Abstract The Goeckerman regimen, consisting of the application of crude coal tar combined with exposure to ultraviolet radiation, was formulated in 1925 for the treatment of psoriasis. While some centers have adapted the Goeckerman regimen for the treatment of eczema, there are no published reports of its efficacy in this condition. Here, we explain how the Goeckerman regimen has been modified for use in an eczema population at the University of California San Francisco (UCSF). We reviewed the treatment records of eczema patients treated with the modified Goeckerman regimen over a 6-year period at UCSF. We found that the Goeckerman regimen was effective in treating patients with severe baseline disease, inducing a mean remission period of 7.2 months. The treatment was tolerated well with mild folliculitis and occasional ultraviolet B phototoxicity noted as the only adverse reactions. Since the use of Goeckerman as a treatment for severe eczema is both effective and safe, it should be considered an excellent alternative or adjunct to the systemic therapies currently being used.
Abstract Background: Several treatment modalities had been used for the treatment of vitiligo but the optimal treatment has not yet been identified. Aim: To evaluate the efficacy and safety of intradermal injection of 5-flurouracil (5-FU) combined with narrow-band ultraviolet B (NB-UVB) as a treatment option for vitiligo. Patients and methods: The study included 60 vitiligo patients with overall symmetrical lesions affecting less than 30% of body surface area. For each patient, one side of the body was treated with NB-UVB alone (control side) while the other side was treated with NB-UVB therapy in addition to intradermal injection of 5-FU (50 mg/ml), 0.01-0.02 ml per injection with 1 cm apart in skin of vitiligo, every 2 weeks for 4 months. Results: The overall repigmentation was significantly higher in the 5-FU side compared with control side in all body parts (p < 0.001) except for the acral lesions where the difference was not significant (p = 0.561). No systemic side effects of 5-FU were detected, and the majority of the patients reported pain during injections. Conclusions: Intradermal 5-FU injection in combination with NB-UVB could be considered as a simple, safe, tolerable and cheap technique for treatment of vitiligo. It shortens the duration of NB-UVB therapy and improves the outcome, repigmentation. Longer follow-up is needed.
Hand eczema is a common inflammatory dermatosis that causes significant patient morbidity. Symptoms such as pain, itch and localised swelling contribute to disruption of activities of daily living, lack of sleep, and missed days from work. The aetiology is often multifactorial. Previous studies comparing psoralen ultraviolet A (PUVA) and narrowband ultraviolet B (NBUVB) have been small, non-randomised and retrospective.
Fructus Psoraleae, a traditional Chinese medicine, is widely used for preventing and treating various diseases such as vitiligo, osteoporosis and psoriasis. Coumarin, such as psoralenoside, isopsoralenoside, psoralen and isopsoralen, are important compounds in Fructus Psoraleae. In our study, ultra performance liquid chromatography coupled with diode array detector was employed for an excellent method validation for simultaneous quantification of psoralenoside, isopsoralenoside, psoralen and isopsoralen, which was further applied in performing general survey of Fructus Psoraleae from the different origins and chemical identification of the roasted from raw Fructus Psoraleae in the light of illuminating the transformed rule of psoralenoside and isopsoralenoside. There is a reciprocal relationship between (iso)psoralenoside and (iso)psoralen, and the total content remains balance in Fructus Psoraleae from the different origins. In addition, we found that (iso)psoralenoside in the powder of the raw Fructus Psoraleae could be easily transformed into (iso)psoralen in methanol aqueous solution, especially above 50% water, rather than the roasted one. Thus, we proposed a hypothesis that transformation between (iso)psoralenoside and (iso)psoralen was hindered by inactivation of β-glucosidase in the process of roasting Fructus Psoraleae, which was further verified by observing transformation of (iso)psoralenoside under the different conditions, such as temperature, pH and β-glucosidase. Therefore, we developed a feasible method to distinguish the roasted from raw Fructus Psoraleae by observing conversion from (iso)psoralenoside to (iso)psoralen in 50% methanol aqueous solution. In summary, these results pave the way for elevating quality standard for Fructus Psoraleae and distinguishing the salt-processed from raw Fructus Psoraleae.
Although disease severity, gender, body weight, and previous treatments have all been reported to affect clinical response of psoriasis vulgaris to narrowband ultraviolet B (NB-UVB) therapy, little information about possible local (lesional) influencing factors is available.
The effects of 8-methoxypsoralen plus ultraviolet A (PUVA) and ultraviolet B (UVB) on imiquimod-induced psoriasis were examined in a mouse model. Mouse skin was treated with repetitive sub-phototoxic doses of PUVA or UVB before or during the induction of toll-like receptor 7/8 activation and psoriasis through the application of imiquimod. PUVA, to a greater degree than UVB, suppressed the established imiquimod-induced psoriatic phenotype, but pretreatment with PUVA prior to administration of imiquimod also reduced the susceptibility of murine skin to respond to imiquimod to a greater degree than did UVB. PUVA downregulated baseline levels of miRNA27a and 29a, as well as interferon-γ, interleukin-17 and -9 cytokines, which drive psoriatic inflammation. Microarray analysis showed enrichment of senescence pathway genes linked to upregulation of p16/p21 proteins after PUVA pretreatment. However, the anti-psoriatic effect of PUVA was lost when there was an interval of 7 days between final exposure to PUVA and the start of administration of imiquimod. This indicated that (UVB and) PUVA diminished imiquimod-induced established psoriatic inflammation, but also primed the skin in favour of a reduced responsiveness to toll-like receptor activation.
Preclinical evaluation of melanocyte transplantation by chitosan-based melanocyte spheroid patch to skin prepared by controlled sunburn blistering
- Journal of biomedical materials research. Part B, Applied biomaterials
- Published 9 months ago
Transplantation of autologous cultured melanocytes as cell suspension has been used for the treatment of vitiligo. The recipient site is often prepared by laser-mediated dermabrasion. Such procedures encounter disadvantages including prolonged transplantation duration, unsecured cell adherence to lesional skin and potential scarring. To improve this, here we propose a method by preparing recipient sites before transplantation by psoralen and ultraviolet A (PUVA)-induced sunburn followed by transplanting cells with a chitosan-based melanocyte spheroid patch. We evaluated the method in nude mice. Application of methoxsalen-soaked filter paper on skin for 30 min followed by ultraviolet A exposure induced controlled sunburn blisters in 2 days. Upon transplantation, the blister roof could be quickly peeled off by a waxing patch. The chitosan membrane on which melanocytes were precultured into multicellular spheroids was transplanted with cells facing the skin. The chitosan patch adhered well to skin and secured the contact of melanocytes with the recipient site. One day later, melanocyte spheroids already detached from the chitosan membrane and adhered to the recipient skin. Our results suggest that the combination of chitosan-based melanocyte spheroid patch with epidermal ablation by PUVA-induced sunburn reaction can be a feasible method to facilitate melanocyte transplantation. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2018.
Furocoumarins (psoralens and angelicins) have been already used under ultraviolet A light (UVA) for the treatment of skin diseases and cutaneous T-cell lymphoma. Besides their high anti-proliferative activity, some severe long-term side effects have been observed, for example genotoxicity and mutagenicity, likely strictly related to the formation of crosslinks. It has been demonstrated that blue light (BL) activation of 8-methoxypsoralen, an FDA-approved drug, leads to less mutagenic monoadducts in the DNA. So far, in this work the less toxic and more penetrating BL is proposed to activate 4,6,4'-trimethylangelicin (TMA), an already known UVA photoactivatable compound.
Photosensitizers are used in the treatment of epidermal proliferation and differentiation disorders such as psoriasis and vitiligo. In the present studies, a ring-expanded carbon homologue of the linear psoralen (furo[3,2-g]benzopyran-7-one) class of photosensitizers, 4,10-dimethyl-2H,8H-benzo[1,2-b:5,4-b']dipyran-2-one (NDH2476), was synthesized and analyzed for biological activity. Following activation by ultraviolet light (UVA, 320-400 nm), NDH2476 was found to be a potent inhibitor of keratinocyte growth (IC50 = 9 nM). Similar derivatives methylated in the pyrane ring, or containing a saturated pyrane ring structure, were markedly less active or inactive as photosensitizers. NDH2476 was found to intercalate and damage DNA following UVA light treatment as determined by plasmid DNA unwinding and nicking experiments. Taken together, these data demonstrate that an intact furan ring in psoralen photosensitizers is not required for keratinocyte growth inhibition or DNA damage. Our findings that low nanomolar concentrations of a benzopyranone derivative was active as photosensitizer indicates that this or a structurally related compound may be useful in the treatment of skin diseases involving aberrant epidermal cell growth and differentiation. This article is protected by copyright. All rights reserved.
- Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete
- Published 10 months ago
We report the case of a 59-year-old woman who simultaneously suffered from psoriasis and vitiligo. The depigmented areas were predominantly but not exclusively limited to current or former psoriatic plaques. These two diseases share many common features, e. g., both are T‑cell-mediated autoimmune diseases in which the Koebner phenomenon occurs. However, it is still not known whether the coincidence is random or significant. Prospective clinical and epidemiological research will hopefully reveal the association soon.