Randa Youssef

Suggested mechanisms of action of UVA phototherapy in morphea: a molecular study

Background: Ultraviolet A (UVA) phototherapy proved to be an efficient line of treatment of scleroderma. The mechanism through which it acts is still not clear.

Narrow band Ultraviolet B 311 nm in the treatment of vitiligo : two right-left comparison studies

Aim: Evaluation of narrow band ultraviolet B (NB UVB 311 nm) in the treatment of vitiligo by two independent studies. The first study compared NB UVB with a well‐established therapeutic modality, psoralen ultraviolet A (PUVA), and the second study was conducted to find out whether psoralen might add to its efficacy.

PUVA and PUVB in vitiligo – are they equally effective?

Background/Aims: The combination of psoralens with different types of ultraviolet (UVL) sources in the treatment of vitiligo has led to different reports of success. The purpose of this trial is to compare in a random right‐left comparison study the efficacy and side effects of oral 8‐MOP plus UVA (PUVA) and oral 8‐MOP plus UVB (broadband, 290–320 nm P‐UVB) in the treatment of vitiligo.

Ultraviolet A in vitiligo

Both types of Ultraviolet (UV), UVB (290–320 nm) and UVA (320–400 nm), produce increased pigmentation or tanning. However, no evaluation of UVA alone in the treatment of vitiligo has been reported. Therefore, it was the purpose of this work to study the pigmentogenic effect of UVA (5 and 15 J/cm2) in vitiligo. The study included 20 randomly selected patients with vitiligo involving more than 30% of the body surface area with a bilateral/symmetrical distribution. They were equally divided into two groups each of 10 patients. All patients received three weekly sessions of UVA, 15 J/cm2 in group I and 5 J/cm2 in group II, a total of 48 sessions over 16 weeks. Overall pigmentation of 60% and above was recorded in 50% and 10% of patients in groups I and II, respectively. We conclude that broadband UVA alone, without psoralens, and in appropriate doses may be of important therapeutic value in vitiligo.

Detection of Herpes Simplex Virus DNA in Serum and Oral Secretions during Acute Recurrent Herpes Labialis

Although herpes simplex virus (HSV) has been detected in the peripheral blood of immunocompromised patients and in neonates with disseminated disease, the extent to which the virus may be present in the blood during a localized infection in otherwise healthy patients is still unknown. Literature on patterns of HSV shedding into the oral cavity at the prodromal stage of the disease, during recurrences, and also during asymptomatic periods is still lacking. The present study aims at the detection of HSV DNA in the serum and oral secretions during acute herpes labialis using a highly sensitive technique, the polymerase chain reaction (PCR). The study included 10 patients with acute herpes labialis and five healthy controls. Using PCR, herpes simplex virus DNA was detected in the serum of seven patients (70%) and in the saliva of nine patients (90%). One of the control cases showed positive HSV DNA in the saliva (20%). There was good statistical agreement between the presence of HSV DNA in the serum and saliva. Frequency of attacks, patients age, and gender had no statistically significant effect on the presence of the virus in serum or in saliva. It is concluded that HSV viremia during attacks of recurrent herpes simplex is more frequent than previously appreciated.

Different narrowband UVB dosage regimens in dark skinned psoriatics : a preliminary study

Background: Psoriasis is a common and relapsing disease, which is both physically and psychologically disabling. Narrowband UVB (NB‐UVB) is used in fair‐skinned population in suberythemogenic doses with good results; however, in the darker skin population (skin types III, IV, V) erythemogenic doses have not been thoroughly investigated.

BB-UVA vs. NB-UVB in the treatment of vitiligo: a randomized controlled clinical study (single blinded).

Vitiligo is an acquired pigmentary disorder that affects between 1% and 2% of the general population. Phototherapy remains the cornerstone of treatment, with NB‐UVB being the most frequently used. BB‐UVA can be a plausible alternative for darker population; skin photo type III and IV.

A comparative study of different treatment frequencies of psoralen and ultraviolet A in psoriatic patients with darker skin types (randomized-controlled study)

Background: Photochemotherapy psoralen and ultraviolet A (PUVA) is a viable option for treatment of psoriasis. However, concerns about its side effects have raised the need to change current PUVA protocols. The aim of this study is to determine whether reducing the treatment frequency of PUVA to twice/week instead of three times/week would affect the efficacy of PUVA therapy.

The role of systemic steroids and phototherapy in the treatment of stable vitiligo: a randomized controlled trial

Pathogenesis of vitiligo is believed to be multifactorial disease with a wide variety of therapeutic modalities. The aim of this work is to assess the efficacy of oral mini‐pulse steroids (OMP) plus Nb‐U.V.B in comparison to OMP alone and Nb‐U.V.B alone in treating stable vitiligo. A prospective randomized controlled study including 45 patients categorized into three groups receiving therapy for 3 months; Group A received Nb‐U.V.B plus OMP, Group B received OMP alone while Group C received Nb‐U.V.B alone. Clinical assessment and PCR evaluation of bFGF, ICAM1, and ELISA for AMA were done. Patients receiving Nb‐U.V.B plus OMP and using Nb‐U.V.B alone gave statistically significant clinical response than those treated with OMP alone. Statistically significant rise of BFGF was noticed after treatment with Nb‐U.V.B plus OMP and with Nb‐U.V.B alone. Patients treated with OMP alone and with Nb‐U.V.B alone showed statistically significant drop of ICAM‐1 after therapy. NB‐U.V.B plus OMP and Nb‐U.V.B alone were found to be clinically superior over OMP alone in treating stable vitiligo patients, hence suggesting that adding OMP to Nb‐U.V.B can maintain clinical and laboratory success for a longer period of time and with less relapse.

Phototherapy in vitiligo: a comparative evaluation of various therapeutic modalities

Phototherapy is the backbone of vitiligo treatment. Besides the use of heliotherapy since ancient times, artificial sources have been introduced for the last decades in different wavelengths and administration devices utilizing a multitude of regimens and treatment combinations. In this article, we present a comprehensive compilation of the use of different modalities of phototherapy in vitiligo on the basis of a multitude of related comparative studies that have been carried out during the last decade, including those performed at the Phototherapy Unit, Kasr Al Aini Hospital. The phototherapeutic modality most commonly utilized in the treatment of vitiligo at present is narrowband ultraviolet B (NB-UVB) (311 nm), although in our area, photochemotherapy still continues to be used. Efforts have been made to take into account most comparative studies including the different combinations of NB-UVB with other modalities. The different types of psoralens used in photochemotherapy are discussed, besides comparison of the use of various ultraviolet light sources in vitiligo. The results of studies comparing both psoralen plus ultraviolet A and NB-UVB are also included. A more recently emerging phototherapeutic modality in the treatment of vitiligo and other photoresponsive dermatoses is broadband UVA, which awaits short-term and long-term safety evaluation studies, both clinical and laboratory. Diverse tools yielding targeted phototherapy are widely being used nowadays in the treatment of vitiligo. Systems range from laser to incoherent pointed light equipment to larger but localized sources, all aiming at sparing the unaffected skin undue radiation exposure.