Excimer laser therapy and narrowband ultraviolet B therapy for exfoliative cheilitis

AbstractBackgroundExfoliative cheilitis is a condition of unknown etiology characterized by hyperkeratosis and scaling of vermilion epithelium with cyclic desquamation. It remains largely refractory to treatment, including corticosteroid therapy, antibiotics, antifungals, and immunosuppressants.ObjectiveWe sought to evaluate the safety and efficacy of excimer laser therapy and narrowband ultraviolet B therapy in female patients with refractory exfoliative cheilitis.MethodsWe reviewed the medical records of two female patients who had been treated unsuccessfully for exfoliative cheilitis. We implemented excimer laser therapy, followed by hand-held narrowband UVB treatments for maintenance therapy, and followed them for clinical improvement and adverse effects.ResultsBoth patients experienced significant clinical improvement with minimal adverse effects with excimer laser therapy 600-700 mJ/cm2 twice weekly for several months. The most common adverse effects were bleeding and burning, which occurred at higher doses. The hand-held narrowband UVB unit was also an effective maintenance tool.LimitationsLimitations include small sample size and lack of standardization of starting dose and dose increments.ConclusionExcimer laser therapy is a well-tolerated and effective treatment for refractory exfoliative cheilitis with twice weekly laser treatments of up to 700 mJ/cm2. Transitioning to the hand-held narrowband UVB device was also an effective maintenance strategy

Identifying gaps in the narrowband ultraviolet B phototherapy guidelines for vitiligo

Phototherapy has been shown to be a safe, effective method of treatment for vitiligo. Although widely utilized, until recently, there were no consensus guidelines regarding protocol for phototherapy. An original article by Madigan et al. in 2016 and subsequent consensus article from the Vitiligo Working Group in 2017 have produced a protocol for phototherapy. This protocol covers frequency, initial dosing and subsequent modifications, how to define course of treatment, and assess response, among other points. This is a very large step in the direction of establishing a universal standard of care for phototherapy of vitiligo. Still, key gaps exist. At the forefront of these gaps is the lack of randomized controlled trials, as most recommendations are based upon expert consensus. In addition, as we move toward new systemic treatment options for vitiligo, including pulse‐dose steroids, minocycline, and JAK inhibitors, many questions arise. Questions that remain open for discussion include the role of phototherapy as an adjuvant to systemic treatment, the duration of treatment including active and maintenance therapy, and whether there is a need for adjustment of maximum or cumulative dose UV dose based upon skin type

VITI-SUN: A multicentric prospective study to evaluate sun protection behavior in patients with vitiligo

Patients with vitiligo have a reduced protection on depigmented areas. To date, however, little is known about photoprotection habits in patients with vitiligo even though these patients are thought to have a decreased ability to efficiently protect their skin against sun damage. Moreover, exposure to artificial UV is one of the major elements of the treatment of vitiligo even though certain phenotypes of vitiligo could be photoinduced. In this context we are conducting a multicentric prospective study between France and the USA to evaluate sun protection habits in patients with vitiligo. For that purpose a semi-directed questionnaire to investigate the sun protection behavior of vitiligo patients (adults\u3e 18 years of age) have been created. Vitiligo severity will be self-assessed by patients using a recently validated patient reported outcome, the SA-VES. The main objective of this study is to describe photoprotective behavior in patients with vitiligo. The secondary objectives are: • To evaluate the link between photo-exposure and occurrence of vitiligo outbreak • To evaluate the photoprotection habits according to patients phototype and to the severity of the disease We plan to include 500 patients with vitiligo including all phototypes. We have currently enrolled more than 200 patients and our results point to different sun protective habits between men and women. Our study may help to correctly address photoprotection in patients with vitilig

Diet and psoriasis, part I: Impact of weight loss interventions.

One of the most frequently asked questions by patients with psoriasis is whether dietary changes can improve their condition. Included in this discussion is whether dietary weight loss can benefit their skin disease. Obesity has been associated with a proinflammatory state and several studies have demonstrated a relationship between body mass index and psoriasis severity. However, the question of whether weight loss interventions can impact psoriasis outcome is less clear. Here, we review the literature to examine the efficacy of weight loss interventions, both dietary and surgical, on psoriasis disease course

Diet and psoriasis, part II: celiac disease and role of a gluten-free diet.

Patients with psoriasis have been shown to have a higher prevalence of other autoimmune diseases including celiac disease, a condition marked by sensitivity to dietary gluten. A number of studies suggest that psoriasis and celiac disease share common genetic and inflammatory pathways. Here we review the epidemiologic association between psoriasis and celiac disease and perform a meta-analysis to determine whether patients with psoriasis more frequently harbor serologic markers of celiac disease. We also examine whether a gluten-free diet can improve psoriatic skin disease

Diet and psoriasis, part I: Impact of weight loss interventions

One of the most frequently asked questions by patients with psoriasis is whether dietary changes can improve their condition. Included in this discussion is whether dietary weight loss can benefit their skin disease. Obesity has been associated with a pro-inflammatory state and several studies have demonstrated a relationship between body mass index (BMI) and psoriasis severity. However, the question of whether weight loss interventions can impact psoriasis outcome is less clear. Here, we review the literature to examine the efficacy of weight loss interventions, both dietary and surgical, on psoriasis disease course

Diet and psoriasis, part III: Role of nutritional supplements

Patients with psoriasis are increasingly turning to the use of alternative and complementary medicine to manage their psoriasis. Patients often inquire about what dietary supplements may be beneficial, including the use of oral vitamin D, vitamin B12, selenium, and omega-3 fatty acids in fish oils. In this review we examine the extent to which each of these common nutritional interventions has been studied for the treatment of psoriasis. We weighed evidence from both controlled and uncontrolled prospective trials. The evidence of benefit was highest for fish oils. For other supplements, there is need for additional large, randomized clinical trials to establish evidence of efficacy

Diet and psoriasis, part II: Celiac disease and role of a gluten-free diet

Patients with psoriasis have been shown to have a higher prevalence of other autoimmune diseases including celiac disease, a condition marked by sensitivity to dietary gluten. A number of studies suggest that psoriasis and celiac disease share common genetic and inflammatory pathways. Here we review the epidemiologic association between psoriasis and celiac disease and perform a meta-analysis to determine whether patients with psoriasis more frequently harbor serologic markers of celiac disease. We also examine whether a gluten-free diet can improve psoriatic skin disease