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BACKGROUND: Fatigue is one of the most common symptoms treated in primary care and can lead to deficits in mental health and functioning. Light therapy can be an effective treatment for symptoms of fatigue; however, the feasibility, scalability, and individual-level heterogeneity of light therapy for fatigue are unknown. OBJECTIVE: This study aimed to evaluate the feasibility, acceptability, and effectiveness of a series of personalized (N-of-1) interventions for the virtual delivery of bright light (BL) therapy and dim light (DL) therapy versus usual care (UC) treatment for fatigue in 60 participants. METHODS: Participants completed satisfaction surveys comprising the System Usability Scale (SUS) and items assessing satisfaction with the components of the personalized trial. Symptoms of fatigue were measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) daily, PROMIS weekly, and ecological momentary assessment (EMA) questionnaires delivered 3 times daily. Comparisons of fatigue between the BL, DL, and UC treatment periods were conducted using generalized linear mixed model analyses between participants and generalized least squares analyses within individual participants. RESULTS: Participants rated the usability of the personalized trial as acceptable (average SUS score=78.9, SD 15.6), and 92% (49/53) of those who completed satisfaction surveys stated that they would recommend the trial to others. The levels of fatigue symptoms measured using the PROMIS daily fatigue measure were lower or improved in the BL (B=-1.63, 95% CI -2.63 to -0.63) and DL (B=-1.44, 95% CI -2.50 to -0.38) periods relative to UC. The treatment effects of BL and DL on the PROMIS daily measure varied among participants. Similar findings were demonstrated for the PROMIS weekly and EMA measures of fatigue symptoms. CONCLUSIONS: The participant scores on the SUS and satisfaction surveys suggest that personalized N-of-1 trials of light therapy for fatigue symptoms are both feasible and acceptable. Both interventions produced significant (P<.05) reductions in participant-reported PROMIS and EMA fatigue symptoms relative to UC. However, the heterogeneity of these treatment effects across participants indicated that the effect of light therapy was not uniform. This heterogeneity along with high ratings of usability and satisfaction support the use of personalized N-of-1 research designs in evaluating the effect of light therapy on fatigue for each patient. Furthermore, the results of this trial provide additional support for the use of a series of personalized N-of-1 research trials. TRIAL REGISTRATION: ClinicalTrials.gov NCT04707846; https://clinicaltrials.gov/ct2/show/NCT04707846.

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Introduction: Atopic dermatitis is one of the most common chronic inflammatory skin diseases adversely affecting the quality of life of both patients and their families. Heliotherapy, a treatment modality with high anti-inflammatory effects, is unjustifiably neglected in a country that has plenty of sunshine days throughout the year, but does not own the Cabinet for artificial phototherapy. Aim: To evaluate the power of individual heliotherapy in ameliorating disease severity and improving the quality of life, as well as to compare the results with those obtained from the studies evaluating group heliotherapies. Material and methods: We assessed disease severity and quality of life at three times: before commencing heliotherapy (Time 1), immediately after heliotherapy (Time 2), and 3 months after heliotherapy (Time 3). The tools we used are authorized scoring systems and questionnaires: SCORing Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI), Dermatology Life Quality Index (DLQI) and Severity of Pruritus Scale (SPS). Results: A total of 24 patients were analysed in this observational study. Good clinical results were observed with a statistically significant decrease in SCORAD index by 40% and 31.1% at Time 2 and Time 3, respectively (p < 0.001). Improvement in the quality of life was statistically significant showing a decrease in DLQI score by 31.57% 3 months after heliotherapy, comparing to baseline values (p < 0.001). Conclusions: Our results revealed that 2-week heliotherapy has shown satisfying, long-lasting effects in clearing the skin changes, reducing and ameliorating pruritus intensity, as well as improving the quality of life.

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Climatotherapy is a well-described treatment of psoriasis. Dead Sea climatotherapy (DSC) in Israel consists of intensive sun and Dead Sea bathing and is very effective in improving clinical and patient-reported outcomes. However, the effect of DSC has not been widely studied. We aimed to investigate the effect of DSC on psoriasis skin using quantitative immunohistochemistry techniques and analysis of blood samples. Skin punch biopsies from 18 psoriasis patients from a previous cohort study were used. Biopsies were obtained from non-lesional skin and from a psoriasis target lesion at baseline. A biopsy was acquired from the target lesion after DSC. Among patients who achieved complete visual clearance, a biopsy was also obtained at relapse. Blood samples were obtained at the same time points. We performed haematoxylin and eosin staining and quantitative immunohistochemical analysis of CD3, CD4, CD8, CD11c, CD103, CD163, CD207, forkhead box P3, Ki67 and myeloperoxidase. We performed blood tests of cholesterol, c-reactive protein, glucose, haemoglobin A1c and triglycerides. All skin biomarkers except for CD207 were decreased after DSC. At relapse, none of the biomarkers were significantly different from the baseline lesional measurements. Total CD207 staining correlated with psoriasis area and severity index at baseline while CD163 staining correlated with psoriasis area and severity index at EOT. No changes were observed in selected blood tests during the study. Consistent with clinical results, DSC is highly effective in the short term almost normalising all investigated biomarkers. However, at relapse, biomarkers were upregulated to the baseline level.

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Actinic keratosis (AK) is a kind of precancerous skin lesions related to long-term light exposure, and photodynamic therapy is one of its main treatment methods. Compared with conventional photodynamic therapy, daylight photodynamic therapy (DL-PDT) with daylight as a light source has advantages of more convenient operation, less pain and higher patient acceptability, but it is liable to be affected by weather and other factors. DL-PDT is suitable for the treatment of grade Ⅰ or Ⅱ AK on the head and face, and its efficacy may be affected by pretreatment, photosensitizers, irradiation dose, etc. This review mainly elaborates the advantages of DL-PDT and introduces its operation methods to help clinicians choose the best treatment protocol for AK.

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OBJECTIVE: Scientometrical analysis of studies the use of climatotherapy methods and formulation of guidelines based on the evidence obtained during the analysis. MATERIAL AND METHODS: The article presents the data of scientometrical analysis of 40 publications on the use of climatotherapy in spa practice. RESULTS: Clinical effects and proposed mechanisms of action of the proven efficacy climatotherapy methods - aerotherapy, heliotherapy and thalassotherapy for the patients with various chronic diseases are presented. The clinical directions for the using of climatotherapy methods in climatic resorts are highlighted. CONCLUSIONS: Regular generalization and analysis of existing evidence-based studies is required, as well as the implementation of new high-quality randomized controlled clinical trials to study the effects of climate therapy on a wide range of patients with common socially significant diseases.

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Background: Dead Sea climatotherapy (DSC) is a treatment option for psoriasis in Denmark. However, the response to DSC has not been particularly well studied. Aim: We sought to determine effectiveness and response duration of DSC on psoriasis-related outcome parameters. Methods: Eighteen patients participated in a 4-week treatment program in Ein Gedi in Israel. Treatment, consisting of sun exposure and bathing, was individualized. Results: DSC was associated with a mean 13.0-point reduction (88%) in Psoriasis Area and Severity Index and a mean reduction of 2.3 (76.7%) on the 5-point Investigator's Global Assessment Scale. Furthermore, patients' quality of life improved measured by the Dermatology Quality of Life Index and EuroQol 5D index values. The mean time from treatment end to reappearance of visible skin symptoms was 93.8 days (SD: 62.5, range: 31-219 days). Conclusions: Our results confirm that DSC has an immediate effect on skin manifestations and improves quality of life, but long-term disease control is not observed.

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This study assessed the effects of liman peloid, followed by bath and heliotherapy in psoriatic patients at Cervia, Emilia, Italy. The psoriatic patients were randomized into two groups: group 1 with 56 patients, treated with liman applications, bath, and heliotherapy, and group 2 with 35 subjects, treated with mud-bath therapy using a clay peloid mixed with tap water and heliotherapy. Data was collected for the following: psoriasis area and severity index (PASI); delta-PASI (difference between post- and pre-treatment PASI); delta-PASI3 and delta-PASI6, 3 and 6 months after the end of treatment, respectively; psoriasis recurrences; and the use of both topical and systemic drugs. Although not significant, a decrease in PASI was recorded in group 1 at the end of treatment and after 3 and 6 months. Compared with group 2, there was a significant change in delta-PASI, delta-PASI3, and psoriasis recurrences in group 1 as well as a significant reduction in the topical use of drugs, both cortisone and nonsteroid drugs. This is the first and preliminary study which documented the efficacy of a specific protocol of liman bath heliotherapy in psoriatic patients as documented by a reduction in delta-PASI and delta-PASI3, a decrease in psoriasis recurrences, and use of topical drugs.

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Goeckerman therapy is a highly effective treatment regimen for moderate-to-severe psoriasis. It involves regular exposure to ultraviolet B radiation and the application of crude coal tar. To our knowledge, only three centers in the USA currently offer a formal Goeckerman therapy treatment program; thus, access to this therapy is geographically limited. In this article, a motivated patient discusses his experience with generalized plaque psoriasis. This patient, while living in a Goeckerman-inaccessible area, deferred treatment with biologics and outpatient phototherapy to develop a modified Goeckerman regimen for at-home use. This home regimen, which did not involve the use of prescription-strength medications, resulted in full clearance of his psoriasis. We also discuss the patient's case from the perspective of a dermatology treatment team that has reviewed his experience.

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ABSTRACT Objective To evaluate if distress respiratory decreases after using helium-oxygen mixture in pediatric patients diagnosed with bronchospasm. Methods This is a retrospective, non-randomized study that included patients diagnosed with bronchospasm, who received a helium-oxygen mixture at three time points (30, 60, and 120 minutes) according to the organization protocol singular, and were admitted to the intensive care unit, from January 2012 to December 2013. This protocol includes patients with bronchospasm who sustained a modified Wood score of moderate to severe, even after one hour of conventional treatment. Results Twenty children were included in the study. The mean score of severity of the disease at the initial moment was 5.6 (SD:2.0), and at moment 120 minutes, it was 3.4 (SD: 2.0). The severity score showed a significant improvement as of 30 minutes (p<0.001). Conclusion The use of helium-oxygen mixture proved to be effective in diminishing the respiratory distress score for children with airway obstructions; it should be considered a supplementary therapeutic option, together with drug therapy, in specific clinical situations.

RESUMO Objetivo Avaliar se o desconforto diminui após o uso da mistura hélio-oxigênio em pacientes pediátricos com diagnóstico de broncoespasmo. Métodos Estudo retrospectivo, não randomizado, no qual foram incluídos pacientes com diagnóstico de broncoespasmo que utilizaram a mistura hélio-oxigênio em três momentos (30, 60 e 120 minutos), seguindo o protocolo institucional, internados em unidade de terapia intensiva pediátrica de janeiro de 2012 a dezembro 2013. Este protocolo incluía pacientes com diagnóstico de broncoespasmo que mantivessem escore de Wood modificado de moderado a grave, mesmo após 1 hora de tratamento convencional. Resultados Foram incluídas 20 crianças neste estudo. A média do escore de gravidade da doença no momento zero foi de 5,6 (DP:2,0) e, no momento 120 minutos, 3,4 (DP: 2,0). O escore de gravidade apresentou melhora significante a partir dos 30 minutos (p<0,001). Conclusão A utilização da mistura hélio-oxigênio mostrou-se eficaz na redução do escore de desconforto respiratório de crianças com doenças obstrutivas e deve ser considerada recurso terapêutico complementar à terapia medicamentosa em situações clínicas específicas.

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A much forgotten figure in the history of artificial and natural light therapies, the nurse played a central role in the administration of beneficial - and harmful - ultraviolet radiation in the treatment of skin diseases, tuberculosis and rickets, especially on child patients. As the primary operators of light therapy equipment, nurses specialised in this new and modern treatment, and both the therapy's successes and failures could be attributed to their skill, or lack thereof. This paper provides an introduction to the history of light therapy, especially phototherapy (artificial light therapy), during the early twentieth century in Britain, and to the 'invisible' technicians who contributed so much to its nascent reputation.

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Statistical analysis of the daily course of exposures to TL-01 tube radiation for 93 psoriatic patients from the Medical University of Lódz during 20-day phototherapy shows that the dose of 1 J/cm(2) represents a unit of single exposure necessary for psoriasis healing. This value is converted to the antipsoriatic effective dose of 317.9 J/m(2) using the TL-01 lamp irradiance spectrum and the antipsoriatic action spectrum. It is proposed that the daily exposure of 317.9 J/m(2) serves as the standard antipsoriatic dose (SAPD) providing a link between the cabinet and the out-door exposures and it could be used for planning heliotherapy in Poland. A model is proposed to calculate ambient antipsoriatic doses for 3 h exposures around the local noon (9 am-12 am GMT) based on satellite measurements of ozone and cloud characteristics. The model constants are determined by a comparison with pertaining antipsoriatic doses measured by the Brewer spectrophotometer in central Poland. It is found that 3 h exposures to solar radiation in the period 15 May-15 September provides the mean (2005-2013) doses in the range 2.7-3.1 SAPD over Poland. Thus, heliotherapy could be treated as an alternative to the cabinet phototherapy for almost 4 months. It seems that the most effective site for antipsoriatic heliotherapy is the south/east part of Poland (the Bieszczady Mountains). The heliotherapy could be carried out in existing national health centers equipped with the standard easy-to-use biometers for on-line monitoring of UV level and controlling duration of sunbathing to avoid erythema risks. It is even possible to control the antipsoriatic heliotherapy by a patient himself, using low-cost hand-held instruments measuring UV index.

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Most of the positive effects of solar radiation are mediated via ultraviolet-B (UVB) induced production of vitamin D in skin. However, several other pathways may exist for the action of ultraviolet (UV) radiation on humans as focused on in this review. One is induction of cosmetic tanning (immediate pigment darkening, persistent pigment darkening and delayed tanning). UVB-induced, delayed tanning (increases melanin in skin after several days), acts as a sunscreen. Several human skin diseases, like psoriasis, vitiligo, atopic dermatitis and localized scleroderma, can be treated with solar radiation (heliotherapy) or artificial UV radiation (phototherapy). UV exposure can suppress the clinical symptoms of multiple sclerosis independently of vitamin D synthesis. Furthermore, UV generates nitric oxide (NO), which may reduce blood pressure and generally improve cardiovascular health. UVA-induced NO may also have antimicrobial effects and furthermore, act as a neurotransmitter. Finally, UV exposure may improve mood through the release of endorphins.