near to or higher than Tr), the chance of clearing improves (P=0.169; 95% CI 0.34 to 341). This study has shown that, for the range of vessels investigated: (1) marked improvement or clearance may be achieved using PDs that range between 0.13 and 1.71 times the Tr; and (2) it also reveals an overall trend towards a higher proportion of clearance when the PD is near to or higher than the Tr.

Narrowband ultraviolet B treatment for psoriasis is highly economical and causes significant savings in cost for topical treatments

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.