Robert B. Armstrong

Acitretin plus UVB therapy for psoriasis. Comparisons with placebo plus UVB and acitretin alone

UVB radiation is beneficial for the treatment of psoriasis vulgaris. Patients with recalcitrant disease, however, are slow to respond to UVB phototherapy with and without the use of coal tars or emollients. Etretinate and, more recently, acitretin have proved useful, but clinical improvement is slow when they are used as monotherapy in plaque psoriasis. Each drug also produces side effects, some of which are dose related. This study was designed to compare results of treatment with UVB combined with either acitretin (50 mg/day) or placebo to determine if psoriasis would respond faster and to less cumulative exposure to UVB and acitretin. The psoriatic disease cleared to a greater degree in patients treated with acitretin-UVB with fewer treatments and smaller amounts of UVB radiation than in patients treated with either placebo-UVB or acitretin alone.

Effect of continued ultraviolet B phototherapy on the duration of remission of psoriasis: A randomized study

Phototherapy using sunburn spectrum ultraviolet radiation (UVB) is now a frequently utilized treatment for psoriasis that is extensive or has not responded to topical preparations. Four university centers performed a prospective randomized clinical trial to compare remission times of patients with psoriasis who continued UVB phototherapy after initial clearing with this therapy and patients whose UVB phototherapy was discontinued within 3 weeks of clearing. As assessed by life table methods, the time to flare after initial clearing for patients on UVB maintenance therapy was significantly longer than for patients who discontinued UVB within 3 weeks after initial clearing. Our data suggest that continuing UVB phototherapy after initial clearing contributes to the duration of disease control and is justified for many patients.

Photoallergic contact dermatitis to musk ambrette: Clinical report of two patients with persistent light reactor patterns

Two male patients with photoallergic contact dermatitis to musk ambrette, 2-methoxy-3,5-dinitro-4-methyl-t-butylbenzene, are reported. Musk ambrette is a synthetic fragrance material commonly used in foods and cosmetics. The clinical distribution of lesions presented by these patients strongly suggested an adverse reaction to light. Over a period of several years no etiology had been determined in these cases despite extensive testing and hospitalization. Photopatch tests to musk ambrette were positive. No other etiology for photosensitivity was found. This report emphasizes that exposure to household or cosmetic products represents a potential source of contact photosensitivity. Patients presenting with dermatoses of unknown origin confined to the light-exposed areas should have fragrances considered as possible etiologic agents.

COAL TAR PHOTOTOXICITY: ACTIVE COMPOUNDS AND ACTION SPECTRA*

Abstract Eight compounds present in crude coal tar were tested for phototoxicity on guinea‐pig skin. Four concentrations (5 μM to 5 mM) of each compound in ethanol were applied to the dorsal surface of 6 guinea‐pigs. Each animal received 1.0 x 105 j/m2 of UVA radiation. The erythematous (phototoxic) response was evaluated after 20 h. Pyrene, anthracene and fluoranthene were strongly phototoxic. Acridine was markedly less phototoxic. Action spectra based on erythema as an endpoint were determined in guinea‐pigs for anthracene, pyrene and fluoranthene. Each compound was applied to 5 animals which received irradiations from 274 to 502 nm in 12 nm bands for 3, 6, 9, 12 and 15 min. The maximum erythema response to anthracene was observed between 346 and 382 nm, to fluoranthene between 322 and 382 nm and to pyrene between 322 and 358 nm.

Photoallergic Contact Dermatitis to Musk Ambrette: Histopathologic Features of Photobiologic Reactions Observed in a Persistent Light Reactor

Studies concerning a patient with contact photosensitivity to musk ambrette, a commonly used fragrance, are reported. The patient had a persistent light reaction. The patients history, clinical appearance, and phototest and photopatch test results are described. The observed patterns of these were identical to those previously noted in patients who had persistent light reactions after exposure to other photosensitizers such as the halogenated salicylanilides. The histopathologic findings in the phototest and photopatch test sites were those of an acute spongiotic dermatitis. No abnormal change was seen with ultraviolet A radiation exposure alone.

Photosensitivity Diseases Related to Interior Lighting

The most frequently used source of indoor lighting is the fluorescent tube. Although there are major variations in phosphors, the majority of these lamps are safe, efficient, and economical illuminators. These fluorescent light sources are currently our primary source of visible light; however, they emit small amounts of ultraviolet A light (UVA) as well as a somewhat larger percentage of infrared radiation. Photosensitivity diseases have been reported in each of these three broad wavelength bands. Specific examples include heat urticaria from infrared exposure, contact photosensitivity of the phototoxic type following exposure to dyes and visible light, and two relatively rare but disabling conditions from ultraviolet A exposure--solar urticaria and contact photosensitivity of the photoallergic type (persistent light reaction). During the past five years, eight patients with photosensitivity induced by musk ambrette and UVA have been treated at Columbia-Presbyterian Medical Center; six of these have been severely disabled and satisfy the criteria for persistent light reactors. Fifteen patients with solar urticaria have also been observed. Ten of these had reactions in the UVA range. The clinical and laboratory findings of these two groups of patients were presented.

Modified Goeckerman Therapy for Psoriasis: A Two-Year Follow-up of a Combined Hospital-Ambulatory Care Program

Two groups totaling 162 patients hospitalized for modified Goeckerman treatment of severe psoriasis were matched for sex, age, and season of admission and followed up for two years after discharge. One group remained hospitalized throughout their average 20.8-day course; the other half was hospitalized 14 days, then transferred to an ambulatory center for the remainder of a course averaging 20.8 days. No difference was detected between the groups in the duration that improvement equaled or exceeded progress achieved at discharge. The percentage of patients remaining continuously improved after discharge was 80% at one month, 55% at six months, 40% at 12 months, and 20% at 24 months. rates of relapse requiring readmission or alternate therapy were also similar: 75% had not relapsed by 12 months and 60% had not relapsed by 24 months.

Photoallergic contact dermatitis to musk ambrette: action spectra in guinea pigs and man.

Abstract— Positive photopatch tests to musk ambrette were elicited using narrow band radiation in two patients with photoallergic contact dermatitis to musk ambrette and in photosensitized guinea pigs. The most effective wavelength range in the two patients was between 334 and 394 nm. Control subjects did not respond to the same light doses either in the presence or absence of musk ambrette. One patient exhibited maximum sensitivity at 346 nm. The action spectrum in guinea pigs extended from 322 to 406 nm with maximum response at 322 nm. Below 322 nm, erythema was observed at the same or higher doses than those required for evoking a minimal erythema response in non‐sensitized animals. Morphologically and histologically the response below 322 nm appeared to be normal delayed erythema. No erythema was elicited by radiation between 322 and 430 nm in non‐photosensitized animals which had received musk ambrette.

P43 Clinical panel assessment of photodamaged skin treated with isotretinoin using photographs

BACKGROUND AND DESIGN Evaluation of the treatment of photodamaged skin requires adequate efficacy criteria. This study tested the ability of five independent dermatologists to distinguish the effect of topical treatment with isotretinoin cream (0.05% for 3 months, then 0.1% for 6 months) in 326 patients compared with vehicle for 9 months in 325 patients using high-quality, reproducible photographic slides. Panelists were blinded to the patients identity, treatment group, and time of the photograph (baseline or end of treatment). A computer randomly projected the baseline photograph to one side of a split screen and the end-of-treatment photograph to the other. OBSERVATIONS Isotretinoin was significantly better than vehicle for overall appearance, fine wrinkles, and discrete pigmentation by multivariate analysis of the combined results for all panelists. Univariate analysis for each panelist also indicated statistically significant superiority of isotretinoin over vehicle for overall appearance (four panelists), fine wrinkles (five panelists), and discrete pigmentation (three panelists). CONCLUSION The clinical panel detected significantly better improvement in photodamaged-skin treated with isotretinoin than in such skin treated with vehicle. The panel provided an independent assessment of the effects of treatment uninfluenced by physical findings during treatment or information provided by the patients treated.

Potential hazards in phototherapy with ultraviolet radiation arising from variation in dose required to produce erythema

Phototherapy using 290-320 nm ultraviolet radiation (ultraviolet B) is an effective form of treatment for several skin diseases and is especially useful for psoriasis. Technical advances have made it more economical and convenient to quantify ultraviolet radiation. Ten volunteers received a series of exposures from three ultraviolet B sources to illustrate how variation in the spectral properties of phototherapy devices can lead to unanticipated and potentially severe sunburn reactions. The corresponding minimal erythema dose was then calculated with the use of irradiance data measured with two commercially available photometers. Variation in minimal erythema dose among the three sources tested indicates the need to characterize the emission spectrum of sources and the spectral sensitivity of the photometer used to measure its output.