RESUMO
BACKGROUND: Medium-dose ultraviolet light A - 1 (UVA-1) phototherapy, given in short courses, has shown efficacy in atopic dermatitis flares; little is known about its use, efficacy, and side effects in prolonged exposure used in the chronic disease despite its extensive use. METHODS: A descriptive retrospective study was conducted; convenience sampling of patients with atopic dermatitis treated with UVA-1 phototherapy was made; evaluation of clinical response by SCORAD, adverse effects, and protocols used in each patient were evaluated. RESULTS: Patients exposed to UVA-1 phototherapy showed a decrease in the SCORAD (30.1 points) - total cumulative dose-dependent (P < 0.0001) - regardless of multiple variables studied. There were low rates of relapse and adverse effects. The most frequent doses were 30 and 60 J/cm2 , three times per week; patients had similar clinical responses and adverse effects in these groups independent of the other variables studied (P = 0.057). CONCLUSION: UVA-1 phototherapy can be an alternative for patients with severe atopic dermatitis even at lower doses than those described in other series (30 J/cm2 ) and not only for acute flares. Cumulative total dose is a variable that affects the clinical response directly. Large prospective studies are needed.
Assuntos
Dermatite Atópica/radioterapia , Países em Desenvolvimento , Terapia Ultravioleta , Adolescente , Corticosteroides/uso terapêutico , Adulto , Idoso , Azatioprina/uso terapêutico , Colômbia , Dermatite Atópica/tratamento farmacológico , Emolientes/uso terapêutico , Feminino , Humanos , Imunossupressores/uso terapêutico , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Dosagem Radioterapêutica , Recidiva , Estudos Retrospectivos , Índice de Gravidade de Doença , Terapia Ultravioleta/efeitos adversos , Terapia Ultravioleta/métodos , Adulto JovemRESUMO
Abstract: Background: Narrow-band UVB is the most innovative steroid sparing treatment in atopic dermatitis. There are studies showing efficacy of Narrow-band UVB in childhood atopic dermatitis, but there is lack of clinical trials in the literature determining the length of remission. Therefore, we sought to highlight its efficacy, safety and its post-treatment efficacy in childhood atopic dermatitis. Objective: To assess the clinical efficacy, safety of Narrow-band UVB in the treatment of paediatric atopic dermatitis and length of remission during 2 years of post-treatment follow-up. Methods: Thirty children (4-14 years) having moderate to severe AD (SCORAD index > 25) were enrolled for 12 weeks. Narrow-band UVB phototherapy was administered twice a week on non-consecutive days for three months. SCORAD index was calculated by the same dermatologist at baseline, 6th, 12th, 18th and 24th treatment session. Secondary outcomes were measured using visual analog scale for pruritus and sleep loss. Patients were also followed-up for 2 years to know the length of remission after end of therapy. Results: There was a significant reduction in SCORAD index at 6th, 12th, 18th and 24th treatment session in comparison to baseline. This improvement in SCORAD was also maintained during the 2 years of post-treatment follow-up period. Consequently, pruritus and sleep loss improved significantly from baseline to end of therapy and even during the 1st and 2nd year of follow-up. Study limitation: Open-label trial without control group. Conclusions: Narrow-band UVB is an efficacious and safe modality of treatment in childhood atopic dermatitis with good therapeutic index and minimal side effects.
Assuntos
Humanos , Masculino , Pré-Escolar , Criança , Adolescente , Terapia Ultravioleta/métodos , Dermatite Atópica/radioterapia , Prurido/radioterapia , Fatores de Tempo , Índice de Gravidade de Doença , Estudos Prospectivos , Reprodutibilidade dos Testes , Análise de Variância , Seguimentos , Resultado do Tratamento , Escala Visual AnalógicaRESUMO
BACKGROUND: Narrow-band UVB is the most innovative steroid sparing treatment in atopic dermatitis. There are studies showing efficacy of Narrow-band UVB in childhood atopic dermatitis, but there is lack of clinical trials in the literature determining the length of remission. Therefore, we sought to highlight its efficacy, safety and its post-treatment efficacy in childhood atopic dermatitis. OBJECTIVE: To assess the clinical efficacy, safety of Narrow-band UVB in the treatment of paediatric atopic dermatitis and length of remission during 2 years of post-treatment follow-up. METHODS: Thirty children (4-14 years) having moderate to severe AD (SCORAD index > 25) were enrolled for 12 weeks. Narrow-band UVB phototherapy was administered twice a week on non-consecutive days for three months. SCORAD index was calculated by the same dermatologist at baseline, 6th, 12th, 18th and 24th treatment session. Secondary outcomes were measured using visual analog scale for pruritus and sleep loss. Patients were also followed-up for 2 years to know the length of remission after end of therapy. RESULTS: There was a significant reduction in SCORAD index at 6th, 12th, 18th and 24th treatment session in comparison to baseline. This improvement in SCORAD was also maintained during the 2 years of post-treatment follow-up period. Consequently, pruritus and sleep loss improved significantly from baseline to end of therapy and even during the 1st and 2nd year of follow-up. STUDY LIMITATION: Open-label trial without control group. CONCLUSIONS: Narrow-band UVB is an efficacious and safe modality of treatment in childhood atopic dermatitis with good therapeutic index and minimal side effects.
Assuntos
Dermatite Atópica/radioterapia , Terapia Ultravioleta/métodos , Adolescente , Análise de Variância , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Prurido/radioterapia , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Escala Visual AnalógicaRESUMO
La radiación ultravioleta ha sido usada durante décadas para el tratamiento de diversas enfermedades cutáneas. La radiación ultravioleta A1 (UVA-1) que tiene una longitud de onda entre los 340nm y 400 nm está disponible desde el año 1981, pero recién en las últimas dos décadas se ha estudiado, publicado y reportado su potencial uso terapéutico en la dermatología. Los primeros beneficios de su uso se reportaron en la dermatitis atópica donde se utilizaron dosis altas de UVA-1 para tratar las exacerbaciones severas de esta condición. Luego, nuevas indicaciones terapéuticas de su uso se fueron expandiendo a otras enfermedades cutáneas tales como: morfea, liquen escleroso, queratosis liquenoide, linfomacutáneo de células T y otras dermatopatías. La radiación UVA-1 al tener una longitud de onda más larga penetra a las capas más profundas de la dermis, lo que le permite una acción en la modificación de la respuesta inflamatoria, la respuesta inmunológica y los mecanismos de reparación cutánea.
Ultraviolet light radiation has been used for decades for the treatment of several cutaneous diseases. The ultraviolet radiation A1 (UVA-1) with a wave length between 340 nm-400 nm has been available since 1981, but only in the last two decades it has been studied and published for therapeutic use in dermatology. The first reported benefits of its use were reported in atopic dermatitis in which high doses of UVA-1were used to treat severe exacerbations of this condition. Thereafter, new therapeutic indications expanded its use for other cutaneous diseases like: morphea, lichen sclerosus, lichenoid keratosis, cutaneous T cell lymphoma and other skin conditions. The UVA-1 radiation has a long wavelength that make possible to reach the deep dermis and to modify the inflammatory response, immunological response and the cutaneous repair mechanisms.
Assuntos
Humanos , Dermatopatias/radioterapia , Terapia Ultravioleta/métodos , Apoptose/efeitos da radiação , Citocinas/efeitos da radiação , Dermatite Atópica/radioterapia , Esclerodermia Localizada/radioterapia , Linfócitos T/efeitos da radiação , Lúpus Eritematoso Sistêmico/radioterapia , Pele/efeitos da radiação , Terapia Ultravioleta/efeitos adversosRESUMO
OBJECTIVE: In the present work, the effect of narrow-band ultraviolet B (UVB) phototherapy on a cutaneous microbial population was evaluated in patients with atopic dermatitis (AD) and compared with control patients (vitiligo). METHODS: Count, isolation and identification of cutaneous microbiota from anticubital fossa were performed in 10 controls and 10 AD patients, both submitted to similar levels (P > 0.05) of UVB phototherapy (4.3 +/- 0.9 and 4.3 +/- 0.8 accumulated joules, respectively). Additionally, Staphylococcus aureus isolates were screened for the production of exotoxins. RESULTS: The total and staphylococcal cutaneous microbial population levels were higher (P < 0.05) in AD patients than in the controls. All these population levels decreased (P < 0.05) for both AD and control patients after UVB phototherapy, which also decreased the SCORAD for AD patients. All patients with AD and 50% of controls were carriers of S. aureus, and harboured the bacteria simultaneously on skin and anterior nares. All of the S. aureus strains recovered from AD patient skin produced toxin and the B type was the most frequently detected (70%), followed by C (20%) and A (10%) toxins. Only 40% of the S. aureus isolates from control patients produced toxin. After UVB treatment, microbial population levels of AD patients were similar (P > 0.05) to the ones found in control patients before phototherapy, and toxin production ability of S. aureus isolates decreased drastically. CONCLUSION: The results of the present study show the beneficial effect of UVB phototherapy on AD and suggest that this may be attributable not only to reduction of skin surface bacteria but also to the suppression of superantigen production from S. aureus.
Assuntos
Dermatite Atópica/microbiologia , Dermatite Atópica/radioterapia , Pele/microbiologia , Terapia Ultravioleta/métodos , Toxinas Bacterianas/biossíntese , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Staphylococcus aureus/isolamento & purificaçãoRESUMO
The atopic dermatitis is a chronic inflammatory skin illness, with remissions and exacerbations, itch, and association with allergic rhinitis and asthma. There is a complex interrelationship of genetic, environmental, pharmacological and psychological factors that contribute to the development and severity of the illness: Different manifestations of immunological disorders are an increment in the number of IgE antibodies toward common antigens, an increment in the liberation of proinflammatory mediators by basophils and mast cells, peripheral and local eosinophilia, biphasic activity Th1/Th2 with the liberation of cytokines (IL-4, IL-5, IL-13), GM-CSF and the IFN-gamma caused by the cells Th1. an increment in the liberation of major basic protein, eosinophil cationic protein besides the expression of chemotactic factors by the monocytes (RANTES, eotaxin, vasoactive intestinal peptide, etc.). In 1980, Hanifin and Rajka made public the diagnostic criteria for the atopic dermatitis and it has been universally accepted as an standard for the diagnosis. Leung reported that a knowledge about the immunopathological bases of the atopic dermatitis has important clinical implications for the diagnosis and possible treatment there are multiple choices for a treatment because of the complexity of the illness. Among these are thalidomide and transfer factor as an immunomodulator treatment with acceptable safety and clinical efficacy.