John Koo and Mio Nakamura - Clinical Cases in Phototherapy

Clinical Cases in Phototherapy — read online for free the complete book (whole text) full work

Below is the text of the book, divided by pages. System saving the place of the last page read, allows you to conveniently read the book "Clinical Cases in Phototherapy" online for free, without having to search again every time where you left off. Put a bookmark, and you can go to the page where you finished reading at any time.

Light

Font size:

↓

↑

Georgia Tahoma Arial Verdana

Reset

Interval:

↓

↑

Bookmark:

Make

1234567...32

Springer International Publishing AG 2017

John Koo and Mio Nakamura Clinical Cases in Phototherapy Clinical Cases in Dermatology 10.1007/978-3-319-51599-1_1

1. Ultraviolet B Phototherapy for the Treatment of Moderate to Severe Psoriasis

John Koo 1 and Mio Nakamura 1

(1)

Psoriasis and Skin Treatment Center, Department of Dermatology, University of California San Francisco, San Francisco, California, USA

Case

A 36-year-old male presents to your office for follow up for generalized psoriasis diagnosed 3 months ago. He has tried various topical corticosteroids and topical calcipotriene without much improvement. Not only is the topical regimen very time consuming and not very effective, but it has been nearly impossible for him to apply the topical medication to his entire body alone. He is otherwise healthy and denies history of photosensitizing disorders. He lives and works only a few blocks away from your office, which offers phototherapy.

On examination, the patient has well-demarcated, mildly erythematous and slightly indurated plaques with fine silvery scale scattered over his trunk and extremities consistent with partially-treated psoriasis (Fig. ). He is Fitzpatrick skin type II. You discuss the option of starting phototherapy, including the fact that he would need to come to the office 3 times per week for at least 3 months initially, followed by potential ongoing maintenance treatments once or twice weekly. You also discuss potential side effects of phototherapy including burning or erythema. After the discussion, the patient states he is ready to commit to phototherapy.

Figure 1.1

Patient with generalized psoriasis who is a candidate for phototherapy

Discussion

Phototherapy involves repeated exposure of the skin to ultraviolet (UV) light to treat various inflammatory skin conditions such as psoriasis, atopic dermatitis, and vitiligo. This practice is one of the oldest treatment modalities in dermatology, dating back to the ancient Egyptians who used natural light in combination with herbal extracts to treat skin disease [].

For psoriasis, phototherapy is indicated for patients whose disease does not adequately respond to topical medications or those who have generalized involvement that is not amenable to topical treatment alone (Fig. ].

Phototherapy is most commonly administered in the office setting in stand-up light booths (Fig. ].

Figure 1.2

A stand-up UVB phototherapy booth in the office setting

Table 1.1

University of California San Francisco Psoriasis and Skin Treatment Center NB-UVB initial dosing protocol

Skin type	Dose (mJ/cm2)	Subsequent increase (mJ/cm2)
I		1550
II		1575
III		15100
IV		15150
V		15200
VI		15200

Table 1.2

University of California San Francisco Psoriasis and Skin Treatment Center BB-UVB initial dosing protocol

Skin type	Dose (mJ/cm2)	Subsequent increase (mJ/cm2)
I		1050
II		1050
III		1050
IIII		1050
V		1075
VI		1075

Table 1.3

Missed treatment protocol for both NB-UVB and BB-UVB

Missed visit	Action (for all skin types)
17 days	Increase dose per protocol
811 days	Hold dose constant
1220 days	Decrease by 25%
2127 days	Decrease by 50%
28 or more days	Restart with initial dose

Figure 1.3

Flow of treatment for UVB phototherapy at the UCSF Phototherapy Unit

Table 1.4

Post-phototherapy skin care regimen

Bathe with mild soap or cleanser

Shorten shower times

Limit to one shower per day

Use warm (not hot) water only

Moisturize skin twice dailya

aBest time to moisturize is immediately after bathing and immediately after phototherapy session

When patients present for phototherapy 3 times per week, approximately 6075% of patients with moderate to severe psoriasis achieve at least 75% improvement in the Psoriasis Area and Severity Index (PASI-75) by week 12 [).

Table 1.5

Side effects of UVB phototherapy

Side effect	Signs/symptoms
Burning	Redness, tenderness, pain, tightness, itching, rarely blistering noticeable 46 h after treatment
Photoaging	Coarseness, wrinkling, laxity, increased fragility, mottled pigmentation, telangiectasias, atrophic or fibrotic areas
Tanning	Skin darkening

Phototherapy is contraindicated in patients with photosensitizing diseases including systemic lupus erythematosus and xeroderma pigmentosum [).

Table 1.6

Recommended monitoring of patients undergoing UVB phototherapy

Baseline monitoring	Full body skin check before initiation of therapy
Ongoing monitoring	Regular full skin examinations every 36 months to monitor for signs of photoaging, pigmentation, and cutaneous malignancies

In the current patient with generalized psoriasis who is resistant to topical corticosteroids and topical calcipotriene, and given that the patients schedule and other logistics are feasible with 3-times per week phototherapy sessions, he is an excellent candidate for UVB phototherapy. Since the patient is skin type II, he should be started at a dose of 220 mJ/cm2 of NB-UVB (or 20 mJ/cm2 BB-UVB) and the dose should be increased by 1575 mJ/cm2 (or 1050 mJ/cm2 for BB-UVB) for subsequent sessions. Prior to each phototherapy session, in order to accurately determine the subsequent dose, the patient should be asked about any symptoms consistent with the side effect of burning, including skin pain, itching, or tightness. The skin should also be examined carefully for erythema, peeling, or blistering, in addition to assessment of disease improvement.

Next page

1234567...32

Light

Font size:

↓

↑

Georgia Tahoma Arial Verdana

Reset

Interval:

↓

↑

Bookmark:

Make

Similar books «Clinical Cases in Phototherapy»

Look at similar books to Clinical Cases in Phototherapy. We have selected literature similar in name and meaning in the hope of providing readers with more options to find new, interesting, not yet read works.

Frank Erwich

Tactics Training--Hikaru Nakamura: How to Improve Your Chess with Hikaru Nakamura and Become a Chess Tactics Master

Anna Waśkiel-Burnat (editor)

Clinical Cases in Scalp Disorders (Clinical Cases in Dermatology)

Seigo Nakamura

Hereditary Breast and Ovarian Cancer: Molecular Mechanism and Clinical Practice

Hikaru Nakamura

Bullet Chess: One Minute to Mate

Patlan John T.

Case files. Internal medicine

Jashin J. Wu

Clinical Cases in Psoriasis

Robert A. A. Norman

Clinical Cases in Geriatric Dermatology

William R. Auger

Clinical Cases in Chronic Thromboembolic Pulmonary Hypertension

Sunil Kothiwala

Clinical Cases in Disorders of Melanocytes

Danica Tiodorovic

Clinical Cases in Dermoscopy of Skin Cancers

Ahn Christine S.

Dermatology: illustrated clinical cases

Terry W. Campbell

Clinical Cases in Avian and Exotic Animal Hematology and Cytology

Discussion, reviews of the book Clinical Cases in Phototherapy and just readers' own opinions. Leave your comments, write what you think about the work, its meaning or the main characters. Specify what exactly you liked and what you didn't like, and why you think so.