Kelly Park

A review of monochromatic excimer light in vitiligo

Phototherapy is a mainstay of vitiligo treatment and has varying rates of efficacy. Narrowband ultraviolet (UV) B (NB‐UVB) and UVA have been used for decades, but it is only recently that monochromatic excimer light (MEL) was developed for use in dermatology and adapted for the treatment of vitiligo. The specific 308‐nm radiation wavelength is delivered in a targeted form by the xenon‐chloride excimer laser and is also available in an incoherent form that is commonly referred to as the excimer lamp. MEL administered by both laser and lamp has shown efficacy superior to NB‐UVB for the treatment of vitiligo and induces more changes at the cellular level than conventional UVB modalities. The excimer laser is effective in adults and children with vitiligo in all skin types as monotherapy or in combination with other established vitiligo therapeutics. Treatment regimens studied included excimer laser two to three times weekly for up to 36 weeks. Patients commonly achieved > 75% repigmentation. The laser has also been used in combination with topical corticosteroids, calcineurin inhibitors and vitamin D analogues, as well as surgery, thus further expanding treatment options for patients with vitiligo. The excimer lamp has been used for treatments one to three times a week for up to 24 weeks and was found to be equal to excimer laser in a head‐to‐head comparison. It has also been used in combination with topical corticosteroids and oral vitamin E. Both MEL modalities have a limited adverse side‐effect profile. Long‐term effects are yet to be determined; however, based on available data on UVB phototherapy as well as the properties of MEL devices, there is probably only a minimal increased malignancy risk.

Use of psychotropic drugs in dermatology: Unique perspectives of a dermatologist and a psychiatrist

Psychocutaneous morbidity is commonly found in dermatologic practice. Patients generally refuse referral to psychiatry, and dermatologists cannot always provide psychotherapeutic support. By establishing an alliance with these patients and with working knowledge of the common psychotherapeutic agents used in dermatology, these patients can be managed comfortably by the clinician. The major categories of psychodermatologic agents include antipsychotics, antidepressants, anxiolytics, and antiobsessive compulsive drugs. In addition, cutaneous dysesthesia and pruritus can be treated with psychotherapeutic agents when other treatments have been exhausted. The motivated dermatologist can apply this knowledge to treat these common yet challenging cases.

Instant barrier repair: a pilot study investigating occlusion with a new hydrogel patch for the treatment of atopic dermatitis

Abstract The ideal repair mechanism for overcoming barrier disruption in atopic dermatitis (AD) needs to completely eliminate microbe and allergen penetration as well as transepidermal water loss. We propose the hydrogel patch as an innovative approach to complete barrier repair. It is composed of an adhesive, thin, flexible, hydrogel layer on an impermeable urethane surface. We conducted a 6-week pilot study with 15 AD patients, who applied the hydrogel patch over one lesion for 6–8 h daily and triamcinolone (TAC) 0.1% cream twice daily to another lesion. Results after 2-week no treatment follow-up showed hydrogel patch had notable efficacy, and comparable to TAC 0.1% cream. Larger studies are needed to validate these results.

Hydroxyurea for the Treatment of Psoriasis with an Emphasis on HIV-Infected Psoriasis Patients: A Review

Hydroxyurea is a drug that has been long forgotten for the treatment of psoriasis. In addition to its anti-psoriatic effects, it has also been shown to have antiviral effects. This dual effect makes it a drug that dermatologists may want to consider when treating psoriasis in HIV-infected patients. Currently, no studies are available that discuss the safety and efficacy of hydroxyurea in the treatment of psoriasis in this immunocompromised group; however, numerous reports discuss the safety and efficacy of hydroxyurea in psoriasis and HIV separately. This review suggests that hydroxyurea is generally safe and effective. The main risk involves the hematologic adverse events (anemia, leukopenia, thrombocytopenia, and macrocytosis), which appear to be dose dependent. Because of the common hematologic adverse events, hydroxyurea may be considered a viable therapeutic option for patients with generalized psoriasis that is inadequately responsive to other safer options, whether or not the patient is HIV positive.

Ultraviolet B (UVB) Phototherapy in the Treatment of Vitiligo

Vitiligo is a common, acquired pigmentary disorder of unknown pathogenesis that presents a therapeutic challenge to many dermatologists (Figure 1). Although surgery in the form of grafting or transplantation is generally the most definitive treatment option, these procedures are limited by concerns of post-procedure cosmesis. Photochemotherapy using psoralen and ultraviolet A (PUVA) therapy, topical and oral immunosuppresants, as well as cosmetic camouflage are also commonly employed with varying clinical efficacy. Phototherapy is a popular treatment option, which includes both of the generalized ultraviolet B (UVB) therapies, broadband UVB (BB-UVB) and narrowband UVB (NB-UVB). The UVB-based therapeutic modalities in development are targeted delivery of BBand NBUVB, monochromatic excimer light (MEL), microphototherapy, and combination therapy. In particular, the sophisticated devices that utilize MEL can emit coherent 308-nm radiation using the xenon chloride (XeCl) excimer laser or microphotography, while incoherent radiation can be supplied by various lamp and light systems. All of the UVB phototherapy modalities can be used in combination with topical or systemic agents, thus further expanding treatment options for vitiligo patients.

Treatment of Psoriasis in HIV-Infected Persons

Choosing a treatment modality for psoriasis in HIV-infected patients can be quite a difficult task for dermatologists. These physicians may be reluctant to treat HIV-infected patients with immunosuppressive agents when the host is already immunologically compromised. The available data on safety and efficacy for various psoriasis treatment options in HIV-infected individuals are very limited; yet it is still a physicians duty to provide the best possible treatment for these patients. A revised algorithm is proposed for the treatment of HIV-infected patients with psoriasis based on a previous recommendation from the medical advisory board of the National Psoriasis Foundation. For psoriasis in HIV-infected persons, good HIV control should be the mainstay of treatment. The use of hydroxyurea is reintroduced as an option to consider before the use of systemic immunosuppressant agents. In addition, tumor necrosis factor-α inhibitors may be considered over the oral systemic immunosuppressive agents.