Abstract Introduction The dry and scaly skin of psoriatic patients decreases the efficacy of ultraviolet B UVB phototherapy. Different agents are used to facilitate the transmission of light, but most of these preparations are cosmetically unfavorable. We have tested a novel preparation containing sodium hyaluronate and nicotinic acid UV Fotogel®; Pernix Ltd.
The other 46 patients used the preparation at their homes before regular sunbathing.
Aim: To assess health related quality of life and cost-of-illness in moderate to severe psoriasis associated with psoriatic arthritis. Method: A cross-sectional questionnaire survey was conducted at two academic dermatology clinics in Hungary. Conclusions: Patients on biological therapy showed significantly better health related quality of life. As for health economics, the efficacy of systemic treatments is appropriate to be assessed together in patients with moderate to severe psoriasis associated with psoriatic arthritis, since actual health gain might exceed that reported in psoriasis or psoriatic arthritis separately.
The median values with the 25th and 75th percentiles 25p and 75p, respectively were determined for the UV Fotogel-treated and control sites and then compared.
There was a significant reduction in the median L-PSI score of patients at the final visit compared to baseline 2. Use psoriasis arthritis new therapy the preparation was not accompanied by considerable adverse effects, and the patients found it cosmetically acceptable.
Application of UV Fotogel prior to sunbathing was well tolerated by the patients, and the cosmetic acceptability was also good.
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Conclusion UV Fotogel is potentially a useful device for enhancement of the efficacy of phototherapy in patients with psoriasis. Phototherapy is a cornerstone in the treatment of psoriasis; however, dry and scaly skin decreases the efficacy of phototherapy. Many treatments used to improve the efficacy of phototherapy have unfavorable cosmetic properties or absorb ultraviolet UV light, requiring higher UV doses to be effective.
The aim of this study was to test whether our novel medical device UV Fotogel® enhances UV phototherapy in psoriatic patients. What was learned from the study? UV Fotogel considerably increased the efficacy of UV phototherapy.
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UV Fotogel was well tolerated by the patients. In contrast to compounds with similar effects, UV Fotogel is cosmetically acceptable. Introduction Psoriasis is a chronic autoimmune disorder, with a prevalence in adults that varies from 0. Although chronic plaque psoriasis, which is nem gyógyuló vörös folt az arcon most common type of psoriasis, can be diagnosed without major difficulties, the disease may still be underdiagnosed and undertreated [ 234 ].
Several treatment options are available for psoriasis.
Topical therapy is typically chosen in mild to moderate manifestations, with corticosteroids [ 5 ], vitamin D3 analogues [ 6 ] and the combination thereof [ 7 ] shown to be effective. In more severe cases, systemic therapy is indicated, most commonly with immunosuppressants e.
In addition to these different pharmacological approaches, phototherapy is also considered to be a safe and effective method for the treatment of psoriasis. Many types of phototherapy use ultraviolet B UVB light [ 11 ], with the most effective wavelengths of the UVB spectrum being between and nm. Wavelengths of — nm have a reduced therapeutic effect and cause severe and unnecessary skin inflammation [ 121314 ].
The efficacy of phototherapy is influenced by the reflection of UV light from the skin surface, with dry, scaly skin reflecting more UV light than healthy skin; accordingly, a lower proportion of the radiation penetrates the psoriatic lesions, thereby decreasing the therapeutic effect.
Thus, the efficacy of phototherapy might be improved by optimizing skin transmittance and irradiating at a wavelength of — nm. Different topicals have been tested with this goal e. The aims of this study was to test a novel medical device containing polyethylene glycolnicotinic acid, and sodium hyaluronate UV Fotogel® for the enhancement of phototherapy in psoriatic patients and to monitor its efficacy and tolerability.
The investigation was performed in two parts. Methods UV Fotogel The gel comprises polyethylene glycolnicotinic acid, sodium hyaluronate, and purified water. Zalaegerszeg, Hungary. Patients Of the 90 patients enrolled in the study, 44 patients participated in Part I 24 males, 20 females; mean age All patients had plaque psoriasis.
The inclusion criteria were: minimum age of 18 years; ability and intention to follow the instructions of the investigator; communicated well with the study personnel; indication for NB-UVB; disintegration and desquamation of stratum corneum; a degree of desquamation of at least 2 points according to the Local Psoriasis Severity Index L-PSI score; and provided a signed informed consent form.
The exclusion criteria were: application of any systemic and topical antipsoriatic drugs e. Informed consent was obtained from all psoriasis arthritis new therapy. In this part of the study, the patients were enrolled on day 0 visit 1at which time they signed the informed consent agreement and the baseline L-PSI scores were recorded.
In addition, the minimal erythema dose MED was determined for each patient range at baseline 0. On psoriasis arthritis new therapy next day visit 2the patients received their first phototherapy treatment.
One to three ipsilateral plaques psoriasis arthritis new therapy the trunk and limbs and on both sides of the body were chosen for treatment.
Randomization and application of UV Fotogel was performed by a nurse specialized in phototherapy. The dose of the first vörös foltok a lábakon gyantázás után was 0. When considerable erythema was present, the last dose was not increased.
The cumulative total dose varied between 2. NB-UVB treatments were given three times a week, and no other anti-psoriatic treatments were allowed throughout psoriasis arthritis new therapy study period. When desquamation ceased, the study was terminated for a given patient.
The duration of treatment for all patients participating in Part 1 was a minimum of 3 weeks and not longer than 6 weeks. Although the patients were instructed to sunbathe 3—5 times weekly, the actual number of times sunbathing per week differed for each patient. Two lesions were chosen for each patient, and the size and L-PSI score of each lesion were determined at baseline. The patients were provided the UV Fotogel to be applied and instructed to sunbathe for 15—30 min three to five times weekly between am and am or between pm and pm.
Patients were instructed to apply UV Fotogel to the chosen lesions and to apply a sun protection preparation to the rest of the exposed skin prior to sun exposure. The length of time and other conditions of each sunbath were recorded.
The patient attended clinic visits at 2-week intervals. The clinical study was terminated when cessation of the desquamation was observed.
Enrollment in Part II of the study was a minimum of 4 weeks and not longer than 6 weeks. The L-PSI score was calculated by monitoring erythema, infiltration, and desquamation and then scoring each of these parameters with a score of 0 to 4 0: not present; 1: mild, 2: moderate; psoriasis arthritis new therapy severe; 4: very severe. Cosmetic acceptability was evaluated on a 5-point scale 1: poor; 2: sufficient; 3: good; 4: very good; 5: excellent.
Patients were asked whether they experienced any of the following symptoms: burning sensations, stabbing pain, itching, stretching, and tingling. These parameters of tolerability were recorded on a 4-point scale 1: not present; 2: mild; 3: moderate; 4: severe.
Part I was a randomized and single-blind study the evaluating dermatologist was blinded to the treatment sideswhereas Part II was an open study.
The Psoriasis and Psoriatic Arthritis Pocket Guide
The Shapiro—Wilk test was used to check normality. The values obtained varied significantly from the pattern expected for a population with normal distribution. Hence, non-parametric methods were chosen for the comparison. The Wilcoxon signed-rank test was applied to compare data obtained before and after treatments, and the Mann—Whitney rank sum test was used to analyze the differences between control and treated sides. Median values are presented with the 25th and 75th percentiles 25p and 75p, respectively.
Results In Part I, one patient left the study due to progression of the disease systemic therapy was required. Cessation of desquamation was observed psoriasis arthritis new therapy three patients by the fourth visit.
With the exception of one patient, the improvement leading to termination of the study was detected on the UV Fotogel-treated side Fig.
V1, V V7 visit 1, visit 2, and all subsequent visits up to visit 7, Prog. Another patient quit due to an adverse effect of the treatment burning sensation but attended the final visit. Desquamation had ceased in 40 patients by visit 3 and in the remaining four patients by visit 4 Fig. Median and 25th and 75th percentiles are shown.
Compared to the median baseline score, there was a statistically significant reduction in this score on both the control and treated sides at the final visit, but the median erythema score of the treated side was significantly lower than that of the control side, indicating a greater decrease in erythema 1. The median infiltration value after treatment at visit 1 was 2.
The median infiltration score at subsequent visits decreased on both the treated and control sides, however improvement of the skin, as indicated by the median infiltration score, on the side treated with UV Fotogel surpassed that of the control side at the final visit 0. The median desquamation score at baseline was 2.
Compared to the median baseline score, there was a statistically significant reduction in this score on both the control and treated psoriasis arthritis new therapy at the final visit, but the reduction, as indicated by the mean desquamation score, was significantly greater on the side treated with UV Fotogel than on the control side 0.
Two patients reported a mild burning sensation, three patients experienced mild itching, and two patients experienced moderate itching. Two patients reported mild stretching. None of the patients reported stabbing pain and tingling. No severe symptoms were reported. The majority of the patients 21 patients found the cosmetic acceptability of UV Fotogel excellent, with ratings of very good and good given by 11 and 11 patients, respectively.
Only one patient found the cosmetic acceptability sufficient Table 1. Table 1 Tolerability, irritability, and cosmetic acceptability of UV Fotogel application in combination with narrow band-ultraviolet B phototherapy Full size table Toleration to and Cosmetic Acceptability of Applying UV Fotogel Prior to Sunbathing The krém pikkelysömör összetételéhez of UV Fotogel prior to sunbathing Part II of the study led to a considerable decrease in median L-PSI score, was well tolerated by the patients, and the cosmetic acceptability was assessed to be good.
At the final visit, one patient reported mild burning sensations and two patients reported moderate burning sensations. One patient experienced mild stabbing pain and another experienced moderate stabbing pain. Mild itch was reported by four patients and moderate itch by three patients. One patient felt psoriasis arthritis new therapy stretching of the skin, and another patient reported moderate stretching of the skin.
No patients reported tingling sensations. Six patients considered the cosmetic acceptability to be excellent, 15 patients found it to be very good, 18 patients evaluated it as good, and six patients found it to be sufficient Table 2. Table 2 Tolerability, irritability, and cosmetic acceptability after application of UV Fotogel with sunbathing Full size table Discussion The treatment of psoriasis depends on the severity of the disease. In mild to moderate psoriasis, topical therapy is indicated alone or psoriasis arthritis new therapy combination with UV phototherapy.
NB-UVB is currently the first-line phototherapy for stable plaque psoriasis. Nevertheless, careful design of the therapy is necessary, as UV light might lead to cataracts, photodermatitis, and photoaging. Carcinogenesis is also a potential risk [ 18 ]. However, the efficacy of UVB therapy can potentially be increased by combining it with different topical and systemic agents.
Historically, UVB phototherapy was combined with coal tar; however, this preparation smells, stains skin, has irritative and carcinogenic properties, and may block UVB rays. Dithranol has also applied to the skin to improve the efficacy of UVB therapy, but this preparation is associated with an increased risk of irritation [ 19 ].
[Disease burden of psoriasis associated with psoriatic arthritis in Hungary]
Other topical treatments used just before UV irradiation e. In the present study, we combined NB-UVB with a preparation which, when used alone, does not have a therapeutic effect, but which may enhance the efficacy of phototherapy. The optical properties of the psoriatic skin differ from those of normal skin [ 1723 ].
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The multiple air—keratin interfaces in psoriatic scales allow reflection and refraction of incident radiation, and the lesions, thereby, act as a partial optic barrier.
Successful treatment of psoriasis with UV-light requires adequate penetration of the radiation to at least the level of viable epidermal cells. Compared to other combination therapies, there appear to be fewer possibilities to modify the transmission of UVB.
A saltwater shower and application of lipophilic compounds may be beneficial [ 1924 ]. These latter compounds reduce the fraction of incident radiation which is then backscattered or re-emitted from the skin. It has been confirmed in vivo that the application of non-photosensitizing oily lubricants to the skin increases the transmission of psoriasis arthritis new therapy through psoriatic plaques, resulting in increased effectivity of the phototherapy [ 151723 ].
Mineral oil e.
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- [Disease burden of psoriasis associated with psoriatic arthritis in Hungary]
However, the majority of psoriasis treating centers have reported that they do not routinely use emollients before UV irradiation [ 16 ]. The lack of randomized controlled studies on the benefit of using emollients concomitantly with UVB is a further difficulty.
The psoriasis arthritis new therapy clinical investigation performed to date was conducted with paraffin oil in children. This study reported a significantly greater improvement in scaling, induration, and area of involvement after application of mineral oil while no adverse effects were observed [ 16 ]. Nevertheless, mineral oil is considered to be cosmetically unfavorable. Other emollient preparations e. The components of the UV Fotogel were selected solely on their optical properties, as the aim was to develop a medical device that decreases the reflection of UVB light while at the same time blocks the shorter wavelengths.
The absorption spectra of different compounds and the UV transmittance through the gel were measured in vitro [ 28 ]. Based on the results of our previous in vitro examination, the components of UV Fotogel facilitate the penetration of Psoriasis arthritis new therapy wavelengths in the to nm range into the skin and block wavelengths in the range of — nm [ 28 ].
Thus, the preparation facilitates penetration of the therapeutically useful fraction and blocks the range which may evoke an inflammatory reaction Fig. Moreover, topical use of the listed components can be considered safe [ 293031 ].