The application of intravenous laser irradiation of the blood for the combined treatment of psoriasis.
The objective of the present comparative study was to estimate the efficacy of the treatment of 104 patients presenting with psoriasis with the use of PUVA therapy and intravenous laser irradiation of the blood or the combination of the two methods. It was shown that the latter treatment caused a faster reduction of the inflammatory processes than the former whereas their joint application was especially efficacious in inducing regression of concomitant infiltrative events. Erythrocytes from the patients undergoing intravenous laser irradiation of the blood were characterized by the enhanced activity of antioxidative enzymes that are known to play an important role in the cellular protection from oxidants. At the same time, PUVA therapy caused no appreciable changes in the antioxidtive status. Both treatments increased the levels of antiinflammatory cytokines and decreased those ofproinflammatory ones which suggests their immunomodulatory effect that was especially pronounced in the case of combined therapy. It is concluded that the introduction of intravenous laser irradiation of the blood in the combined treatment of psoriatic patients exerts positive effect on compromised immunoregulation, stimulates the antioxidative system, and improves microcirculation.
Acta Dermatovenerol Croat. 2011 Sep;19(3):195-205.
Phototherapy of psoriasis in the era of biologics: still in.
MUDr. Nina Benáková, Dermatovenerologická klinika 1. LFUK, U nemocnice 2, 128 08 Praha 2, Czech Republic; firstname.lastname@example.org.
This article reviews recent literature on phototherapy for psoriasis, particularly narrowband UVB. The efficacy, safety, tolerability and acceptance of phototherapy are discussed. It focuses in detail on how to improve the efficacy and safety in practice by trying to optimize the protocols, using combination therapy, monitoring the cumulative dose and providing skin cancer surveillance. Careful patient selection, individualized treatment, long-term therapy plan and complex approach to patients are the prerequisites for this. Narrowband UVB as the most widely used modality of phototherapy for psoriasis has a relatively good efficacy, cost, availability and minimal side effects. It represents a valuable treatment, which deserves more utilization and research. Although not so dynamic as in systemic drugs, research into phototherapy is ongoing. Even in the era of biologics, phototherapy remains an important therapeutic modality for psoriasis and other dermatoses and represents an essential part of modern dermatological therapy.
Lasers Surg Med. 2010 Mar;42(3):201-10.
Cellular and molecular effects of pulsed dye laser and local narrow-band UVB therapy in psoriasis.
Rácz E, de Leeuw J, Baerveldt EM, Kant M, Neumann HA, van der Fits L, Prens EP.
Department of Dermatology, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands. e.racz@erasmusmc
BACKGROUND AND OBJECTIVES: Pulsed dye laser (PDL) therapy is effective in clearing psoriasis plaques, but the mechanism of action is only partially understood. Local narrow-band ultraviolet B (NB-UVB), which has a better-defined mode of action, is an effective standard treatment for psoriasis. Our aim was to evaluate the cellular and molecular effects of PDL and to compare them with those of local NB-UVB in order to gain further insight into their mechanisms of action in psoriasis.
STUDY DESIGN/PATIENTS AND METHODS: Nineteen patients with stable plaque-type psoriasis were treated either with PDL or NB-UVB. Lesional punch biopsies were obtained from all patients before treatment. Additional biopsies were obtained at 3 and 24 hours after PDL treatment in five of these patients. In 14 patients additional biopsies were taken after 7 and 13 weeks of treatment. Samples were histopathologically examined for the level of dermal T cell infiltrate, and the expression of epidermal beta-defensin 2, immune cell-derived tumor necrosis factor (TNF)-alpha, endothelial E-selectin, vascular endothelial growth factor receptor (VEGFR) 2 and 3, and the expression of interleukin (IL)-23 before and after treatment.
RESULTS: The expression of VEGFR2, VEGFR3, and E-selectin was decreased in clinically high responders within 24 hours after PDL treatment. The expression of IL-23, TNF-alpha mRNA, and E-selectin protein were significantly reduced after two PDL treatments, whereas the expression of all epidermal markers and dermal T cell infiltrates had normalized after four treatments. The expression of epidermal activation markers and E-selectin were significantly reduced after 13 weeks of NB-UVB treatment.
CONCLUSIONS: The expression of epidermal activation markers and the dermal T cell infiltrates were decreased after both treatments. The decreased expression of VEGFR2 and VEGFR3 followed by the down-regulation of TNF-alpha and IL-23p19 may be contributory factors in the efficacy of PDL in stable plaque-type psoriasis.
Photomed Laser Surg. 2010 Feb;28(1):141-6.
Combination of 830-nm and 633-nm light-emitting diode phototherapy shows promise the treatment of recalcitrant psoriasis: preliminary findings.
Ablon Skin Institute, Los Angeles, California, USA. email@example.com
BACKGROUND AND OBJECTIVES: Psoriasis is one of the major problems facing dermatologists worldwide. Planar arrays of light-emitting diodes (LEDs) have recently attracted attention in the treatment of difficult dermatological entities, 830 nm in near infrared (near-IR) and 633 nm in visible red. This study was designed to assess the efficacy of combination 830-nm and 633-nm LED phototherapy in the treatment of recalcitrant psoriasis.
SUBJECTS AND METHODS: Nine informed and consenting patients with psoriasis were enrolled in this preliminary study, (3 men, 6 women, mean age 34.3, skin types I to IV). All had chronic psoriasis, which in most cases had proved resistant to conventional treatments. They were treated sequentially with LED arrays delivering continuous-wave 830 nm (near-IR) and 633 nm (red) in two 20-min sessions over 4 or 5 weeks, with 48 h between sessions (830 nm, 60 J/cm(2); 633 nm, 126 J/cm(2)).
RESULTS: All patients completed their LED regimens (4 requiring 1 regimen, 5 requiring a second). Follow-up periods were from 3 to 8 months, except in two patients who were lost to follow-up. Clearance rates at the end of the follow-up period ranged from 60% to 100%. Satisfaction was universally very high.
CONCLUSIONS: The antiinflammatory effects of LED energy at 830 nm and 633 nm have been well documented, as has their use in wound healing. LED phototherapy is easy to apply, pain free and side-effect free, and is well tolerated by patients of all skin types. The promising results of this preliminary study warrant a proper controlled double-blind study with a larger patient population.
J Drugs Dermatol. 2007 Aug;6(8):794-8.
Excimer laser for psoriasis: a review of theories regarding enhanced efficacy over traditional UVB phototherapy.
Zakarian K, Nguyen A, Letsinger J, Koo J.
Department of Pediatrics, University of California, Irvine, CA, USA. firstname.lastname@example.org
BACKGROUND: Fiber-optically targeted ultraviolet B (UVB) therapy has been shown to clear plaques of psoriasis in a significantly fewer number of treatments and reduce overall cumulative UVB dose than traditional UVB phototherapy.
OBJECTIVE: This article reviews existing theories in the literature attempting to explain the superior efficacy of targeted UVB.
METHODS: Medline was used to perform a comprehensive review of the literature from 1965 to present. Only information from the English language journals are reported in this study.
RESULTS: The theories proposed to explain the higher efficacy of the excimer (XeCl) laser relative to traditional UVB include the ability to use higher intensities of ultraviolet (UV) light and a more efficient induction of T cell apoptosis.
CONCLUSION: The possible explanations for the superior efficacy of the excimer laser over traditional UVB therapy for psoriasis include: 1) a higher intensity UV light to plaques, which is more effective in clearing psoriasis; 2) penetration into the dermis where it may induce T cell apoptosis, potentially to a greater extent than the wavelength or given energy level predicts; and 3) the difference in the delivery of UVB light may result in cell death and skin immune system suppression more effectively than traditional UVB.
Acta Dermatovenerol Croat. 2004;12(1):42-50.
Phototherapy of psoriasis: review and update.
Kostovi K, Pasi A.
Department of Dermatology and Venerology, Zagreb University Hospital Center, Croatia. email@example.com
Along with topical and systemic therapy, phototherapy is one of the three fundamental treatment options for managing psoriasis. The use of UVB continues to be one of the most important therapeutic interventions for mild to moderate psoriasis. An advance in UVB phototherapy has been the introduction of narrowband UVB lamps (311 nm). UVB lamps are superior to conventional broadband UVB in clearing psoriasis. PUVA is very effective therapy and is still the most effective form of phototherapy for severe, extensive form od the disease. There has been a trend towards whole-body PUVA-bath. Advantages of PUVA bath are lack of gastrointestinal side effects and no need for post-treatment eye photoprotection because there is no systemic photosensitization. UVB and PUVA can be administered in combination with a variety of topical and systemic treatments to achieve more effective results more quickly. The most recent form of phototherapy, 308-nm excimer laser, holds promise for becoming a useful tool in the treatment of stable, localized psoriasis.
Hautarzt. 2004 Jan;55(1):48-57
The excimer laser in dermatology and esthetic medicine
[Article in German]
Grema H, Raulin C.
Laserklinik Karlsruhe, Karlsruhe, Germany.
First reports about the use of the excimer laser in dermatology date back to 1997. It is seen as an improvement on conventional phototherapy and photochemotherapy because of the lower cumulative UV-dose involved, the shorter time frame required for treatment and the option of targeting individual lesions without affecting the surrounding healthy skin. In addition to the indications of psoriasis vulgaris, vitiligo and atopic eczema (for which there is now FDA approval in the US), the spectrum of possible uses for the excimer laser is growing rapidly, especially in the field of light-sensitive dermatoses. Case studies so far have ranged from post-operative hypopigmentation to acne vulgaris and from alopecia areata to parapsoriasis en plaque. The foremost priorities in the future will be to evaluate reproducible therapeutic regimens with realistic prospects of success in large-scale studies; assess potential iatrogenic risks in treatment; develop pathogenetic models for the mechanism of action; and define therapeutic approaches to new indications. This paper summarizes the publications to date and discusses our observations and experiences.
Aerosp Am. 2000 Apr;38(4):24-5.
From growing plants to killing tumors.
NASA: A technique called photodynamic therapy, originally developed for commercial plant growth research on the Space Shuttle, has been used by surgeons in two successful operations for brain tumors. The device uses pin-head-size light emitting diodes (LEDs) that release long, cool, wavelengths of light which activate photosensitive antineoplastic drugs. The device is being adapted to non-space uses through a Small Business Innovation Research grant. The LEDs also are used to treat skin cancer, psoriasis, and rheumatoid arthritis. Research is being conducted regarding LED use in wound healing, tissue growth, and prevention of muscle and bone atrophy in astronauts.