Ernest Lee,MD , John Koo, MD, and Tim Berger, MD
Abstract
Background
UVB phototherapy is a common treatment modality for psoriasis and other skin diseases. Although UVB has been in use for many decades, many clinicians are hesitant to use this type of phototherapy because of concern over increasing the skin cancer risk. Over the past 20 years, numerous studies have been published examining this issue, but a consensus or analysis of the skin cancer risk is required for the dermatologist to make an educated risk–benefit analysis.
Objective
To assess the risk of skin cancer associated with UVB phototherapy.
Methods
All prospective or retrospective studies were identified in MEDLINE from 1966 to June 2002. Bibliographies were searched to identify any additional studies examining this issue. All studies that attempted to quantify or qualify any additional skin cancer risk from UVB phototherapy were included. Study selection was performed by two independent reviewers. Results Eleven studies (10 of which concerned psoriasis patients), involving approximately 3400 participants, were included. Of note, three of the studies involved the same cohort: members of the 16-center US Psoralen plus UVA (PUVA) Follow-up Study. Other than the most recent Finnish study, all studies eventually showed no increased skin cancer risk with UVB phototherapy.One of the PUVA cohort studies examined genital skin cancers, and found an increased rate of genital tumors associated with UVB phototherapy, although this study has not been duplicated.
Conclusion
The evidence suggests that UVB phototherapy remains a very safe treatment modality
Buy UVB Home Phototherapy online without a prescription or doctors letter
Monday, August 31, 2009
Therapies for the Management of Childhood Psoriasis
Therapies for the Management of Childhood Psoriasis
Authors and Disclosures:
K. M. Cordoro, MD, Department of Dermatology,
University of California, San Francisco, CA, USA
Phototherapy is an excellent, safe, and appropriate treatment for carefully selected patients with refractory plaque, guttate and pustular disease, diffuse (>15%-20% body surface area) involvement, or focal debilitating palmoplantar psoriasis. To avoid burns and other light-associated complications, it is essential to utilize a phototherapy unit with experienced and well-trained personnel who are comfortable working with children. Three main types of therapeutic light options exist: broadband UVB (BB-UVB, 280-320nm), NB-UVB (311-313nm) and UVA (320-400nm).
BB-UVB encompasses the most biologically active radiation in sunlight and guttate psoriasis responds best, but plaque psoriasis in children tends to be thinner and will respond to higher doses and a longer duration of treatment. One of the greatest advances in phototherapy for psoriasis is the use of NB-UVB, which, at therapeutic doses, is lesserythemogenic than other wavelengths in the UVB range.[16]
Centered on 311-313nm, NB-UVB is safe and effective for a number of photoresponsive dermatoses in children, including psoriasis.[17-19] Short-term side-effects of UVBphototherapy are usually mild and consist of xerosis, erythema, pruritus, and photoactivation of herpesvirus. Potential long-term effects include premature photoagingand cutaneous carcinogenesis.[20]
Photochemotherapy (psoralen plus ultraviolet A, [PUVA]) is based on the interaction between UVA radiation and psoralen, a photosensitizing chemical. In children less than12 years, oral PUVA is rarely used and if so, is done with extreme caution and should be restricted to psoriasis and phototherapy centers staffed by well trained, experiencedphysicians and nurses.
Many authors consider oral psoralen relatively contraindicated in children less than age 12 and prefer topical PUVA because of the many short- and longterm toxicities associated with psoralen ingestion (e.g., nausea, vomiting, headache, hepatotoxicity, generalizedphotosensitization requiring 24 hours of photoprotection, ocular toxicity, acute risk of burning, and long-term risk of skin cancer).[21] In children, NB-UVB is more convenient and may be less carcinogenic. Given the downsides of using psoralens in children and adults, NB-UVB is now considered first-line phototherapy.[22]
Kopp T, Karlhofer F, Szepfalusi Z, et al. Successful use of acitretin in conjunction with narrowband ultraviolet B phototherapy in a child with severe pustular psoriasis, von Zumbusch type. Br J Dermatol 151(4):912-6 (2004 Oct).
Lee CS, Koo J. A review of acitretin, a systemic retinoid for the treatment of psoriasis. Expert Opin Pharmacother 6(10):1725-34 (2005 Aug).
Lacour M, Mehta-Nikhar B, Atherton DJ, et al. An appraisal of acitretin therapy in children with inherited disorders of keratinization. Br J Dermatol 134(6):1023-9 (1996 Jun).
Brecher AR, Orlow SJ. Oral retinoid therapy for dermatologic conditions in children and adolescents. J Am Acad Dermatol 49(2):171-82 (2003 Aug).
Katugampola RP, Finlay AY. Oral retinoid therapy for disorders of keratinization: single-centre retrospective 25 years´ experience on 23 patients. Br J Dermatol 154(2):267-76 (2006 Feb).
Halverstam CP, Zeichner J, Lebwohl M. Lack of significant skeletal changes after long-term, low-dose retinoid therapy: case report and review of the literature. J Cutan Med Surg 10(6):291-9 (2006 Nov-Dec).
Paller AS. Dermatologic uses of methotrexate in children: indications and guidelines. Pediatr Dermatol 2(3):238-43 (1985 Mar).
Callen JP, Kulp-Shorten CL, Wolverton SE. Methotrexate. In: Wolverton SE, editor. Comprehensive dermatologic drug therapy. 2nd ed. Philadelphia: Saunders Elsevier; p163-81 (2007).
Swords S, Lauer SJ, Nopper AJ. Principles of treatment in pediatric dermatology: systemic treatment. In: Schachner LA, Hansen RC, editors. Pediatric dermatology. 3rd ed. Philadelphia: Mosby (Elsevier); p133-43 (2003).
Gisondi P, Fantuzzi F, Malerba M, et al. Folic acid in general medicine and dermatology. J Dermatolog Treat 18(3):138-46 (2007).
Lebwohl M, Ali S. Treatment of psoriasis. Part 2. Systemic therapies. J Am Acad Dermatol 45(5):649-61 (2001 Nov).
Pereira TM, Vieira AP, Fernandes JC, et al. Cyclosporin A treatment in severe childhood psoriasis. J Eur Acad Dermatol Venereol 20(6):651-6 (2006 Jul).
Koo J. Systemic sequential therapy of psoriasis: a new paradigm for improved therapeutic results. J Am Acad Dermatol 41(3 Pt 2):S25-8 (1999 Sep).
Ellis CN. Safety issues with cyclosporine. Int J Dermatol 36 Suppl 1:7-10 (1997 Dec).
Cordoro KM, Feldman SR. TNF-alpha inhibitors in dermatology. Skin Therapy Lett 12(7):4-6 (2007 Sep).
Kist JM, Van Voorhees AS. Narrowband ultraviolet B therapy for psoriasis and other skin disorders. Adv Dermatol 21:235-50 (2005).
al-Fouzan AS, Nanda A. UVB phototherapy in childhood psoriasis. Pediatr Dermatol 12(1):66 (1995 Mar).
Jain VK, Aggarwal K, Jain K, et al. Narrow-band UV-B phototherapy in childhood psoriasis. Int J Dermatol 46(3):320-2 (2007 Mar).
Tay YK, Morelli JG, Weston WL. Experience with UVB phototherapy in children. Pediatr Dermatol 13(5):406-9 (1996 Sep-Oct).
Pasic A, Ceovic R, Lipozencic J, et al. Phototherapy in pediatric patients. Pediatr Dermatol 20(1):71-7 (2003 Jan-Feb).
Wolff K. Side-effects of psoralen photochemotherapy (PUVA). Br J Dermatol 122 Suppl 36:117-25 (1990 Jun).
MacDonald A, Burden AD. Psoriasis: advances in pathophysiology and management. Postgrad Med J 83(985):690-7 (2007 Nov).
Owen CM, Chalmers RJ, O´Sullivan T, et al. A systematic review of antistreptococcal interventions for guttate and chronic plaque psoriasis. Br J Dermatol 145(6):886-90 (2001 Dec).
Wilson JK, Al-Suwaidan SN, Krowchuk D, et al. Treatment of psoriasis in children: is there a role for antibiotic therapy and tonsillectomy? Pediatr Dermatol 20(1):11-5 (2003 Jan-Feb).
Lebwohl M. Combination, rotational and sequential therapy. In: Weinstein G, Gottlieb A, editors. Therapy of moderate to severe psoriasis. 2nd ed. New York: Marcel Dekker; p179-95 (2003).
See the latest psoriasis uv treatment information and buy Dermalight80 online
Authors and Disclosures:
K. M. Cordoro, MD, Department of Dermatology,
University of California, San Francisco, CA, USA
Phototherapy is an excellent, safe, and appropriate treatment for carefully selected patients with refractory plaque, guttate and pustular disease, diffuse (>15%-20% body surface area) involvement, or focal debilitating palmoplantar psoriasis. To avoid burns and other light-associated complications, it is essential to utilize a phototherapy unit with experienced and well-trained personnel who are comfortable working with children. Three main types of therapeutic light options exist: broadband UVB (BB-UVB, 280-320nm), NB-UVB (311-313nm) and UVA (320-400nm).
BB-UVB encompasses the most biologically active radiation in sunlight and guttate psoriasis responds best, but plaque psoriasis in children tends to be thinner and will respond to higher doses and a longer duration of treatment. One of the greatest advances in phototherapy for psoriasis is the use of NB-UVB, which, at therapeutic doses, is lesserythemogenic than other wavelengths in the UVB range.[16]
Centered on 311-313nm, NB-UVB is safe and effective for a number of photoresponsive dermatoses in children, including psoriasis.[17-19] Short-term side-effects of UVBphototherapy are usually mild and consist of xerosis, erythema, pruritus, and photoactivation of herpesvirus. Potential long-term effects include premature photoagingand cutaneous carcinogenesis.[20]
Photochemotherapy (psoralen plus ultraviolet A, [PUVA]) is based on the interaction between UVA radiation and psoralen, a photosensitizing chemical. In children less than12 years, oral PUVA is rarely used and if so, is done with extreme caution and should be restricted to psoriasis and phototherapy centers staffed by well trained, experiencedphysicians and nurses.
Many authors consider oral psoralen relatively contraindicated in children less than age 12 and prefer topical PUVA because of the many short- and longterm toxicities associated with psoralen ingestion (e.g., nausea, vomiting, headache, hepatotoxicity, generalizedphotosensitization requiring 24 hours of photoprotection, ocular toxicity, acute risk of burning, and long-term risk of skin cancer).[21] In children, NB-UVB is more convenient and may be less carcinogenic. Given the downsides of using psoralens in children and adults, NB-UVB is now considered first-line phototherapy.[22]
Kopp T, Karlhofer F, Szepfalusi Z, et al. Successful use of acitretin in conjunction with narrowband ultraviolet B phototherapy in a child with severe pustular psoriasis, von Zumbusch type. Br J Dermatol 151(4):912-6 (2004 Oct).
Lee CS, Koo J. A review of acitretin, a systemic retinoid for the treatment of psoriasis. Expert Opin Pharmacother 6(10):1725-34 (2005 Aug).
Lacour M, Mehta-Nikhar B, Atherton DJ, et al. An appraisal of acitretin therapy in children with inherited disorders of keratinization. Br J Dermatol 134(6):1023-9 (1996 Jun).
Brecher AR, Orlow SJ. Oral retinoid therapy for dermatologic conditions in children and adolescents. J Am Acad Dermatol 49(2):171-82 (2003 Aug).
Katugampola RP, Finlay AY. Oral retinoid therapy for disorders of keratinization: single-centre retrospective 25 years´ experience on 23 patients. Br J Dermatol 154(2):267-76 (2006 Feb).
Halverstam CP, Zeichner J, Lebwohl M. Lack of significant skeletal changes after long-term, low-dose retinoid therapy: case report and review of the literature. J Cutan Med Surg 10(6):291-9 (2006 Nov-Dec).
Paller AS. Dermatologic uses of methotrexate in children: indications and guidelines. Pediatr Dermatol 2(3):238-43 (1985 Mar).
Callen JP, Kulp-Shorten CL, Wolverton SE. Methotrexate. In: Wolverton SE, editor. Comprehensive dermatologic drug therapy. 2nd ed. Philadelphia: Saunders Elsevier; p163-81 (2007).
Swords S, Lauer SJ, Nopper AJ. Principles of treatment in pediatric dermatology: systemic treatment. In: Schachner LA, Hansen RC, editors. Pediatric dermatology. 3rd ed. Philadelphia: Mosby (Elsevier); p133-43 (2003).
Gisondi P, Fantuzzi F, Malerba M, et al. Folic acid in general medicine and dermatology. J Dermatolog Treat 18(3):138-46 (2007).
Lebwohl M, Ali S. Treatment of psoriasis. Part 2. Systemic therapies. J Am Acad Dermatol 45(5):649-61 (2001 Nov).
Pereira TM, Vieira AP, Fernandes JC, et al. Cyclosporin A treatment in severe childhood psoriasis. J Eur Acad Dermatol Venereol 20(6):651-6 (2006 Jul).
Koo J. Systemic sequential therapy of psoriasis: a new paradigm for improved therapeutic results. J Am Acad Dermatol 41(3 Pt 2):S25-8 (1999 Sep).
Ellis CN. Safety issues with cyclosporine. Int J Dermatol 36 Suppl 1:7-10 (1997 Dec).
Cordoro KM, Feldman SR. TNF-alpha inhibitors in dermatology. Skin Therapy Lett 12(7):4-6 (2007 Sep).
Kist JM, Van Voorhees AS. Narrowband ultraviolet B therapy for psoriasis and other skin disorders. Adv Dermatol 21:235-50 (2005).
al-Fouzan AS, Nanda A. UVB phototherapy in childhood psoriasis. Pediatr Dermatol 12(1):66 (1995 Mar).
Jain VK, Aggarwal K, Jain K, et al. Narrow-band UV-B phototherapy in childhood psoriasis. Int J Dermatol 46(3):320-2 (2007 Mar).
Tay YK, Morelli JG, Weston WL. Experience with UVB phototherapy in children. Pediatr Dermatol 13(5):406-9 (1996 Sep-Oct).
Pasic A, Ceovic R, Lipozencic J, et al. Phototherapy in pediatric patients. Pediatr Dermatol 20(1):71-7 (2003 Jan-Feb).
Wolff K. Side-effects of psoralen photochemotherapy (PUVA). Br J Dermatol 122 Suppl 36:117-25 (1990 Jun).
MacDonald A, Burden AD. Psoriasis: advances in pathophysiology and management. Postgrad Med J 83(985):690-7 (2007 Nov).
Owen CM, Chalmers RJ, O´Sullivan T, et al. A systematic review of antistreptococcal interventions for guttate and chronic plaque psoriasis. Br J Dermatol 145(6):886-90 (2001 Dec).
Wilson JK, Al-Suwaidan SN, Krowchuk D, et al. Treatment of psoriasis in children: is there a role for antibiotic therapy and tonsillectomy? Pediatr Dermatol 20(1):11-5 (2003 Jan-Feb).
Lebwohl M. Combination, rotational and sequential therapy. In: Weinstein G, Gottlieb A, editors. Therapy of moderate to severe psoriasis. 2nd ed. New York: Marcel Dekker; p179-95 (2003).
See the latest psoriasis uv treatment information and buy Dermalight80 online
Is Home phototherapy comparable to in-clinic treatment?
Is Home phototherapy comparable to in-clinic treatment?
SOURCE: Kristina Fiore, Staff Writer, MedPage Today
Published: May 08, 2009
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
TITLE: Home phototherapy is comparable to hospital-based ultraviolet B treatment for psoriasis patients, researchers have found.
In a randomized controlled trial, home phototherapy was as safe and effective as hospital-based treatment, Mayke Koek, M.D., of the University Medical Center Utrecht in the Netherlands, and colleagues reported online in BMJ.
“We regard home ultraviolet B phototherapy to be a worthy alternative to standard outpatient ultraviolet B phototherapy for patients with psoriasis,” the researchers concluded.
They explained that many patients who could benefit from phototherapy don’t get it because of time constraints: treatment typically involves going to the hospital three times a week for eight to 10 weeks.
Also, some dermatologists believe that home phototherapy is inferior to hospital treatment and carries more risks, such as inaccurate dosimetry, phototoxicity, and unsupervised continuation of irradiation. The researchers said there is little evidence for this.
So the present study looked at 196 psoriasis patients from 14 hospital dermatology departments in the Netherlands who received either home- or hospital-based phototherapy.
Home therapy patients used a TL-01 home phototherapy unit, while those who came to the hospital for treatment received standard, narrowband ultraviolet B phototherapy.
The researchers found that home phototherapy was as safe and effective as outpatient phototherapy, both clinically and in terms of quality of life.
A total of 82% of patients treated at home reached a treatment effect as measured by the self-administered psoriasis area and severity index (SAPASI), compared with 79% of those treated in an outpatient setting.
Likewise, 70% reached treatment effect as measured by the clinically assessed psoriasis area and severity index (PASI), compared with 73% of outpatients.
The treatment effects were significant across all groups (P<0.001).
As for safety concerns, the researchers found that patients treated themselves at home more frequently than they would have been treated at the hospital. But the cumulative dose they received by the end of treatment was only slightly higher than hospital-treated patients.
They found that regardless of treatment, 87% of patients had at least one occurrence of mild erythema, while 58% reported burning sensations, 39% had severe erythema, and 6% had blistering. No differences were observed between groups.
“Our results refute the widespread fear of more acute safety risks with ultraviolet B phototherapy used at home,” the researchers said.
They also found that the burden of undergoing phototherapy was significantly lower for patients treated at home (P<0.001).
Quality of life increased equally, regardless of treatment, but those treated at home were more likely to rate their experience with the therapy as “excellent” (42% versus 23%, P=0.001).
The researchers concluded that phototherapy administered at home is “equally safe and equally effective, both clinically and for quality of life, as ultraviolet B phototherapy administered in an outpatient setting.”
In an accompanying editorial, Alex Anstey, M.D., of Royal Gwent Hospital, called the study “pragmatic” and said an economic assessment of different phototherapy service models is now needed.
“This should include the costs of the equipment, costs of teaching patients how to use the equipment, and costs for a clinical governance system within which home phototherapy can operate,” Dr. Anstey said.
He added that dermatologists “should reflect on the shortcomings of current phototherapy services, where many patients are excluded because they live too far from their local unit. The case for home provision of UVB phototherapy for psoriasis is most persuasive in sparsely populated areas.”
Review the latest UVB phototherapy devices like Dermalight80 and DermarayUV
SOURCE: Kristina Fiore, Staff Writer, MedPage Today
Published: May 08, 2009
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
TITLE: Home phototherapy is comparable to hospital-based ultraviolet B treatment for psoriasis patients, researchers have found.
In a randomized controlled trial, home phototherapy was as safe and effective as hospital-based treatment, Mayke Koek, M.D., of the University Medical Center Utrecht in the Netherlands, and colleagues reported online in BMJ.
“We regard home ultraviolet B phototherapy to be a worthy alternative to standard outpatient ultraviolet B phototherapy for patients with psoriasis,” the researchers concluded.
They explained that many patients who could benefit from phototherapy don’t get it because of time constraints: treatment typically involves going to the hospital three times a week for eight to 10 weeks.
Also, some dermatologists believe that home phototherapy is inferior to hospital treatment and carries more risks, such as inaccurate dosimetry, phototoxicity, and unsupervised continuation of irradiation. The researchers said there is little evidence for this.
So the present study looked at 196 psoriasis patients from 14 hospital dermatology departments in the Netherlands who received either home- or hospital-based phototherapy.
Home therapy patients used a TL-01 home phototherapy unit, while those who came to the hospital for treatment received standard, narrowband ultraviolet B phototherapy.
The researchers found that home phototherapy was as safe and effective as outpatient phototherapy, both clinically and in terms of quality of life.
A total of 82% of patients treated at home reached a treatment effect as measured by the self-administered psoriasis area and severity index (SAPASI), compared with 79% of those treated in an outpatient setting.
Likewise, 70% reached treatment effect as measured by the clinically assessed psoriasis area and severity index (PASI), compared with 73% of outpatients.
The treatment effects were significant across all groups (P<0.001).
As for safety concerns, the researchers found that patients treated themselves at home more frequently than they would have been treated at the hospital. But the cumulative dose they received by the end of treatment was only slightly higher than hospital-treated patients.
They found that regardless of treatment, 87% of patients had at least one occurrence of mild erythema, while 58% reported burning sensations, 39% had severe erythema, and 6% had blistering. No differences were observed between groups.
“Our results refute the widespread fear of more acute safety risks with ultraviolet B phototherapy used at home,” the researchers said.
They also found that the burden of undergoing phototherapy was significantly lower for patients treated at home (P<0.001).
Quality of life increased equally, regardless of treatment, but those treated at home were more likely to rate their experience with the therapy as “excellent” (42% versus 23%, P=0.001).
The researchers concluded that phototherapy administered at home is “equally safe and equally effective, both clinically and for quality of life, as ultraviolet B phototherapy administered in an outpatient setting.”
In an accompanying editorial, Alex Anstey, M.D., of Royal Gwent Hospital, called the study “pragmatic” and said an economic assessment of different phototherapy service models is now needed.
“This should include the costs of the equipment, costs of teaching patients how to use the equipment, and costs for a clinical governance system within which home phototherapy can operate,” Dr. Anstey said.
He added that dermatologists “should reflect on the shortcomings of current phototherapy services, where many patients are excluded because they live too far from their local unit. The case for home provision of UVB phototherapy for psoriasis is most persuasive in sparsely populated areas.”
Review the latest UVB phototherapy devices like Dermalight80 and DermarayUV
UV phototherapy with Dermalight 80 on the eyelids.
Present status of eyelid phototherapy.
Clinical efficacy and transmittance of ultraviolet and visible radiation through human eyelids.
Prystowsky JH, Keen MS, Rabinowitz AD, Stevens AW, DeLeo VA.
Department of Dermatology, Columbia-Presbyterian Medical Center, New York, NY.
BACKGROUND: Phototherapy for the eyelid has not previously been recognized as a safe and effective treatment of photoresponsive dermatoses of the eyelid, such as atopic dermatitis, vitiligo, psoriasis, lymphomatoid papulosis, and parapsoriasis.
OBJECTIVE: The purpose of this study was to demonstrate the efficacy and safety of this treatment.
METHODS: Two cases are presented to demonstrate clinical efficacy. In addition, a retrospective eye evaluation of seven patients receiving a combined total of greater than 1300 eyelid phototherapy treatments was performed. To determine whether potentially harmful UV radiation is significantly transmitted through eyelid skin, an in vitro study was conducted to measure the percentage transmittance of ultraviolet-visible radiation through five excised eyelids.
RESULTS: In the two cases presented, remarkable improvement occurred without adverse side effects, suggesting that it is possible to deliver incremental UV dosages to eyelid skin to achieve clearing of skin disease. Retrospective analysis of patients’ records revealed no ocular disease from the phototherapy. In vitro eyelid examination produced data that indicated negligible quantities of UV radiation were transmitted through eyelid skin compared with the visible spectrum, in which up to 77% of the radiation was transmitted through the tissue.
CONCLUSION: The combined clinical experience and transmittance data suggest that eyelid phototherapy is a safe and effective treatment in selected patients.
Clinical efficacy and transmittance of ultraviolet and visible radiation through human eyelids.
Prystowsky JH, Keen MS, Rabinowitz AD, Stevens AW, DeLeo VA.
Department of Dermatology, Columbia-Presbyterian Medical Center, New York, NY.
BACKGROUND: Phototherapy for the eyelid has not previously been recognized as a safe and effective treatment of photoresponsive dermatoses of the eyelid, such as atopic dermatitis, vitiligo, psoriasis, lymphomatoid papulosis, and parapsoriasis.
OBJECTIVE: The purpose of this study was to demonstrate the efficacy and safety of this treatment.
METHODS: Two cases are presented to demonstrate clinical efficacy. In addition, a retrospective eye evaluation of seven patients receiving a combined total of greater than 1300 eyelid phototherapy treatments was performed. To determine whether potentially harmful UV radiation is significantly transmitted through eyelid skin, an in vitro study was conducted to measure the percentage transmittance of ultraviolet-visible radiation through five excised eyelids.
RESULTS: In the two cases presented, remarkable improvement occurred without adverse side effects, suggesting that it is possible to deliver incremental UV dosages to eyelid skin to achieve clearing of skin disease. Retrospective analysis of patients’ records revealed no ocular disease from the phototherapy. In vitro eyelid examination produced data that indicated negligible quantities of UV radiation were transmitted through eyelid skin compared with the visible spectrum, in which up to 77% of the radiation was transmitted through the tissue.
CONCLUSION: The combined clinical experience and transmittance data suggest that eyelid phototherapy is a safe and effective treatment in selected patients.
Enbrel Psoriasis Drug
What is the most important information I should know about ENBREL?
ENBREL is a medicine that affects your immune system. ENBREL can lower the ability of your immune system to fight infections. Serious infections have happened in patients taking ENBREL. These infections include tuberculosis (TB) and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Some patients have died from these infections. Your doctor should test you for TB before you take ENBREL and monitor you closely for TB while on ENBREL.
Before starting ENBREL, tell your doctor if you:
Think you have, are being treated for, have signs of, or are prone to infection. You should not start taking ENBREL if you have any kind of infection.
Have any open cuts or sores
Have diabetes or an immune system problem
Have TB or have been in close contact with someone who has had TB
Were born in, lived in, or traveled to countries where there is more risk for getting TB. Ask your doctor if you are not sure.
Live or have lived in certain parts of the country (such as, the Ohio and Mississippi River valleys, or the Southwest) where there is a greater risk for certain kinds of fungal infections, such as histoplasmosis. These infections may develop or become more severe if you take ENBREL. If you don't know if histoplasmosis or other fungal infections are common in the areas where you live or have lived, ask your doctor.
Have or have had hepatitis B
Have heart failure
Develop symptoms such as persistent fever, bruising, bleeding, or paleness while taking ENBREL
Use the medicine Kineret® (anakinra)
Have or develop a serious nervous disorder, seizures, any numbness or tingling, or a disease that affects your nervous system such as multiple sclerosis
Are scheduled to have surgery
Are scheduled for any vaccines. All vaccines should be brought up-to-date before starting ENBREL. Patients taking ENBREL should not receive live vaccines.
Are allergic to rubber or latex
Are pregnant, planning to become pregnant, or breastfeeding
After starting ENBREL, call your doctor right away if you have any sign of infection, including a fever, cough, flu-like symptoms, or have any open sores on your body. ENBREL can make you more likely to get infections or make any infection you have worse.
Possible side effects of ENBREL
Serious side effects include: serious infections including TB; nervous system problems, such as multiple sclerosis, seizures, or inflammation of the nerves of the eyes; rare reports of serious blood problems (some fatal); heart failure, including new heart failure or worsening of heart failure you already have; allergic reactions; immune reactions, including a lupus-like syndrome and lymphoma (a type of cancer). People with rheumatoid arthritis and psoriasis may have a higher chance for getting lymphoma.
Common side effects include: Injection site reaction, upper respiratory infections (including sinus infection), and headaches.
In a medical study of patients with JIA, infection, headache, abdominal pain, vomiting, and nausea occurred more frequently than in adults. The kinds of infections reported were generally mild and similar to those usually seen in children. Other serious adverse reactions were reported, including serious infection and depression/personality disorder.
If you have any questions about this information, be sure to discuss them with your doctor. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
Please see Prescribing Information and Medication Guide.
INDICATIONS
Moderate to Severe Rheumatoid Arthritis (RA)
ENBREL is indicated for reducing signs and symptoms, keeping joint damage from getting worse, and improving physical function in patients with moderate to severe rheumatoid arthritis. ENBREL can be taken with methotrexate or used alone.
In medical studies, ENBREL was shown to be effective in about 2 out of 3 adults with RA who used it, and has been shown to begin working in as few as 2 weeks, with most patients receiving benefit within 3 months. In an RA medical study, 55% of patients had no progression of joint damage.
Moderate to Severe Polyarticular Juvenile Idiopathic Arthritis (JIA)
ENBREL is indicated for reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis (JIA) in children ages 2 years and older.
In a medical study, ENBREL was shown to be effective in about 3 out of 4 children with JIA who used it. For these JIA patients, ENBREL has been shown to begin working in approximately 2 to 4 weeks.
Psoriatic Arthritis
ENBREL is indicated for reducing signs and symptoms, keeping joint damage from getting worse, and improving physical function in patients with psoriatic arthritis. ENBREL can be used in combination with methotrexate in patients who do not respond adequately to methotrexate alone.
In a medical study, ENBREL was shown to be effective in about 50% of psoriatic arthritis patients who used it. Clinical responses were apparent at the time of the first visit (4 weeks) and were maintained through 6 months of therapy.
Ankylosing Spondylitis (AS)
ENBREL is indicated for reducing signs and symptoms in patients with active ankylosing spondylitis.
In a medical study, ENBREL was shown to be effective in about 3 out of 5 adults with AS who used it. Clinical responses were seen at 2 weeks in 46% of patients, with 59% of patients receiving benefit within 8 weeks.
Moderate to Severe Plaque Psoriasis
ENBREL is indicated for the treatment of adult patients (18 years or older) with chronic moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy.
In medical studies, nearly half of patients saw a significant improvement in their plaque psoriasis within 3 months of using ENBREL. Overall, 3 out of 4 patients saw improvement. ENBREL can work fast; many patients saw improvement within 2 months. ENBREL has been shown to be effective through 12 months of therapy.
Why risk dangeous drugs like Enbrel? Consider a Dermalight80 or Deramaray UV
ENBREL is a medicine that affects your immune system. ENBREL can lower the ability of your immune system to fight infections. Serious infections have happened in patients taking ENBREL. These infections include tuberculosis (TB) and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Some patients have died from these infections. Your doctor should test you for TB before you take ENBREL and monitor you closely for TB while on ENBREL.
Before starting ENBREL, tell your doctor if you:
Think you have, are being treated for, have signs of, or are prone to infection. You should not start taking ENBREL if you have any kind of infection.
Have any open cuts or sores
Have diabetes or an immune system problem
Have TB or have been in close contact with someone who has had TB
Were born in, lived in, or traveled to countries where there is more risk for getting TB. Ask your doctor if you are not sure.
Live or have lived in certain parts of the country (such as, the Ohio and Mississippi River valleys, or the Southwest) where there is a greater risk for certain kinds of fungal infections, such as histoplasmosis. These infections may develop or become more severe if you take ENBREL. If you don't know if histoplasmosis or other fungal infections are common in the areas where you live or have lived, ask your doctor.
Have or have had hepatitis B
Have heart failure
Develop symptoms such as persistent fever, bruising, bleeding, or paleness while taking ENBREL
Use the medicine Kineret® (anakinra)
Have or develop a serious nervous disorder, seizures, any numbness or tingling, or a disease that affects your nervous system such as multiple sclerosis
Are scheduled to have surgery
Are scheduled for any vaccines. All vaccines should be brought up-to-date before starting ENBREL. Patients taking ENBREL should not receive live vaccines.
Are allergic to rubber or latex
Are pregnant, planning to become pregnant, or breastfeeding
After starting ENBREL, call your doctor right away if you have any sign of infection, including a fever, cough, flu-like symptoms, or have any open sores on your body. ENBREL can make you more likely to get infections or make any infection you have worse.
Possible side effects of ENBREL
Serious side effects include: serious infections including TB; nervous system problems, such as multiple sclerosis, seizures, or inflammation of the nerves of the eyes; rare reports of serious blood problems (some fatal); heart failure, including new heart failure or worsening of heart failure you already have; allergic reactions; immune reactions, including a lupus-like syndrome and lymphoma (a type of cancer). People with rheumatoid arthritis and psoriasis may have a higher chance for getting lymphoma.
Common side effects include: Injection site reaction, upper respiratory infections (including sinus infection), and headaches.
In a medical study of patients with JIA, infection, headache, abdominal pain, vomiting, and nausea occurred more frequently than in adults. The kinds of infections reported were generally mild and similar to those usually seen in children. Other serious adverse reactions were reported, including serious infection and depression/personality disorder.
If you have any questions about this information, be sure to discuss them with your doctor. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
Please see Prescribing Information and Medication Guide.
INDICATIONS
Moderate to Severe Rheumatoid Arthritis (RA)
ENBREL is indicated for reducing signs and symptoms, keeping joint damage from getting worse, and improving physical function in patients with moderate to severe rheumatoid arthritis. ENBREL can be taken with methotrexate or used alone.
In medical studies, ENBREL was shown to be effective in about 2 out of 3 adults with RA who used it, and has been shown to begin working in as few as 2 weeks, with most patients receiving benefit within 3 months. In an RA medical study, 55% of patients had no progression of joint damage.
Moderate to Severe Polyarticular Juvenile Idiopathic Arthritis (JIA)
ENBREL is indicated for reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis (JIA) in children ages 2 years and older.
In a medical study, ENBREL was shown to be effective in about 3 out of 4 children with JIA who used it. For these JIA patients, ENBREL has been shown to begin working in approximately 2 to 4 weeks.
Psoriatic Arthritis
ENBREL is indicated for reducing signs and symptoms, keeping joint damage from getting worse, and improving physical function in patients with psoriatic arthritis. ENBREL can be used in combination with methotrexate in patients who do not respond adequately to methotrexate alone.
In a medical study, ENBREL was shown to be effective in about 50% of psoriatic arthritis patients who used it. Clinical responses were apparent at the time of the first visit (4 weeks) and were maintained through 6 months of therapy.
Ankylosing Spondylitis (AS)
ENBREL is indicated for reducing signs and symptoms in patients with active ankylosing spondylitis.
In a medical study, ENBREL was shown to be effective in about 3 out of 5 adults with AS who used it. Clinical responses were seen at 2 weeks in 46% of patients, with 59% of patients receiving benefit within 8 weeks.
Moderate to Severe Plaque Psoriasis
ENBREL is indicated for the treatment of adult patients (18 years or older) with chronic moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy.
In medical studies, nearly half of patients saw a significant improvement in their plaque psoriasis within 3 months of using ENBREL. Overall, 3 out of 4 patients saw improvement. ENBREL can work fast; many patients saw improvement within 2 months. ENBREL has been shown to be effective through 12 months of therapy.
Why risk dangeous drugs like Enbrel? Consider a Dermalight80 or Deramaray UV
Evaluation of narrow-band UVB phototherapy in 150 patients with vitiligo
Evaluation of narrow-band UVB phototherapy in 150 patients with vitiligo
AUTHORS: Y Hari Kishan Kumar1, G Raghu Rama Rao1, K.V.T Gopal, G Shanti, K Veerabhadra Rao
Background: Very few studies have been performed to evaluate the efficacy and safety of narrow-band ultraviolet B (NBUVB) therapy in Indian patients with vitiligo and are of small sample size.
Aims: The purpose of this study is to know the efficacy and safety of NBUVB in 150 vitiligo patients of various age groups.
Methods: One hundred fifty patients (69 males, 81 females), aged 3-70 years, with vitiligo were treated twice weekly with NBUVB. The starting dose was 250 mJ/cm 2 in adults and 150 mJ/cm 2 in children, with 20% dose increments at each subsequent visit given for a maximum period of 1 year and were followed-up for 6 months for stability of repigmentation. Statistical methods were employed to establish the relation between the response and the number of exposures, duration of treatment, cumulative dose and the compliance.
Results: Analysis of our study showed that a majority of our cases, about 73, achieved 25-75% repigmentation, with an average of 51 ± 19 exposures, 51 had <25%>75% repigmentation, with an average of 74 ± 24 exposures. Good response to therapy was directly associated with good compliance, more number of exposures and increasing cumulative dose, which was statistically significant (P < 0.01). Adverse effects were minimal. Only three patients developed depigmentation of repigmented sites during follow-up.
Conclusion: Our study proves that NBUVB therapy is an effective and safe tool in the management of vitiligo, with good stability of repigmentation and cosmetic appearance.
Compare Dermalight 80 and Dermaray UV
AUTHORS: Y Hari Kishan Kumar1, G Raghu Rama Rao1, K.V.T Gopal, G Shanti, K Veerabhadra Rao
Background: Very few studies have been performed to evaluate the efficacy and safety of narrow-band ultraviolet B (NBUVB) therapy in Indian patients with vitiligo and are of small sample size.
Aims: The purpose of this study is to know the efficacy and safety of NBUVB in 150 vitiligo patients of various age groups.
Methods: One hundred fifty patients (69 males, 81 females), aged 3-70 years, with vitiligo were treated twice weekly with NBUVB. The starting dose was 250 mJ/cm 2 in adults and 150 mJ/cm 2 in children, with 20% dose increments at each subsequent visit given for a maximum period of 1 year and were followed-up for 6 months for stability of repigmentation. Statistical methods were employed to establish the relation between the response and the number of exposures, duration of treatment, cumulative dose and the compliance.
Results: Analysis of our study showed that a majority of our cases, about 73, achieved 25-75% repigmentation, with an average of 51 ± 19 exposures, 51 had <25%>75% repigmentation, with an average of 74 ± 24 exposures. Good response to therapy was directly associated with good compliance, more number of exposures and increasing cumulative dose, which was statistically significant (P < 0.01). Adverse effects were minimal. Only three patients developed depigmentation of repigmented sites during follow-up.
Conclusion: Our study proves that NBUVB therapy is an effective and safe tool in the management of vitiligo, with good stability of repigmentation and cosmetic appearance.
Compare Dermalight 80 and Dermaray UV
Canadian Study discusses safety of UVB Narrow Band
Canadian Study discusses safety of UVB Narrow Band
Are narrow-band ultraviolet B home units a viable option for continuous or maintenance therapy of photoresponsive diseases?
Narrow-band ultraviolet B home phototherapy was found to be an effective form of maintenance therapy for photoresponsive diseases.
AUTHORS: Haykal KA, DesGroseilliers JP.
Division of Dermatology, University of Ottawa, Canada. khayk097@uottawa.ca
BACKGROUND: Phototherapy is an effective treatment for several photoresponsive diseases. Many patients are unable to attend hospital-based treatment and prefer home phototherapy.
OBJECTIVES: The purpose of this study is to survey patients who were prescribed home phototherapy to determine the viability of narrow-band ultraviolet B home units in the continuous or maintenance treatment of photoresponsive diseases.
METHODS: A patient questionnaire was prepared focusing on different areas of interest: the reason for choosing home therapy, appropriate teaching, previous medical treatment, present exposure therapy, improvement of the condition, side effects, regular dermatologic follow-ups, and the effectiveness of this approach. Twenty-seven patients who attended the photodermatology clinics at the Sisters of Charity of Ottawa Health Service at the Elisabeth Bruyère Health Centre in Ottawa and the Ottawa Hospital Civic Campus were contacted, and they completed a questionnaire by telephone or electronic mail.
RESULTS: Twenty-five patients completed the questionnaire. One refused to participate, and one was out of the country. The main reasons for choosing home phototherapy were time (40%), travel expenses (25%), difficulty with work schedule (17%), and recommendation by a physician (6%). Other reasons included loss of earnings, personal stress, knowledge that the disease recurs when phototherapy is discontinued, moving from the city, personal stress, and the convenience of being at home. Regarding the effectiveness of the home phototherapy, 24 patients (96%) viewed the home unit approach to be effective. All patients agreed that they would continue the treatment; they would repeat it, and they would recommend it. Few patients reported side effects, such as erythema (36%), blisters (1%), pruritus (8%), and dryness (1%). Fourteen patients (56%) reported not experiencing any side effects.
CONCLUSION: Narrow-band ultraviolet B home phototherapy was found to be an effective form of maintenance therapy for photoresponsive diseases. It is safe and presents few side effects when patients receive appropriate guidelines, teaching, and follow-ups.
PMID: 17234107 [PubMed - indexed for MEDLINE]
Article Source http://www.ncbi.nlm.nih.gov/pubmed/17234107
2006 Sep-Oct;10(5):234-40
Buy the latest Narrow Band UVB Dermaray UV here
Are narrow-band ultraviolet B home units a viable option for continuous or maintenance therapy of photoresponsive diseases?
Narrow-band ultraviolet B home phototherapy was found to be an effective form of maintenance therapy for photoresponsive diseases.
AUTHORS: Haykal KA, DesGroseilliers JP.
Division of Dermatology, University of Ottawa, Canada. khayk097@uottawa.ca
BACKGROUND: Phototherapy is an effective treatment for several photoresponsive diseases. Many patients are unable to attend hospital-based treatment and prefer home phototherapy.
OBJECTIVES: The purpose of this study is to survey patients who were prescribed home phototherapy to determine the viability of narrow-band ultraviolet B home units in the continuous or maintenance treatment of photoresponsive diseases.
METHODS: A patient questionnaire was prepared focusing on different areas of interest: the reason for choosing home therapy, appropriate teaching, previous medical treatment, present exposure therapy, improvement of the condition, side effects, regular dermatologic follow-ups, and the effectiveness of this approach. Twenty-seven patients who attended the photodermatology clinics at the Sisters of Charity of Ottawa Health Service at the Elisabeth Bruyère Health Centre in Ottawa and the Ottawa Hospital Civic Campus were contacted, and they completed a questionnaire by telephone or electronic mail.
RESULTS: Twenty-five patients completed the questionnaire. One refused to participate, and one was out of the country. The main reasons for choosing home phototherapy were time (40%), travel expenses (25%), difficulty with work schedule (17%), and recommendation by a physician (6%). Other reasons included loss of earnings, personal stress, knowledge that the disease recurs when phototherapy is discontinued, moving from the city, personal stress, and the convenience of being at home. Regarding the effectiveness of the home phototherapy, 24 patients (96%) viewed the home unit approach to be effective. All patients agreed that they would continue the treatment; they would repeat it, and they would recommend it. Few patients reported side effects, such as erythema (36%), blisters (1%), pruritus (8%), and dryness (1%). Fourteen patients (56%) reported not experiencing any side effects.
CONCLUSION: Narrow-band ultraviolet B home phototherapy was found to be an effective form of maintenance therapy for photoresponsive diseases. It is safe and presents few side effects when patients receive appropriate guidelines, teaching, and follow-ups.
PMID: 17234107 [PubMed - indexed for MEDLINE]
Article Source http://www.ncbi.nlm.nih.gov/pubmed/17234107
2006 Sep-Oct;10(5):234-40
Buy the latest Narrow Band UVB Dermaray UV here
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