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Lasers in Medical Science 04/2013; · 2.00 Impact Factor
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ABSTRACT: BACKGROUND: Self-administration of narrowband (TL-01) UVB phototherapy by patients at home is a safe and effective mode of treatment. Could selected patients self-administer phototherapy in hospital? OBJECTIVES: To assess the feasibility of outpatient self-administration of UVB phototherapy as a potential service development. METHODS: A total of 20 patients with psoriasis (n = 15) and eczema (n = 5), (13 females, mean age 32 years, range 17 to 56), were included in this pilot project. Patients underwent a training programme over two days, which included a Minimal Erythemal Dose (MED) test and supervised treatment, prior to commencing self-administration of phototherapy. Questionnaires were used to gather feedback from patients and staff. RESULTS: Treatment data were collected for 18 (of 20) patients. The mean number of exposures was 25 (range 3 to 45), and the mean cumulative dose was 16 J/cm² (range 0.23 to 41.27). No unexpected adverse effects were noted. These results were similar to that of a sample group of outpatients who had nurse administered UVB phototherapy, for whom the mean number of exposures was 24 (range 4 to 49) and the mean cumulative dose was 17 J/cm² (range 0.53 to 71.16). Thirteen (of 20) patients completed the questionnaires. All concluded that the training programme sufficiently prepared them for self-administering phototherapy, and 12 reported that they would be happy to self-administer treatment in the future. CONCLUSIONS: Self-administration of UVB phototherapy is practicable, safe and effective for most selected patients. This mode of treatment provides training and support for patients to gain more control over management of their skin disease, empowering them to take an active role in their treatment. Self-administration of UVB phototherapy by outpatients provides an intermediate level of care between nurse-administered hospital phototherapy and self-administered home phototherapy.
British Journal of Dermatology 03/2013; · 3.67 Impact Factor
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ABSTRACT: Background Exposure to ultraviolet (UV) radiation from sunlight is recognized as the principal cause of skin cancer. Moreover, sunbeds have been classified as carcinogenic by the International Agency for Research on Cancer. Despite this, there is a shortage of objective data on UV exposure levels in sunbeds in England. Objectives We set out to measure UV emission levels in sunbeds at sites around England, and to compare these levels with both current standards and natural sunlight. Methods Between October 2010 and February 2011, UV spectra were measured on site from a total of 402 artificial tanning units in England. Measurement instrumentation was calibrated, traceable to the National Physical Laboratory. Compliance with the relevant British and European standard was determined, and a skin-cancer weighting factor was used to compare the carcinogenic potential of sunbeds with that of sunlight. Results For compliance with the European standard, erythemal-effective irradiance should not exceed 0·3 W m(-2) . The values that we measured ranged between 0·10 and 1·32 W m(-2) with a mean of 0·56 ± 0·21 W m(-2) . Only 10% of sunbeds surveyed were within the recommended limit. Application of the skin-cancer weighting factor produced values that varied from 0·17 to 2·52 W m(-2) with a mean of 0·99 ± 0·41 W m(-2) . The comparable value for Mediterranean noonday sun was 0·43 W m(-2) . Conclusions Nine out of 10 sunbeds surveyed throughout England emitted levels of UV radiation that exceed the maximum levels contained within the European standard. Moreover, the skin cancer risk for comparable times of exposure was up to six times higher than that for Mediterranean sunlight. This situation is unacceptable and stricter control measures must be put in place.
British Journal of Dermatology 01/2013; · 3.67 Impact Factor
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ABSTRACT: The choice of light source is important for the efficacy of photodynamic therapy (PDT) of non-melanoma skin cancer. We simulated the photodynamic dose (PDD) delivered to a tumour during PDT using theoretical radiation transfer simulations performed via our 3D Monte Carlo radiation transfer (MCRT) model for a range of light sources with light doses up to 75 J cm(-2). The PDD delivered following superficial irradiation from (A) non-laser light sources, (B) monochromatic light, (C) alternate beam diameters and (D) re-positioning of the tumour within the tissue was computed. (A) The final PDD deposited to the tumour at a depth of 2 mm by the Paterson light source was 2.75, 2.50 and 1.04 times greater than the Waldmann 1200, Photocure and Aktilite, respectively. (B) Tumour necrosis occurred at a depth of 2.23 mm and increased to 3.81 mm for wavelengths 405 and 630 nm, respectively. (C) Increasing the beam diameter from 10 to 50 mm had very little effect on depth of necrosis. (D) As expected, necrosis depths were reduced when the tumour was re-positioned deeper into the tissue. These MCRT simulations show clearly the importance of choosing the correct light source to ensure optimal light delivery to achieve tumour necrosis.
Physics in Medicine and Biology 09/2012; 57(20):6327-45. · 2.83 Impact Factor
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A C Kerr,
J Ferguson,
S K Attili,
P E Beattie,
A J Coleman,
R S Dawe,
B Eberlein,
V Goulden,
S H Ibbotson,
H du P Menage, H Moseley,
L Novakovic,
S L Walker,
J A Woods,
A R Young,
R P E Sarkany
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ABSTRACT: Whole-body ultraviolet (UV)A1 (340-400 nm) phototherapy was first introduced 30 years ago, but is currently available in the UK in only three dermatology departments. A workshop to discuss UVA1 was held by the British Photodermatology Group in May 2009, the aim of which was to provide an overview of UVA1 phototherapy and its role in practice, and to identify areas in which further studies are required. The conclusions were that UVA1 phototherapy is an effective treatment in several inflammatory skin diseases, including localized scleroderma and atopic eczema (AE); however, deficiencies and limitations exist in the published evidence base. For most diseases, such as AE, other treatments also exist, which are generally more effective than UVA1. However, for some diseases, particularly morphoea, the evidence of efficacy is stronger for UVA1 than for other treatments. Acute adverse effects of UVA1 are minimal. The risk of long-term adverse effects, particularly skin cancer, is unknown. Medium to high doses of UVA1 are needed for efficacy in most situations, but the equipment to deliver such doses is large, expensive and difficult to install. UVA1 is currently underprovided, and the recommendation of the workshop is that more tertiary centres should have access to UVA1 phototherapy in the UK.
Clinical and Experimental Dermatology 01/2012; 37(3):219-26. · 1.20 Impact Factor
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ABSTRACT: Every year in the UK about 75,000 cases of non-melanoma skin cancer (NMSC) are registered, and about 9500 people are diagnosed with cutaneous melanoma (CM). The main risk factor for these cancers is exposure to sunlight. The effects of light on skin are wavelength dependent, with wavelengths in the UVB waveband (280-315 nm) being the most carcinogenic. UVB is directly absorbed by DNA, producing dimeric pyrimidine photoproducts including cyclobutane pyrimidine dimers (CPD) and pyrimidine (6-4) pyrimodone photoproducts (6-4PP). However UVA (315-400 nm) can also produce CPD, induce skin tumours in mice, and has been shown to be mutagenic in cell culture. Although the precise role of UVA in human skin cancer remains to be elucidated, it comprises the major portion of solar UV radiation, transmits through window glass and can be delivered in high doses from tanning lamps. Non-steroidal anti-inflammatory drugs (NSAIDs), in particular the 2-aryl propionic acid derivatives, are a well-documented group of photosensitising chemicals producing clinical phototoxic and photoallergic reactions. We have used carprofen, a model compound from this group to see if it could amplify the effects of UVA and contribute to the formation of CPD by UVA. Preliminary work has shown that carprofen combined with low doses of UVA (lambda(max): 365 nm; 5 J/cm(2)) can produce both strand breaks (SB) and CPD in human skin or blood cells. CPD were detected indirectly by both an immunofluorescence method and as T4 endonuclease V sensitive sites in the comet assay. These findings show that compounds other than fluoroquinolones and psoralen derivatives may contribute to CPD formation in skin cells in combination with UVA.
Toxicology in Vitro 03/2010; 24(4):1126-32. · 2.78 Impact Factor
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ABSTRACT: Background Photodynamic therapy (PDT) is a popular treatment for nonmelanoma skin cancer with clearance rates of between 70% and 100%. Although reported to have a superior cosmetic outcome, the inconvenience of hospital visits and discomfort during therapy are considered drawbacks.Objectives To present an open pilot study of a low-irradiance, potentially disposable, lightweight, organic light-emitting diode (OLED), which is an area-emitting light source (2 cm diameter), suitable for ambulatory PDT.Methods Twelve patients with Bowen’s disease (eight) and superficial basal cell carcinoma (four) < 2 cm in diameter were recruited into the study following histological confirmation of the diagnosis. Two treatments (45–60 J cm−2 red light, 550–750 nm, peak 620 nm, irradiance 5 mW cm−2) were administered 1 month apart following application of aminolaevulinic acid for 4 h.Results At the 12-month follow-up, seven of the 12 patients remained clear, with four of the nonresponders demonstrating peripheral margin failure. Patients were scored for pain during and immediately after treatment using the numerical rating scale (NRS; 1–10). All 12 subjects scored pain as < 2 using the NRS (median score 1). In contrast, a similar cohort of 50 consecutive patients from our routine PDT clinic (Aktilite® inorganic LED source; 75 J cm−2, irradiance 80 mW cm−2) scored a median of 6 on the NRS.Conclusions Pain and inconvenience are practical barriers to the use of conventional PDT. This pilot study suggests that OLED-PDT is less painful than conventional PDT with the added advantage of being lightweight, and therefore has the potential for more convenient ‘home PDT’. These results need to be validated in larger studies.
British Journal of Dermatology 06/2009; 161(1):170 - 173. · 3.67 Impact Factor
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ABSTRACT: Photodynamic therapy (PDT) is a popular treatment for nonmelanoma skin cancer with clearance rates of between 70% and 100%. Although reported to have a superior cosmetic outcome, the inconvenience of hospital visits and discomfort during therapy are considered drawbacks.
To present an open pilot study of a low-irradiance, potentially disposable, lightweight, organic light-emitting diode (OLED), which is an area-emitting light source (2 cm diameter), suitable for ambulatory PDT.
Twelve patients with Bowen's disease (eight) and superficial basal cell carcinoma (four) < 2 cm in diameter were recruited into the study following histological confirmation of the diagnosis. Two treatments (45-60 J cm(-2) red light, 550-750 nm, peak 620 nm, irradiance 5 mW cm(-2)) were administered 1 month apart following application of aminolaevulinic acid for 4 h.
At the 12-month follow-up, seven of the 12 patients remained clear, with four of the nonresponders demonstrating peripheral margin failure. Patients were scored for pain during and immediately after treatment using the numerical rating scale (NRS; 1-10). All 12 subjects scored pain as < 2 using the NRS (median score 1). In contrast, a similar cohort of 50 consecutive patients from our routine PDT clinic (Aktilite inorganic LED source; 75 J cm(-2), irradiance 80 mW cm(-2)) scored a median of 6 on the NRS.
Pain and inconvenience are practical barriers to the use of conventional PDT. This pilot study suggests that OLED-PDT is less painful than conventional PDT with the added advantage of being lightweight, and therefore has the potential for more convenient 'home PDT'. These results need to be validated in larger studies.
British Journal of Dermatology 03/2009; 161(1):170-3. · 3.67 Impact Factor
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ABSTRACT: Compact fluorescent lamps (CFLs) are due to replace common incandescent lamps over the next few years. There has been no investigation of the possible effect of this on patients with photosensitive disorders.
To determine the effect of exposure of photosensitive individuals to light from CFLs.
The spectral emission from a sample of CFLs was measured using a calibrated spectroradiometer. The erythemal response was determined in one normal individual and four photosensitive individuals by direct exposure of the skin to light from a CFL. The susceptibility of a wider group of photosensitive individuals was predicted based on the light dose known to elicit a reaction during phototesting at discrete ultraviolet (UV) wavelengths.
CFLs emit UV radiation at wavelengths down to 254 nm. Prolonged exposure of a normal individual's skin produced erythema. However, an exposure of only 2.5 min at 5 cm elicited marked erythema in one of the abnormally photosensitive patients.
CFLs could be a source of harmful UV radiation to photosensitive individuals. Patients with chronic actinic dermatitis are thought to be at greatest risk. The use of a protective envelope is recommended.
British Journal of Dermatology 02/2009; 160(3):659-64. · 3.67 Impact Factor
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ABSTRACT: Excessive facial hair in women can cause significant psychological distress. A variety of treatment methods are available, including lasers and, more recently, intense pulsed light (IPL) sources. There are very few studies comparing laser and IPL devices. The purpose of our study was to compare a laser diode device with an IPL, using a within-patient, right-left, assessor-blinded, controlled, study design. Hair counts were made, using coded close-up photographs. Treatments were carried out on three occasions at 6-week intervals, and a final assessment was made 6 weeks following the third treatment. Patient self-assessment was also included. Nine women were recruited, and seven completed the study. Average hair counts in a 16 cm(2) area before and after treatment were, respectively, 42.4 and 10.4 (laser), 38.1 and 20.4 (IPL), 45.3 and 44.7 (control). Both laser and IPL reduced the hair count substantially; laser vs control was significant at P=0.028, but IPL vs control had P=0.13, suggesting that more subjects or more treatments were required if statistical significance were to be achieved. Despite subjecting the patients to higher pain scores and more inflammation, laser was preferred by five patients; two preferred IPL and one had no preference.
Lasers in Medical Science 12/2007; 23(4):393-7. · 2.00 Impact Factor
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ABSTRACT: A survey of all sunbeds in a local authority area was carried out in 1998. Since then, there have been technological developments leading to new 'fast-tan' sunlamps which have become increasingly popular, along with unmanned sun parlours. In addition, new British and European sunbed standards have been set.
To discover the commercial uptake of new high power sunlamps and to determine the impact on carcinogenic risk from sunbeds.
Onsite spectral measurements, traceable to national standards, were conducted at all commercial sunbed premises within two local authorities and a quantitative risk assessment applied to the findings using a skin cancer model. Sunbed users were asked to complete a questionnaire regarding their reasons for using a sunbed and the risk associated with its use.
We found a 30% increase in the number of privately operated sunbeds since our 1998 survey. The median cancer-weighted exposure of all 133 sunbeds was comparable to that of Mediterranean sunlight. This was a significant increase compared to 1998. Moreover, 83% of sunbeds produced ultraviolet (UV) B radiation levels that exceeded the European standard. Fifteen per cent of respondents thought that there were no risks from use of sunbeds.
Sunbeds in current use carry a cancer risk comparable to Mediterranean sunlight. This is due to the use of new high power lamps. New British and European standards are being largely ignored with more than four out of five sunbeds exceeding the limit specified in the standard. There is a strong case for regulation of sunbed operators coupled to improved public education.
British Journal of Dermatology 09/2007; 157(2):350-6. · 3.67 Impact Factor
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A M Bryden, H Moseley,
S H Ibbotson,
M M U Chowdhury,
M H Beck,
J Bourke,
J English,
P Farr,
I S Foulds,
D J Gawkrodger, [......],
S Shaw,
J McFadden,
P Norris,
P Podmore,
S Powell,
L E Rhodes,
J Sansom,
M Wilkinson,
H van Weelden,
J Ferguson
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ABSTRACT: Photoallergic contact dermatitis can be difficult to diagnose if not appropriately investigated. Currently, the most common U.K. photoallergens appear to be sunscreen chemicals. The investigation of choice is photopatch testing (PPT), which is probably underused. In part, this is due to differences in methodology and results interpretation.
To conduct PPT using a group of sunscreen chemicals, defined indications and a standardized methodology including interpretation and relevance of reactions in patients attending for investigation at 17 centres across the U.K., Ireland and the Netherlands.
Patients (n = 1155) who fulfilled the inclusion criteria were investigated with PPT using sunscreen chemicals in addition to suspected topical products. Readings were taken at 24, 48 and 72 h following standardized ultraviolet A irradiation (5 J cm(-2)). The clinical relevance of any reaction was recorded.
Of the 1155, 130 had allergic reactions (11.3%). Of these, 51 had photoallergy (PA) (4.4%), 64 had contact allergy (CA) (5.5%), and 15 patients had combined PA and CA (1.3%). Multiple PA was seen in some. The most common photoallergen was benzophenone-3 (27 reactions; 21%). Most reactions (60%) were clinically relevant. The most common indication for testing in patients found to have PA was a history of reacting to a sunscreen (41%). The other 59% had an exposed-site dermatitis/skin problem or a photodermatosis. Some centres (n = 8) performed readings after the standard 48-h reading, and an extra 32 PA and 22 CA reactions were detected, which were not evident at 48 h. A new photoallergen (octyl triazone) was detected in two patients.
Sunscreen PA and CA are probably equally uncommon. Most reactions, of both reaction types, were relevant clinically. A large proportion of patients (59%) found to have PA was unaware of reacting to a sunscreen chemical, suggesting that PA should be considered as an explanation in any exposed-site dermatitis. Although this study focused on reactions at 48 h postirradiation, readings performed up to 96 h, while inconvenient, add value by detecting additional relevant responses. A previously unknown photoallergen was found, highlighting the need for awareness of novel photoallergens in the marketplace. A standardized PPT method not only encourages more use of this investigation, but also facilitates comparison of results between centres and so will improve our understanding of PA.
British Journal of Dermatology 11/2006; 155(4):737-47. · 3.67 Impact Factor
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A.M. Bryden, H. Moseley,
S.H. Ibbotson,
M.M.U. Chowdhury,
M.H. Beck,
J. Bourke,
J. English,
P. Farr,
I.S. Foulds,
D.J. Gawkrodger, [......],
S. Shaw,
J. McFadden,
P. Norris,
P. Podmore,
S. Powell,
L.E. Rhodes,
J. Sansom,
M. Wilkinson,
H. Van Weelden,
J. Ferguson
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ABSTRACT: Background Photoallergic contact dermatitis can be difficult to diagnose if not appropriately investigated. Currently, the most common U.K. photoallergens appear to be sunscreen chemicals. The investigation of choice is photopatch testing (PPT), which is probably underused. In part, this is due to differences in methodology and results interpretation.Objectives To conduct PPT using a group of sunscreen chemicals, defined indications and a standardized methodology including interpretation and relevance of reactions in patients attending for investigation at 17 centres across the U.K., Ireland and the Netherlands.Methods Patients (n = 1155) who fulfilled the inclusion criteria were investigated with PPT using sunscreen chemicals in addition to suspected topical products. Readings were taken at 24, 48 and 72 h following standardized ultraviolet A irradiation (5 J cm−2). The clinical relevance of any reaction was recorded.Results Of the 1155, 130 had allergic reactions (11·3%). Of these, 51 had photoallergy (PA) (4·4%), 64 had contact allergy (CA) (5·5%), and 15 patients had combined PA and CA (1·3%). Multiple PA was seen in some. The most common photoallergen was benzophenone-3 (27 reactions; 21%). Most reactions (60%) were clinically relevant. The most common indication for testing in patients found to have PA was a history of reacting to a sunscreen (41%). The other 59% had an exposed-site dermatitis/skin problem or a photodermatosis. Some centres (n = 8) performed readings after the standard 48-h reading, and an extra 32 PA and 22 CA reactions were detected, which were not evident at 48 h. A new photoallergen (octyl triazone) was detected in two patients.Conclusions Sunscreen PA and CA are probably equally uncommon. Most reactions, of both reaction types, were relevant clinically. A large proportion of patients (59%) found to have PA was unaware of reacting to a sunscreen chemical, suggesting that PA should be considered as an explanation in any exposed-site dermatitis. Although this study focused on reactions at 48 h postirradiation, readings performed up to 96 h, while inconvenient, add value by detecting additional relevant responses. A previously unknown photoallergen was found, highlighting the need for awareness of novel photoallergens in the marketplace. A standardized PPT method not only encourages more use of this investigation, but also facilitates comparison of results between centres and so will improve our understanding of PA.
British Journal of Dermatology 09/2006; 155(4):737 - 747. · 3.67 Impact Factor
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D. Bilsland,
B.L. Diffey,
P.M. Farr,
J. Ferguson,
N.K. Gibbs,
J.L.M. Hawk,
B.E. Johnson,
I.A. Magnus, H. Moseley,
G.M. Mruphy,
P.G. Norris,
A. Pierce
British Journal of Dermatology 07/2006; 127(3):297 - 299. · 3.67 Impact Factor
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ABSTRACT: The Scottish PDT Centre has carried out 3,442 treatments on 762 patients with superficial skin lesions, especially superficial basal cell carcinoma (sBCC), Bowen's disease (BD) and actinic keratosis (AK). STUDY DESIGN MATERIALS AND METHODS: The article reviews our experience of various light sources and associated dosimetry; thereafter we discuss clinical outcome followed by some of our research studies in clinically important areas.
We show that improved dosimetry is required to ensure an optimal light dose is delivered to the tumour. We have shown that photosensitizers and proteins interact in such a way that their photophysical and photochemical properties are modified. We have also demonstrated the presence of DNA strand breaks with two different photosensitizers, but there is no evidence that PDT is significantly mutagenic in clinical practice.
In our experience, topical PDT is generally well tolerated and is an effective treatment of sBCC, BD, AK, field change and lesions at sites of poor healing.
Lasers in Surgery and Medicine 07/2006; 38(5):403-16. · 2.75 Impact Factor
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ABSTRACT: Photodynamic therapy (PDT) has been shown to be effective in treating Bowen's disease, superficial basal cell carcinoma and actinic keratosis.
To investigate the feasibility of delivering PDT using a portable light-emitting diode device.
A prototype diode array, comprising 37 AlGaInP diodes cast in epoxy with a diffuser, and driven by a battery pack, was designed and constructed. A pilot study was carried out in five patients with histologically proven Bowen's disease who were referred for PDT with 5-aminolaevulinic acid. They were all treated in the hospital-based dermatology PDT suite such that each received the same level of supervision as patients receiving PDT with nonambulatory light sources. Patients recorded pain levels. In accordance with our usual practice, patients received two treatments at a 4-week interval.
Four of five patients were clear at follow-up (range 6-13 months, median 9). Pain was classified as none or mild in 80% of treatments and moderate in the remainder.
There are many potential benefits of ambulatory PDT, including the possibility of a much higher patient throughput, and allowing effective treatment at home. This pilot study provides early promising data of the safety and efficacy of this approach.
British Journal of Dermatology 05/2006; 154(4):747-50. · 3.67 Impact Factor
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ABSTRACT: Dead Sea (DS) salt solution soaks are used in combination with narrowband ultraviolet B (NB-UVB) to treat psoriasis in many centres, particularly in continental Europe. No previously published controlled study has assessed DS salt + NB-UVB balneophototherapy.
To compare DS salt balneophototherapy with NB-UVB monotherapy for chronic plaque psoriasis.
Sixty patients with chronic plaque psoriasis participated in this paired, controlled study, with pretreatment DS salt soaks randomly allocated to each participant's right or left study limb. Psoriasis severity was assessed with a Scaling, Erythema and Induration score by a blinded observer. Assessments were weekly during the therapy course, and thereafter 8-weekly until relapse or for up to 1 year after clearance.
The mean area under the psoriasis severity-time curves during treatment was not detectably lower with DS salt balneophototherapy than with NB-UVB monotherapy (P = 0.099). The psoriasis severity score fell slightly more from beginning to end of courses with DS salt balneophototherapy than with NB-UVB monotherapy (P = 0.019). There was no detectable difference in times to relapse.
In this population the addition of pretreatment DS salt soaks to NB-UVB did not result in a clinically important improvement in clearance of psoriasis.
British Journal of Dermatology 10/2005; 153(3):613-9. · 3.67 Impact Factor
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ABSTRACT: Extract of St. John's Wort (Hypericum perforatum) is commonly used as natural remedy for treatment of mild to moderate depression. However, it contains a powerful photoactive component, hypericin, which can cause a severe photodermatitis when eaten by grazing animals (hypericism). In humans, there is evidence that supplementation with St. John's Wort can reduce the minimal erythemal dose (MED) in patients undergoing high dose UVA-1 phototherapy. This is a recent development in phototherapy where the most erythemogenic parts of the UVA spectrum are filtered out, allowing delivery of higher doses of the longer wavelengths of UVA. Although current published evidence suggests that the plasma levels of hypericin are unlikely to cause clinical phototoxicity, it has been established that photoactive compounds can cause DNA damage at sub-toxic and sub-erythemal doses, the effects of which might not be apparent for many years after the event. The present study used HaCaT keratinocytes to investigate the photoclastogenic ability of hypericin on irradiation with UVA. The results show that although the combination of hypericin and UVA light increased the genotoxic burden, when all factors are taken into account, the risk of significant photogenotoxic damage incurred by the combination of Hypericum extracts and UVA phototherapy may be low in the majority of individuals.
Toxicology Letters 10/2005; 158(3):220-4. · 3.23 Impact Factor
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ABSTRACT: Background Dead Sea (DS) salt solution soaks are used in combination with narrowband ultraviolet B (NB-UVB) to treat psoriasis in many centres, particularly in continental Europe. No previously published controlled study has assessed DS salt + NB-UVB balneophototherapy.Objectives To compare DS salt balneophototherapy with NB-UVB monotherapy for chronic plaque psoriasis.Methods Sixty patients with chronic plaque psoriasis participated in this paired, controlled study, with pretreatment DS salt soaks randomly allocated to each participant's right or left study limb. Psoriasis severity was assessed with a Scaling, Erythema and Induration score by a blinded observer. Assessments were weekly during the therapy course, and thereafter 8-weekly until relapse or for up to 1 year after clearance.Results The mean area under the psoriasis severity–time curves during treatment was not detectably lower with DS salt balneophototherapy than with NB-UVB monotherapy (P = 0·099). The psoriasis severity score fell slightly more from beginning to end of courses with DS salt balneophototherapy than with NB-UVB monotherapy (P = 0·019). There was no detectable difference in times to relapse.Conclusions In this population the addition of pretreatment DS salt soaks to NB-UVB did not result in a clinically important improvement in clearance of psoriasis.
British Journal of Dermatology 08/2005; 153(3):613 - 619. · 3.67 Impact Factor
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H Moseley
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ABSTRACT: The aim of the study was to investigate the state of ultraviolet (UV) A dosimetry in photopatch testing centres in Europe.
It has been acknowledged that a widespread disparity exists in the way photopatch testing is carried out in different countries throughout Europe. This prompted the formation of a European taskforce that developed a consensus methodology. One issue that was not addressed directly was that of UVA dosimetry, which clearly impacts on the consistency of the clinical results.
Ten UV meters from photopatch test centres throughout Europe were set up at a reproducible position from a photopatch test light source containing UVA fluorescent lamps and the irradiances were noted from each meter. One meter served as a reference meter with calibration carried out in an optical laboratory traceable to the National Physical Laboratory.
The mean of all the measurements was 5.74 mW/cm(2) with a SD of 0.36 mW/cm(2). Expanded uncertainty at 95% confidence level was 12%.
It is desirable that meter calibration should have an accuracy of the order of +/-10%. The variation in recorded values among the 10 meters investigated was within acceptable limits. The meter must be calibrated using a similar light source to that used in the phototest equipment, in this case a UVA fluorescence lamp.
Journal of the European Academy of Dermatology and Venereology 04/2005; 19(2):187-90. · 2.98 Impact Factor
