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PubMedDate not supplied

Effect of phototherapy for neonatal jaundice on cognitive performance.

Phototherapy for neonatal hyperbilirubinemia was introduced to our medical center in March 1971. To assess the influence of phototherapy on subsequent cognitive outcome, we compared the intelligence test scores at 17 years of age of subjects born 4 months before and 10 months after the introduction of phototherapy. The intelligence quotient score (mean +/- SE) at 17 years for 84 subjects with severe neonatal hyperbilirubinemia was 108 +/- 2 for those treated by phototherapy and 107 +/- 2 for controls matched for gestational age and birth weight. The confounding effect on intelligence quotient scores of perinatal factors (bilirubin concentrations, gestational age, birth weight, Apgar score) and demographic characteristics (ethnic origin, socioeconomic status, paternal education) was taken into account in a multiple logistic regression analysis by using a General Linear Models procedure. Phototherapy was found to have no independent effect on intelligence quotient scores after adjustment for the effect of confounding factors. We conclude that for full-term newborn infants with neonatal hyperbilirubinemia, phototherapy had neither a beneficial nor an adverse effect on intellectual ability in late adolescence.

Adolescent↗
PubMed1977

The lack of effects of phototherapy on neonatal oxygen dissociation curves and hemoglobin concentration in vivo.

Phototherapy has been shown to cause hemolysis of fetal red cells and a shift to the right in the neonatal oxygen dissociation curve (deltaP50) in vitro. To determine if these parameters act similarly in vivo, we have studied 16 icteric infants before and after phototherapy and compared them with eight control infants studied at birth and at 3 days of age, measuring the change in P50, 2,3-diphosphoglycerate (2,3-DPG), serum bilirubin, the percent of bilirubin/albumin saturation, and the hemoglobin concentration in the two groups. Following phototherapy, in the icteric infants there was a shift to the right in the O2 dissociation curve of + 1.7 mm Hg, a rise in 2,3-DPG of 2.26 micronmol/gm Hb, a fall in serum bilirubin of 4.3 mg/100 ml, a decrease in percent bilirubin/albumin saturation of 12.4%, and a drop in hemoglobin of 1.1 gm/100 ml. The control group showed a deltaP50 of + 2.0 mm Hg, a rise in 2,3-DPG of 3.67 micronmol/gm Hb, an increase in serum bilirubin of 3.2 mg/100 ml, an increase in percent bilirubin/albumin saturation of 9.3%, and a fall in hemoglobin of 0.3 gm/100 ml. Significant differences between the groups were seen only in the changes in bilirubin concentration and percent bilirubin/albumin satruation. The magnitude of changes in P50, 2,3-DPG, and hemoglobin concentration was similar in the phototherapy and control groups and was related to the expected changes with reference to postnatal age. These results suggest that phototherapy in vivo neither affects (fetal erythrocytic affinity for oxygen nor causes hemolysis. Pediatrics, 59:1027-1031, 1977 PHOTOTHERAPY, 2,3-DIPHOSPHOGLYCERATE, HEMOLYSIS, NEWBORN INFANT.

Diphosphoglyceric Acids↗
PubMed1993

Home UV phototherapy of early mycosis fungoides: long-term follow-up observations in thirty-one patients.

BACKGROUND: In 1982 we reported our preliminary observations on the use of home UV phototherapy for patch and early plaque phase mycosis fungoides (MF). OBJECTIVE: Our purpose was to present follow-up data of the original 31 patients, covering an interval of up to 15 years. METHODS: All patients used a commercially available UV phototherapy unit that contained four Westinghouse FS40 fluorescent lamps for daily exposures of their non-sun-exposed skin regions. RESULTS: A complete clinical and histologic response to home phototherapy occurred in 23 patients (74%) with a maximum duration of the response from 5 months to more than 15 years (median 51 months). After maintenance phototherapy was discontinued, seven patients (23%) had a sustained disease-free interval lasting more than 58 months (median > 90 months). This indicates that cure may have been achieved in a minority of patients. Phototherapy was well tolerated without evidence of significant photodamage or photocarcinogenicity. CONCLUSION: These observations indicate that home phototherapy may be a therapeutic option for treatment of selected patients with early MF.

Adult↗
PubMed1996

Effect of UVB phototherapy and oral calcitriol (1,25-dihydroxyvitamin D3) on vitamin D photosynthesis in patients with psoriasis.

BACKGROUND: Phototherapy and activated froms of vitamin D help clear psoriasis. OBJECTIVE: The influence of UVB phototherapy and oral calcitriol (1,25-dihydroxyvitamin D3) on vitamin D photosynthesis was assessed in 16 patients. METHODS: Patients were randomly selected to receive orally either placebo or calcitriol (0.5 to 2 micrograms daily) for the duration of the 8-week study; all patients received approximately 21 UVB treatments. Before and after treatment, serum levels of 25-hydroxyvitamin D and calcitriol were measured by high-pressure liquid chromatography. RESULTS: Although calcitriol had no additive effect on phototherapy as a treatment modality, a significant increase in serum 25-hydroxyvitamin D levels occurred in both groups; in three patients extraordinarily high levels developed (> 120 ng/ml). Oral calcitriol significantly increased calcitriol serum levels. Increased serum calcitriol did not inhibit cutaneous synthesis of vitamin D or its hepatic conversion to serum 25-hydroxyvitamin D. CONCLUSION: UVB induces high levels of vitamin D photosynthesis. Because oral or topical calcitriol alone helps clear psoriasis, studies to explore the possible influence of UVB phototherapy on its production should be considered. If UVB phototherapy induces cutaneous calcitriol synthesis this could explain the lack of added benefit to treatment when oral calcitriol is administered with phototherapy.

Administration, Oral↗
PubMed2000

Tazarotene plus UVB phototherapy in the treatment of psoriasis.

BACKGROUND: The addition of oral retinoids to phototherapy may accelerate and enhance antipsoriatic efficacy, but can result in systemic adverse events and additional laboratory monitoring costs. OBJECTIVE: Our purpose was to determine whether the topical addition of tazarotene to UVB phototherapy improves efficacy without problems related to photosensitivity. METHODS: Bilateral target plaques were randomized to receive two of the following, one on each plaque once daily for 14 days: tazarotene 0.1% gel, vehicle gel, or no treatment. Thereafter, the same treatments were continued 3 times per week, plus UVB phototherapy 3 times per week, for an additional 67 days. RESULTS: Tazarotene plus UVB phototherapy achieved faster and significantly greater reductions in plaque elevation and scaling throughout treatment and achieved at least 50% improvement from the pretreatment baseline with a significantly lower median cumulative UVB exposure than vehicle gel plus UVB light or UVB phototherapy alone. No case of unusual photosensitivity was noted in the tazarotene plus UVB treatment group. CONCLUSION: The addition of tazarotene to UVB phototherapy improves and accelerates efficacy and maintains acceptable safety and tolerability.

Administration, Topical↗
PubMed2004

UVA/UVB phototherapy for atopic dermatitis revisited.

BACKGROUND: Atopic dermatitis (AD) is a genetically determined pruritic skin disease affecting predominantly young people. The therapy of AD includes mainly corticosteroids (CS), antihistamines and immunosuppressors. CS are known to cause a variety of side effects and attempts have been made to reduce or eliminate their use through alternative methods such as phototherapy (UVA/UVB, UVA(1), UVB 311 nm). In order to optimize therapeutic efficacy the effects of CS and UV radiation are often combined. OBJECTIVE: To evaluate the efficacy of UVA/UVB and UVA/UVB plus topical CS phototherapy of AD and to compare the two regimens with regard to their therapeutic effect, duration of treatment and remissions, cumulative UVA and UVB doses and side effects. METHODS: Thirty-one patients (mean age 19 years) with moderate-to-severe forms of AD were enrolled in the study (mean disease duration of 17.7 years). Seventeen patients were treated with UVA/UVB phototherapy (Group I). Fourteen patients received UV irradiation combined with topical CS (Group II). The starting UVA dose was 2-2.5 J/cm(2). The initial UVB dose depended on skin phototype. The procedures were held five times weekly. In order to evaluate therapeutic efficacy, 10 severity criteria and 10 topographic sites were scored at the beginning and at the end of treatment. RESULTS: A statistically significant difference in the severity of the disease was observed before and after phototherapy in both groups (overall clinical score Group I: t=10.1, p=0.0001; Group II: t=13.9, p=0.0001). Erythema (t=12.1, p<0.0001), excoriations (t=10.1, p<0.0001) and vesiculation improved most dramatically after UVA/UVB phototherapy. Lichenification (t=2.5, p=0.024), xerosis (t=10.2, p<0.001) and pruritus (t=13.7, p<0.0001) also diminished significantly. The combination regimen had a similar effect on different severity criteria, but initial signs of improvement appeared earlier. Side effects observed during phototherapy included erythema, burning, skin xerosis and sweating. No statistically significant difference was established between the therapeutic efficacy of the two treatment modalities (t=0.2, p=0.904), but the addition of CS reduced the duration of treatment (number of procedures: t=2.5, p=0.02) and total UVB dose (t=2.3, p=0.03). There was no significant difference between the duration of remissions (t=0.9, p=0.39) and frequency of side effects in the two groups of patients. CONCLUSION: Both UVA/UVB monotherapy and UVA/UVB + topical CS lead to significant clinical improvement in patients with AD, but the addition of CS reduces the total UVB dose and duration of treatment without influencing the duration of remissions and frequency of side effects.

Administration, Topical↗
PubMed2006

Home ultraviolet B phototherapy for psoriasis: discrepancy between literature, guidelines, general opinions and actual use. Results of a literature review, a web search, and a questionnaire among dermatologists.

BACKGROUND: Home ultraviolet B (UVB) phototherapy is a debated treatment. It is currently being prescribed for patients with psoriasis, although literature on the subject is scarce. Despite the apparent contradiction between clinical practice and literature, no systematic study of either has been conducted. OBJECTIVES: To assess and compare the available publications and guidelines about home UVB phototherapy for psoriasis with the actual opinions and use of this therapy. METHODS: The literature and guidelines were searched using databases, search engines and e-mail. A postal survey of 343 Dutch dermatologists and 142 dermatologists from 32 other countries was carried out; 255 and 102 dermatologists respectively responded. Outcome measures were the reported advantages, drawbacks and prescription rates of home UVB phototherapy. RESULTS: Fourteen publications (nonrandomized) and six guidelines concerning home UVB phototherapy for psoriasis were identified. Most were reticent about the use of this treatment. Publications describing nonclinical research (7/14) reported most of the drawbacks mentioned (24/31). Home UVB phototherapy was prescribed to 5% (median) of all patients with psoriasis in The Netherlands who required UVB. However, 28% (68/244) of the Dutch dermatologists prescribed home UVB in 20 to 100% of their cases. Dermatologists from other countries reported that 0-10% of UVB treatments were offered at home. For both Dutch and other dermatologists, the most important reasons for prescribing home UVB concerned time and travel distance (80%, i.e. 163 of 205 and 75%, i.e. 33 of 44). Therapy-related drawbacks (such as poor service and equipment) were the objections mentioned most often (55%, i.e. 103 of 186 and 63%, i.e. 57 of 91). Concerns about the medicolegal liability of home UVB were rarely expressed by individual respondents, but frequently mentioned in the various reports. CONCLUSIONS: A discrepancy exists between the actual use of home UVB phototherapy and the general opinions found in publications. The treatment is prescribed for a considerable number of patients despite the fact that literature and guidelines advise caution. Personal and nonevidence-based opinions on this therapy are widespread while randomized clinical studies have thus far not been conducted.

Attitude of Health Personnel↗
PubMed2005

[New and established indications for phototherapy with narrowband UVB].

Phototherapy with ultraviolet (UV) irradiation of wavelengths between 280 and 320 nm (UV-B) is a safe and effective treatment for a variety of inflammatory skin diseases. In addition to standard broad band UVB, narrow band phototherapy with fluorescent bulbs emitting near monochromatic UV between 310-315 nm has become an important treatment for diseases such as psoriasis, atopic dermatitis or vitiligo. Other diseases respond favorably to narrow band UV-B phototherapy, the number of potential indications for such phototherapy is continuously growing. The differential effects of narrow band UV-B phototherapy in comparison to other UV phototherapies, as well as new and established indications for this treatment modality are reviewed.

Humans↗
PubMed2006

UVB phototherapy in an outpatient setting or at home: a pragmatic randomised single-blind trial designed to settle the discussion. The PLUTO study.

BACKGROUND: Home ultraviolet B (UVB) treatment is a much-debated treatment, especially with regard to effectiveness, safety and side effects. However, it is increasingly being prescribed, especially in the Netherlands. Despite ongoing discussions, no randomised research has been performed, and only two studies actually compare two groups of patients. Thus, firm evidence to support or discourage the use of home UVB phototherapy has not yet been obtained. This is the goal of the present study, the PLUTO study (Dutch acronym for "national trial on home UVB phototherapy for psoriasis"). METHODS: We designed a pragmatic randomised single-blind multi-centre trial. This trial is designed to evaluate the impact of home UVB treatment versus UVB phototherapy in a hospital outpatient clinic as to effectiveness, quality of life and cost-effectiveness. In total 196 patients with psoriasis who were clinically eligible for UVB phototherapy were included. Normally 85% of the patients treated with UVB show a relevant clinical response. With a power of 80% and a 0.05 significance level it will be possible to detect a reduction in effectiveness of 15%. Effectiveness will be determined by calculating differences in the Psoriasis Area and Severity Index (PASI) and the Self Administered PASI (SAPASI) scores. Quality of life is measured using several validated generic questionnaires and a disease-specific questionnaire. Other outcome measures include costs, side effects, dosimetry, concomitant use of medication and patient satisfaction. Patients are followed throughout the therapy and for 12 months thereafter. The study is no longer recruiting patients, and is expected to report in 2006. DISCUSSION: In the field of home UVB phototherapy this trial is the first randomised parallel group study. As such, this trial addresses the weaknesses encountered in previous studies. The pragmatic design ensures that the results can be well generalised to the target population. Because, in addition to effectiveness, aspects such as quality of life and cost-effectiveness are also taken into consideration, this study will produce valuable evidence to either support or discourage prescription of home UVB phototherapy. TRIAL REGISTRATION: Current controlled trials/Nederlands Trial register: ISRCTN83025173. Clinicaltrials.gov: NCT00150930.

Adult↗
PubMed2003

Altered decorin expression of systemic sclerosis by UVA1 (340-400 nm) phototherapy: immunohistochemical analysis of 3 cases.

BACKGROUND: Ultraviolet A1 (340-400 nm, UVA1) phototherapy is highly effective in sclerotic lesions of systemic sclerosis (SSc). Histological evaluation of skin specimens obtained before and after UVA1 phototherapy revealed loosening of collagen bundles and the appearance of small collagen fibers. We have previously shown that UVA1 irradiation induced collagenase in vitro study by using SSc fibroblasts. The increased levels of mRNA and protein of decorin in SSc fibroblasts were reported. In this study, we focus on the lesional expression of small dermatan sulfate proteoglycan, decorin that has a role of binding to collagen and fibrillogenesis. CASE PRESENTATION: We employed immunohistochemical analysis of decorin before and after UVA1 phototherapy. The skin specimens from three patients who were effectively treated with UVA1 phototherapy were analysed. Monoclonal antibody 6B6 as the specific reactivity to decorin was used. The increased decorin was focally accumulated in the newly synthesized collagen fibers in the sclerotic lesion of SSc. After UVA1 phototherapy, decorin was decreased in upper to middle dermis, although decorin was slightly increased in papillary dermis. CONCLUSIONS: These results suggest that decreased and normalized levels of accumulated decorin may relate to the efficacy of sclerotic lesions in UVA1 phototherapy.

Aged↗
PubMed1982

The pattern of bilirubin response to phototherapy for neonatal hyperbilirubinaemia.

The pattern of bilirubin response to phototherapy was studied using lamps with an emission spectrum closely similar to the bilirubin absorption spectrum. A dose-response relationship was demonstrated, with increased intensity of phototherapy resulting in greater response; however, the rate of bilirubin decline progressively decreased with increasing radiance till a 'saturation' point was reached, beyond which no further response occurred with further increase in radiance, suggesting a curvilinear relationship of the nature of an asymptotic regression. At the 'saturation' point, a 24-h decline of about 50% was achieved. With extended periods of phototherapy, a gradually decreasing response to phototherapy with declining bilirubin levels was observed, both with maximal or moderate intensity phototherapy; an exponential regression was suggested. At about 5 mg/dl little further decline was observed with continued phototherapy. The rate of the 24-h decline evaluated at 6-h intervals was observed to be proportional to the bilirubin level at the start of the 24-h period.

Bilirubin↗
PubMed2003

Prospects for ultraviolet A1 phototherapy as a treatment for chronic cutaneous graft-versus-host disease.

BACKGROUND AND OBJECTIVES: Standard or investigative immunosuppressive therapies for cutaneous chronic graft-versus-host disease (GVHD) may prove not only ineffective but also cause serious adverse effects. Repeated exposure of the skin to ultraviolet radiation in the wavelength range 340-400 nm (so-called ultraviolet A1) was recently reported to have a strong local (intracutaneous) immunomodulatory activity. This study was undertaken to evaluate efficacy and safety of this phototherapy. DESIGN AND METHODS: Nine patients with cutaneous (4 lichenoid and 5 sclerodermoid) GVHD and mild or no other organ involvement were enrolled. All patients had developed serious drug toxicity and/or opportunistic infections. Phototherapy was administered three times a week. RESULTS: Complete remission was seen in 5 (2 lichenoid and 3 sclerodermoid) cases and a partial improvement in 4 (2 lichenoid and 2 sclerodermoid) after having received 15.8+/-3.8 (lichenoid GVHD) or 21.6+/-8.0 (sclerodermoid GVHD) sessions of phototherapy. Adverse effects were not registered. At follow-up (range: 6-25 months), two patients with sclerodermoid lesions relapsed after 5 months but responded to another treatment cycle. Patients with lichenoid GVHD showed relapses within one month and prolonged maintenance phototherapy was needed. Problems of drug toxicity and opportunistic infections improved as phototherapy allowed the reduction or interruption of systemic drug therapies. INTERPRETATION AND CONCLUSIONS: Ultraviolet A1 phototherapy may be considered as an appropriate therapeutic approach for sclerodermoid GVHD with no or mild involvement of internal organs. Patients with lichenoid GVHD should be treated only if they develop serious adverse effects to immunosuppressive therapies and opportunistic infections because of the carcinogenic hazard of high cumulative doses of ultraviolet A1 radiation.

Adult↗
PubMed1993

Efficacy of phototherapy in neonatal hyperbilirubinaemia associated with glucose-6-phosphate dehydrogenase deficient status.

The efficacy of phototherapy in a group of 427 infants with hyperbilirubinaemia associated with glucose-6-phosphate dehydrogenase (G6PD) deficiency and a comparable group of 3924 G6PD normal infants with non-haemolytic hyperbilirubinaemia was evaluated. Phototherapy was highly effective in reducing bilirubin levels in both groups of infants, being significantly more effective in the group with normal G6PD status. Failure rate was very low (2.03/1000) in the group with normal G6PD status and nil in the G6PD deficient group. Bilirubin rebound after phototherapy was unremarkable with very few infants requiring a second exposure--4.68/1000 in the G6PD deficient group and 6.37/1000 in the G6PD normal group. All the babies tolerated phototherapy well. Phototherapy would therefore seem to be a simple and effective method for the management of severe jaundice associated with G6PD deficiency.

Glucosephosphate Dehydrogenase Deficiency↗
PubMedDate not supplied

Testicular changes in newborn rats exposed to phototherapy.

In this study we investigated the long-term effects of 72-h continuous phototherapy on the reproductive system of newborn rats. The animals' weight, fertilization rates, and number of newborn and histopathological changes in the gonads in a normal group not exposed to phototherapy and in the test animals were compared. At the age of 24 weeks there were no significant differences between the two groups, apart from the histology of the testicles of the male rats who were exposed to the phototherapy. The study group showed a significantly reduced diameter of the seminiferous tubules when compared to the controls (P < 0.001). It can be postulated that phototherapy may cause histological degenerative changes in the structure of the rat's testes, even though there were no changes in fertilization rates. Further studies are necessary to reveal the effects of phototherapy on humans and to determine the effects, if any, on fertility.

Animals↗
PubMed1983

The behavior of jaundiced infants treated with phototherapy.

This study was performed in order to evaluate possible changes in behavior in jaundiced infants without perinatal complications other than hyperbilirubinemia treated with phototherapy. Thirty jaundiced infants (mean bilirubinemia 13.3 mg/100 ml, range 8.4-17.5) born spontaneously at term and undergoing phototherapy for 6 h or more, and 30 comparison subjects similar for sex, birthweight, gestational age, Apgar score, obstetrical history and father's profession were examined during the 3rd day of life according to Brazelton Neonatal Behavior Assessment Scale (BNBAS). For 6 of 26 items we found higher values for comparison group (Wilcoxon's Test): inanimate visual median (m.) 5 vs. 3 (P less than 0.05); animate visual m. 5 vs. 3.5 (P less than 0.01); visual and auditory 5.5 vs. 4 (P less than 0.005); pull-to-sit m. 6 vs. 5 (P less than 0.01); cuddliness m. 5 vs. 4 (P less than 0.01); alertness m. 5 vs. 4 (P less than 0.005). Visual orientation responses were the most compromised. On the 4th day of life, 14 infants who had terminated phototherapy at least 2 h before (mean 9.9 h) were compared with their matched comparison group subjects and the same significantly poorer performances, mainly in visual orientation, were found. At one month of age, 12 of these infants treated with phototherapy still showed a significantly poorer performance in 2 items of orientation: inanimate visual m. 6 vs. 4.5 (P less than 0.05); visual and auditory m. 6.5 vs. 4 (P less than 0.05). Whether these results depend on the jaundice or on the phototherapy remain to be established.

Behavior↗
PubMed1975

The lack of effect of phototherapy on serum bilirubin-binding capacity in newborn infants.

Using a Sephadex G-25 separation technique, the total bilirubin-binding capacity was measured in 18 jaundiced infants before and after phototherapy. The initial total bilirubin-binding capacity obtained at 20 to 113 hours of age averaged 17.5 +/- 4.4 mg/dl (mean +/- SD) and was unchanged during phototherapy at 34 to 135 hours of age. In ten infants, the total bilirubin-binding capacity was measured before, during, and 24 hours after the cessation of phototherapy. Here too, phototherapy did not significantly influence the TBBC. These data indicate that in vivo, phototherapy does not alter the serum bilirubin binding capacity of newborn infants.

Bilirubin↗
PubMed1977

Light (phototherapy)--induced riboflavin deficiency in the neonate.

Phototherapy with blue light decomposes riboflavin, which has a maximum absorption at 450 nm. A study was designed to determine whether riboflavin deficiency developed in neonates who received phototherapy for moderate hyperbilirubinemia. Twenty-one infants with normal erythrocyte glucose-6-phosphate dehydrogenase activity were investigated. Five infants with moderate hyperbilirubinemia who did not require phototherapy served as the controls. Riboflavin deficiency was determined from the degree of saturation of erythrocyte glutathione reductase, a method shown to reflect riboflavin nutritional status in the neonate. Sixteen of 21 infants who were exposed to phototherapy developed riboflavin deficiency; all who had phototherapy for 49 hours or more developed the deficiency. That the concentration of serum bilirubin or the duration of hyperbilirubinemia was not a factor is supported by the fact that none of the controls became deficient. This observation may have important metabolic and clinical consequences for the neonate.

Female↗
PubMed1998

Rebound bilirubin levels in infants receiving phototherapy.

A retrospective medical record review was completed for 264 consecutive newborns receiving phototherapy for hyperbilirubinemia to determine whether a "rebound" increase in total serum bilirubin (TSB) level occurs after termination of phototherapy. The difference between mean TSB levels at discontinuation of phototherapy and at rebound was calculated by paired t test. TSB levels at rebound were significantly lower than at discontinuation of phototherapy for infants weighing > 1800 g (positive and negative Coombs' test results). There were no statistically significant differences among infants in the smaller weight categories, regardless of Coombs' test results. Infants completing phototherapy for hyperbilirubinemia who are otherwise healthy do not require follow-up solely to identify a rebound bilirubin level.

Bilirubin↗