Biomedical subjects
Publications and source records attributed to J L Peyron.
Paradoxical as it may seem, phototherapy, and in particular PUVA therapy, is of considerable interest in the treatment of such photodermatoses as polymorphous light eruptions, solar urticaria and remanent photosensitivity syndrome. When used rationally, with the appropriate therapeutic regimen and under close monitoring of the parameters, these treatments give very satisfactory results in preventing the occurrence of photo-induced skin eruptions.
In a left-right comparative study, the Philips TL-01 sunlamp, a new UVB fluorescent lamp, was evaluated in 15 patients with symmetrical psoriasis. One half of the body was treated in a cabin containing TL-01 lamps, and the other half in a cabin containing TL-12 lamps. The patients were treated three times/week, and the study was conducted in a randomized, double-blind fashion. The percentage response of psoriatic lesions was determined on the tenth and twentieth exposures. The therapeutic effect of the TL-01 lamps was superior to that of the TL-12 lamps, and treatment was better tolerated, particularly with regard to episodes of burning. This new lamp appears to provide more effective and safer phototherapy for psoriasis.
The authors report the results of an open study conducted on 53 patients with psoriasis treated by narrow-band UVB phototherapy, using Philips' TL01 lamp. With a simple procedure which did not require MED determination this treatment gave satisfactory results in 92 p. 100 of the cases, with mild burns in only 9 p. 100. The morphological type of psoriasis (patchy, guttate or nummular) had no influence on the therapeutic result, but the degree of infiltration of the lesions and their location on the lower limbs proved to be a factor of relative resistance. In most patients the results were obtained in 20 sessions with a mean cumulative dose of 20.19 +/- 2.7 J/cm2. Some patients had an additional treatment of 6 sessions. The results obtained with Philips' TL01 lamp were as satisfactory as those obtained with the conventional UVB lamps, but the TL01 lamp seemed to be easier to handle and better tolerated, which gives them some advantages over the latter.
We report the results of a French multicentre study to evaluate the efficiency of psoralen plus ultraviolet A (PUVA) therapy in the prophylactic treatment of benign summer light eruption (BSLE) and to establish the optimal protocol of radiation. Nine photobiology centres took part in this study; 83 patients (76 of them women) were evaluated. The radiation protocols were as follows: oral psoralen (8-methoxypsoralen; 0.6 mg/kg) was taken at each session; the starting dose of UVA radiation was determined according to skin type, with increments of 0.5 J/cm2 every 2 sessions. The subjects were randomized to receive 10-20 sessions 3 times per week. PUVA therapy was very effective: 68 patients (82%) reported total protection from BSLE. Four patients (5%) showed progress. Only 13% showed no improvement. The satisfactory results were not correlated with either the number of sessions or the J/cm2 of UVA. The intensity of tanning after the PUVA sessions did not appear to predict cure. Thirty-six percent of the patients had adverse reactions to treatment, including erythema, pruritus and triggering of BSLE. However, these effects only required the treatment to be stopped in 2% of the cases (for severe pruritus). The results in the various centres were similar.
The pharmacological basis for the treatment of photosensitivity diseases is poorly understood. The supposed pathogenesis of photosensitivity reactions is reviewed, and the mechanism of action of drugs known to be efficient in this type of reaction (antimalarials, beta-carotene, thalidomide, PUVA therapy) discussed.
Perfumes are increasingly used in an ever wider variety of fields, including perfumes proper, cosmetic products, hygienic products, drugs, detergents and other household products, plastics, industrial greases, oils and solvents, foods, etc. Their composition is usually complex; it involves numerous natural and synthetic sweet-smelling constituents, more than 5,000 of which are known (13). Perfumes may produce toxic and, more often, allergic respiratory disorders (asthma), as well as neurological (10) and cutaneous disorders. They are the most common cause of skin allergy to cosmetic products (1, 11) and one of the most important causes of skin allergy to topical drugs or even to syrups which may reactivate contact dermatitis (24). People engaged in the manufacturing of these products may become sensitized to perfumes.
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The authors describe the occurrence of Hodgkin's disease in a patient suffering from actinic reticuloid since 12 years. The severity of the disease (MED less than 1 mJ/cm2 UVB) imposed corticosteroids and immunosuppressive therapy (chlorambucil). The role of actinic reticuloid's pathogeny (persistent light reaction) and principally use of immunosuppressive drugs are discussed and may explain the occurrence of Hodgkin's disease.
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The authors try to estimate the percutaneous absorption of a new corticosteroid, derived from triamcinolone: Amcinonide, which is presented as a cream and 0.1% ointment. The study was carried out on 13 patients; cream was applied to 5 of them under occlusive dressings during 48 h, 4 other had ordinary topical applications of the cream, and the 4 remaining patients were treated with the ointment. The parameters studied were 17-ketosteroids and 17-hydroxysteroids in the 24-hour urine, daily sodium and potassium urinary elimination, plasma cortisol levels and ACTH stimulation test before and after treatment. Only extensive occlusive plastic dressings (50--90% of the body area) lead to a temporary decrease in the activity of the pituitary adrenal system (lowering of the 17-hydroxysteroids in the 24-hour urine in all patients, lowering of the normal adrenocortical response after stimulation with exogenous ACTH in 1 patient). On the other hand, the elimination of urinary ions is not significantly modified. With ordinary topical application of cream or ointment no systemic effect could be observed.
The authors describe a new case of Kaposi's sarcoma associated with psoriasis. The patient (a 68-year-old Nord-African man) had suffered from psoriasis for 14 years and had applied local betamethasone or fluocinolone for 125 months when Kaposi's sarcoma occurred. The association between these two diseases is discussed. The role of local steroid therapy and the immunological abnormality occurring in psoriasis are analyzed in order to explain the association between psoriasis and Kaposi's sarcoma or other malignant diseases.
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