Narrow-band UVB phototherapy in patients with atopic dermatitis: analysis of the factors determining treatment efficacy

Background. Efficacy the narrow-band UVB phototherapy in patients with atopic dermatitis varies greatly. An important condition for achieving optimal therapeutic effect is the identification of factors that can impact on the efficacy of therapy and considering their influence when prescribing treatment. Aims. The present study aimed to identify the factors which affect the efficacy of narrow-band phototherapy in patients with atopic dermatitis Methods. A prospective, open-label trial was conducted to evaluate the efficacy and safety of narrow-band UVB phototherapy for patients with moderate-to-severe atopic dermatitis. All patients were treated with narrow-band UVB phototherapy four times weekly for 5 weeks. Disease severity was evaluated by SCORing of the Atopic Dermatitis Index (SCORAD) and Eczema Area and Severity Index (EASI). Distribution of patients by the severity of therapeutic effect was evaluated. To compare the efficacy of therapy depending on initial atopic dermatitis severity, initial and cumulative irradiation doses, skin phototype, and smoking status patients were divided into subgroups. Results. 40 patients with moderate-to-severe atopic dermatitis received course of narrow-band UVB phototherapy. After NB-UVB therapy SCORAD and EASI scores reduced from 45.6 ± 11.4 at baseline to 22.6 ± 12.4 (p 0,05) and from 14.4 ± 7.2 at baseline to 4.1 ± 3.9 (p 0,05) respectively demonstrating the efficacy of narrow-band UVB phototherapy in patients with atopic dermatitis. Our investigation showed that tobacco smokers had definitely lower efficacy of NB-UVB phototherapy in comparison with non-smokers. Narrow-band UVB phototherapy had definitely higher efficacy when it is started with an initial dose 0.2–0.3 J/cm2 chosen in compliance with results of MED determing in comparison with an initial dose 0.05–0.15 J/cm2 selected according to skin phototype. Conclusions. Factors that impact on the efficacy of narrow-band UVB phototherapy in patients with atopic dermatitis were identified. It was determined that using higher initial dose is associated with higher efficacy of therapy. The obtained data suggest the opportunity of decrease in efficacy of therapy in smokers with atopic dermatitis

Cutaneous lichen amyloidosis within scratched areas

It is considered that pruritus might be either a predisposing factor of development of cutaneous lichen amyloidosis or its symptom. In this case report we try to elucidate this issue. Case of 27-years old patient of Asian origin with cutaneous lichen amyloidosis is presented. Sites of lesions closely matched the scratched areas. Within the affected area there was a melanocytic nevus, which the patient avoided to touch. The area around the nevus was free from amyloidosis lesions. It proves the role of pruritus followed by scratching in the development of cutaneous lichen amyloidosis patches

Современные подходы к ведению пациентов с крапивницей

The Union of Pediatricians of Russia together with the Russian Association of Allergologists and Clinical Immunologists and the Russian Society of Dermatovenerologists and Cosmetologists have developed new clinical guidelines for the urticaria in adults and children. Urticaria is a common disease; its various clinical variants are diagnosed in 15–25% of people in the global population, and a quarter of all cases belongs to chronic urticaria. The prevalence of acute urticaria is 20%, and 2.1–6.7% in child population, whereas acute urticaria is more common in children than in adults. The prevalence of chronic urticaria in adults in the general population is 0.7 and 1.4%, and 1.1% in children under 15 years of age, according to the systematic review and meta-analysis, respectively. This article covers features of epidemiology, etiology, and pathogenesis of the disease with particular focus on differential diagnostic search. Guidelines on treatment and step-by-step therapy scheme (both based on principles of evidencebased medicine) for pediatric patients were presented. Clarification on the analysis of the therapy efficacy and the degree of disease activity was given.Союзом педиатров России совместно с Российской ассоциацией аллергологов и иммунологов и Российским обществом дерматовенерологов и косметологов (РОДВК) разработаны новые клинические рекомендации для диагноза «крапивница» для взрослых и детей. Крапивница является распространенным заболеванием: различные ее клинические варианты диагностируются у 15–25% людей в популяции, при этом четверть случаев приходится на хроническую крапивницу. Распространенность острой крапивницы составляет 20%, среди детского населения — 2,1–6,7%, при этом острая крапивница у детей встречается чаще, чем у взрослых. По данным систематического обзора и мета-анализа, хроническая крапивница у взрослых в общей популяции составляет 0,7 и 1,4% соответственно, у детей до 15 лет — до 1,1%. В статье рассматриваются особенности эпидемиологии, этиологии и патогенеза заболевания, особое внимание уделено вопросам дифференциально-диагностического поиска. Для пациентов детского возраста приведены рекомендации по лечению согласно принципам доказательной медицины и предложена ступенчатая схема терапии. Дано четкое разъяснение к проведению анализа эффективности терапии и оценки степени активности заболевания