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Clinics in Dermatology

Lawrence Charles Parish, Michael J Lavery, Andrzej Grzybowski, Jennifer L Parish, Daniel H Parish
No abstract text is available yet for this article.
September 2016: Clinics in Dermatology
Stefano Caccavale, Diana Di Mattia, Eleonora Ruocco
Lately, the innovative concept of an immunocompromised cutaneous district (ICD) has been introduced to explain why a previously injured cutaneous site may become in time a privileged location for the onset of opportunistic infections, tumors, and immune reactions. The injuring events capable of rendering a skin region a potential ICD are various, numerous, and most of the time identifiable by means of a careful clinical history. The reason that only a small minority of injured skin areas actually becomes ICDs, with subsequent opportunistic localization of a second and unrelated skin disorder, is presently unknown...
September 2016: Clinics in Dermatology
Clay J Cockerell
Physicians are faced with many stressors today that place them at risk of disenchantment, depression, and burnout. Although this is costly to the individual physician, it is equally costly to society, because physician stress can lead to exercise of poor judgment and medical errors. It also threatens to exacerbate physician shortages, as more physicians opt to retire or, in some cases, change careers altogether. In this essay, suggestions are made as to how to deal with these stressors that, if used, can ameliorate them at least to some degree...
September 2016: Clinics in Dermatology
Lauren M Madigan, Henry W Lim
As the use of indoor tanning beds gained popularity in the decades after their appearance in the market in the early 1970s, concerns arose regarding their use. Clinical research has revealed an association between indoor tanning and several health risks, including the subsequent occurrence of melanoma and nonmelanoma skin cancers, the development of psychologic dependence, and a tendency toward other high-risk health behaviors. In the face of mounting evidence, legislation has been passed, which includes the restriction of access to tanning beds by minors in 42 states and the District of Columbia, and the recent reclassification by the Food and Drug Administration, which now categorizes tanning beds as class II devices and worthy of restrictions and oversight...
September 2016: Clinics in Dermatology
Cary S Crall, Jillian F Rork, Sophia Delano, Jennifer T Huang
Phototherapy can be a safe and effective treatment for various skin diseases in children. Special considerations governing the use of this treatment modality in pediatric populations include patient, family, and facility-based factors that are oriented around heightened concerns with regard to safety and tolerability of treatment. Although phototherapy has been found to be effective in a wide range of dermatologic conditions affecting pediatric populations, including psoriasis, atopic dermatitis, pityriasis lichenoides, cutaneous T-cell lymphoma, and vitiligo, there is need for additional research on other conditions in which phototherapy has shown promise...
September 2016: Clinics in Dermatology
Oliverio Welsh
Phototherapy is a useful therapeutic method for various skin diseases due to its modulatory effect on the cutaneous immune system. Alopecia areata is a dermatosis characterized by partial or complete hair loss. Collapse of the immune privilege of the hair follicle, which induces noncicatricial alopecia, is an important factor in its etiology. Several forms of phototherapy are used in dermatology.
September 2016: Clinics in Dermatology
Joshua Brownell, Stephanie Wang, Maria M Tsoukas
Light therapy has been incorporated into the art of healing and cosmesis for thousands of years and currently has found utility in many areas of medicine. Various modalities of cosmetic phototherapy are detailed, as well as the indications and mechanism of action for each modality. These modalities can be used to treat many common cosmetic conditions, including acne vulgaris, solar lentigo, and melasma. Phototherapy is considered a safe and effective option in the treatment of many of these disorders.
September 2016: Clinics in Dermatology
Noelle M Teske, Heidi T Jacobe
Phototherapy is an effective treatment strategy for a variety of sclerosing skin conditions. There are a number of phototherapeutic modalities used for the treatment of sclerosing skin conditions, including ultraviolet (UV)A1, broadband UVA, psoralen plus UVA, and narrowband UVB phototherapy. As controlled trials with validated outcome measures are lacking for these therapies, existing evidence is largely level II for morphea and is even more minimal for scleroderma and other sclerosing disorders (scleroderma, lichen sclerosus, and chronic graft-versus-host disease, among others)...
September 2016: Clinics in Dermatology
Dorothy L Rodenbeck, Jonathan I Silverberg, Nanette B Silverberg
Phototherapy is a second-line treatment for moderate to severe atopic dermatitis (AD) that effectively decreases cutaneous inflammation with minimal or no systemic side effects. Children in grade school, adolescents, and adults may benefit from phototherapy, when they have chronic AD refractory to first-line topical treatments. This review focuses on six approaches for phototherapy in AD: (1) broadband ultraviolet B (UVB), (2) Goeckerman regimen (coal tar + broadband UVB), (3) narrowband UVB, (4) excimer lasers for targeted areas, (5) combination UVA/UVB, and (6) UVA-1...
September 2016: Clinics in Dermatology
Viktoria Eleftheriadou, Khaled Ezzedine
Vitiligo is the most common depigmentation disorder, affecting around 1% of population worldwide. There is no cure, and no firm clinical recommendations can be made for the treatment of vitiligo. A European guideline suggests early treatment of small lesions of recent onset and childhood vitiligo with combination of phototherapy and topical agents. Suitable facilities and equipment, such as hand-held portable phototherapy devices, are needed, if this new guideline is to be implemented. Hand-held units are suitable for small lesions, making phototherapy available for patients with limited and/or early vitiligo...
September 2016: Clinics in Dermatology
Samia Esmat, Wedad Mostafa, Rehab A Hegazy, Suzan Shalaby, Vaneeta Sheth, Randa Youssef, Medhat El-Mofty
Phototherapy has been the mainstay of vitiligo therapy for several decades. A variety of wavelengths and modalities are available, but narrowband ultraviolet B remains the safest and most commonly used treatment. Acting on multiple steps in vitiligo pathogenesis, narrowband ultraviolet B is one of the few therapies that can effectively induce stabilization and stimulate repigmentation. Achievement of optimal results involves using a combination of appropriate treatment protocols, careful patient selection, and patient education to set expectations...
September 2016: Clinics in Dermatology
Tiago R Matos, Tsui C Ling, Vaneeta Sheth
Psoriasis is a chronic and common disease mediated by resident memory T cells that negatively affects a broad range of people worldwide. One of the oldest and most commonly used treatments is phototherapy. We reviewed the existing literature on the four main ultraviolet B (UVB) modalities of phototherapy in the management of psoriasis: heliotherapy, broadband UVB, narrowband UVB, and excimer laser and lamp. Despite the many studies done on these therapies, there is significant variation in their prescription and use...
September 2016: Clinics in Dermatology
Joshua Brownell, Stephanie Wang, Maria M Tsoukas
When beginning a phototherapy regimen for a patient, consideration of compliance rates is important. Compliance to phototherapy can be affected by several factors, including the grade of discomfort and side effects from therapy, failure of previous therapies, accessibility and convenience to reach the phototherapy center, grade of improvement during phototherapy, patient relief due to light therapy, and rapport with staff. Understanding how these factors can affect patient adherence can allow for phototherapy regimens to be tailored in a manner that optimizes health outcomes and allows for proper patient selection...
September 2016: Clinics in Dermatology
Ana Filipe Monteiro, Margarida Rato, César Martins
Drug-induced photosensitivity refers to the development of cutaneous disease due to the interaction between a given chemical agent and sunlight. Photosensitivity reactions can be classified as phototoxic or photoallergic. Sometimes, there is an overlap between these two patterns, making their distinction particularly difficult for the clinician. We review the drugs that have been implicated as photosensitizers, the involved mechanism, and their clinical presentations. The main topical agents that cause contact photosensitivity are the nonsteroidal antiinflammatory drugs, whereas the main systemic drugs inducing photosensitivity are antimicrobials, nonsteroidal antiinflammatory agents, and cardiovascular drugs...
September 2016: Clinics in Dermatology
Margarida Moura Valejo Coelho, Tiago R Matos, Margarida Apetato
Ultraviolet radiation (UVR) can have a beneficial biologic impact on skin, but it is also the most significant environmental risk factor for skin cancer development. Photocarcinogenesis comprises a complex interplay between the carcinogenic UVR, skin, and the immune system. UVB is absorbed by the superficial skin layers and is mainly responsible for direct DNA damage, which, if unrepaired, can lead to mutations in key cancer genes. UVA is less carcinogenic, penetrates deeper in the dermis, and mainly causes indirect oxidative damage to cellular DNA, proteins, and lipids, via photosensitized reactions...
September 2016: Clinics in Dermatology
Margarida Moura Valejo Coelho, Margarida Apetato
Phototherapy is a valuable therapeutic tool in Dermatology, but there may be drawbacks. Acute and long-term adverse effects, of variable severity, include skin erythema, xerosis, pruritus, blistering, altered pigmentation, photoaging, and photocarcinogenesis. Despite concerns over the carcinogenic potential of ultraviolet radiation, most studies have not found an increased risk of non-melanoma or melanoma skin cancer in patients treated with ultraviolet B (broadband and narrowband) and ultraviolet A1 phototherapy...
September 2016: Clinics in Dermatology
Asta Juzeniene, Mantas Grigalavicius, Marina Juraleviciute, William B Grant
The skin is the site for the photosynthesis of vitamin D and is a target tissue for the active metabolite of vitamin D. An increasing body of evidence indicates that vitamin D produced during phototherapy may be responsible for the positive effects observed during treatment of some skin diseases. Topical or oral application of vitamin D derivatives are used alone or with phototherapy. This paper reviews what is known about the use of phototherapy to enhance vitamin D levels, the use of vitamin D analogues with phototherapy, the efficacy of combination therapies, and controversies regarding some of the outcomes...
September 2016: Clinics in Dermatology
Tiago R Matos, Vaneeta Sheth
The health benefits of natural sunlight have been noted since the rise of civilization, even without the knowledge of its mechanisms of action. Currently, phototherapy remains an effective and widely used treatment for a variety of skin diseases. Ultraviolet radiation, from either the sun or artificial light sources, has a profound immunomodulatory effect that is responsible for its beneficial clinical outcomes. Ultraviolet radiation mostly induces the innate while suppressing the adaptive immune system, leading to both local and systemic effects...
September 2016: Clinics in Dermatology
Andrzej Grzybowski, Jarosław Sak, Jakub Pawlikowski
From ancient times, light has played a significant role in the treatment of diseases. The modern discoveries (eg, ultraviolet radiation) and modern inventions (eg, the electric generator or the electric lightbulb), as well as balneologic experiences of the treatment with sunlight, contributed to the transition from heliotherapy to artificial light phototherapy at the end of the 19th century. Nils Ryberg Finsen (1860-1904) was the founder of modern phototherapy. He is famous for applying an electric carbon arc torch in treating patients with lupus vulgaris using ultraviolet radiation...
September 2016: Clinics in Dermatology
Tiago R Matos, Vaneeta Sheth
No abstract text is available yet for this article.
September 2016: Clinics in Dermatology
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