Phototherapy in Pediatric Dermatology

Background: Phototherapy is a safe and effective treatment modality for skin diseases in children such as psoriasis, atopic dermatitis, pityriasis lichenoides, vitiligo, cutaneous cell lymphoma, pityriasis rubra pilaris, and other skin disorders. It is reported to be effective with less side effects compare to the administration of systemic medicine. Short and long term side effects should be taken into account when applying this model of therapy, especially in children. Purpose: To identify special considerations regarding the use of phototherapy modalities in the field of dermatology in children. Review: Phototherapy is the use of ultraviolet (UV) radiation for therapeutic purposes. The various wavelengths of UV radiation used for phototherapy have their own respective photochemical and photobiological properties. There are modality choices that have been proven to provide benefits in treating various skin diseases, including broadband UVB and narrowband UVB, psoralen UVA photochemotherapy (PUVA), ultraviolet A 1 (UVA1), and targeting phototherapy. Special considerations regarding the use of this treatment modality in the pediatric population increase with safety and treatment tolerance. Conclusion: Special considerations should be taken when providing phototherapy treatment options to children with skin disorders requiring phototherapy. The therapies are generally well tolerated and mostly have minor adverse side effects, such as sunburn.

New therapeutic strategies of lichen ruber planus

Lichen ruber planus/lichen planus (LP), is a chronic immune-mediated inflammatory disease that affects the skin, oral mucosa, genital mucosa, scalp and nails. Planar, purple, polygonal, pruritic, papules and plaques appear on the flexor surfaces of the wrists, forearms and legs. Mucosal lesions are often lacy, reticular, white lines known as Wickham striae. Topical corticosteroids are the first-line therapy for all forms of LP, for severe, widespread LP systemic corticosteroids, acitretine, oral immunosuppressants or narrowband UVB therapy should be considered. Cutaneous LP may resolve spontaneously within one or two years, while mucosal LP may be more persistent and resistant to treatment.

Phototherapy in Dermatology

Phototherapy is a therapeutic procedure in dermatology. Phototherapy uses certain ultraviolet wavelengths classified into 3 types,broadband UVB (BBUVB), narrowband UVB (NBUVB), and psoralen UVA (PUVA). The most widely used is NBUVB for treating psoriasis, atopic dermatitis and vitiligo. The mechanism of action of phototherapy is to reduce epidermal proliferation, suppress the immune system, reduce the inflammatory process, and induce repigmentation. Before starting phototherapy, the dose adjustment depends on skin type and minimal erythema dose (MED). Frequency of use is recommended based on the severity of the disease, continuously administered needed. Besides of this therapeutic effect, some contraindications and side effects that need to be considered in the use of phototherapy such as drug interactions, photoallergic and risk of skin malignancy.

THE 308-nm EXCIMER LASER: AN XCEPTIONAL TREATMENT MODALITY IN VITILIGO- A CASE SERIES

Objective: Vitiligo is a common depigmenting condition that carries a high psychosocial morbidity and social stigma. Present treatment modalities for vitiligo like topical corticosteroids, immunomodulators, phototherapy with psoralens plus UVA radiations and broadband or narrowband UVB radiation phototherapy requires many months of treatment with not so promising results. The excimer laser comprising of a targeted phototherapy with single wavelength laser light is a new treatment option which may be time efficient and a better treatment option in terms of repigmentation in management of vitiligo.

Netherton Syndrome: Case Report and Review of the Literature

Netherton syndrome (NS) is a rare genodermatosis with an autosomal recessive pattern of inheritance caused by pathogenic variants in the SPINK5 gene. It is characterized by a triad consisting of atopic diathesis, ichthyosis linearis circumflexa, and hair shaft abnormalities. Ichthyosis linearis circumflexa can be confused with atopic dermatitis leading to a delayed diagnosis. Furthermore, difficulty in making the differential diagnosis with other atopiform, erythrodermic, and ichthyosiform entities that exhibit hair shaft abnormalities represent a challenge. Trichoscopy is an accessible and noninvasive auxiliary diagnostic tool in these cases; the hair shaft abnormalities found in NS are bamboo, golf tee, and matchstick hairs. Identification of a pathogenic variant in the SPINK5 gene through genetic testing is necessary to confirm the diagnosis. Multiple treatment options are available including topical therapy with emollients, corticosteroids, calcineurin inhibitors, antiseptics, and narrowband UVB phototherapy. Systemic treatments comprehend intravenous immunoglobulins, and advances in the understanding of the pathophysiology of NS have led to more directed therapies with biologics such as infliximab, ixekizumab, secukinumab, ustekinumab, and dupilumab. Treatments currently under investigation include inhibitors of kallikrein 5, cathelicidins, drugs activating the transcription factor nuclear factor erythroid-derived 2-like 2, and gene therapy using autologous keratinocytes induced with a lentiviral vector encoding SPINK5.

Topical Simvastatin Solution Combined With Narrowband UVB in Treatment of Vitiligo: a Case Report

Background: Simvastatin is now considered a potential therapeutic agent to treat vitiligo. To the best of our knowledge, this is the first case report about the successful treatment of topical simvastatin with narrowband UVB.Case presentation: a 34-year-old Chinese female patient vitiligo was cured by topical simvastatin solution with narrowband UVB.Conclusions: topical simvastatin may be a potential treatment against vitiligo.

Tofacitinib with Concomitant Therapy for Vitiligo: protocol for a phase II randomized clinical trial (Preprint)

UNSTRUCTURED Vitiligo is the most common acquired skin depigmentation disorder that affects about 35 million people worldwide. This debilitating disease causes autoimmune destruction of the epidermal melanocytes, forming macules and patches of hypopigmented skin, which causes considerable stigma and a decrease in the quality of life in affected individuals. Narrowband UVB (NB-UVB) is the preferred treatment right now, alone or in combination with immunomodulator drugs. It is not 100% effective and has many adverse effects, as noted in the literature previously. The addition of topical Tofacitinib to the already present therapy has the potential to be a novel treatment with a high level of efficacy for vitiligo. This can significantly improve the quality of life in the millions of people suffering from vitiligo worldwide.