1. Phototherapy in the treatment of inflammatory dermatoses
Dr V Goulden

2. Conditions
Prurigo Pityriasis lichenoides Lichen planus Granuloma annulare

3. Prurigo Intensely itchy papules/nodules. Sleep disturbance
Severe impact on quality of life
Sub-acute prurigo
Nodular prurigo

5. Subacute prurigo

7. Nodular prurigo

8. Prurigo - aetiology Atopic background Idiopathic Pruritus
Iron deficiency
Throid dieases
Malignancy
Liver/renal impairement
Drugs
Atopic background
Idiopathic

9. Evidence base for phototherapy
No RCT
6 prospective studies
2 retrospective studies
3 case series
TL01 UVB for sub-acute prurigo
PUVA for nodular prurigo

10. Lichen Planus
T cell-mediated autoimmune disease Immune inflammatory reaction within skin and mucosal keratinocytes.

11. Lichen planus Flat topped violaceous papules and plaques
Plaques crossed with fine white scale (Wickham striae)
Post-inflammatory hyperpigmentation
Hypertrophic lesions - legs

12. Lichen Planus

13. Lichen planus

14. Lichen planus

15. Hypertrohic lichen planus

16. Lichen planus – aetiology
Genetic predisposition
Physical and emotional stress
Injury to the skin (Koebnerisation)
Systemic viral infection, such as hepatitis C
Drugs

17. Phototherapy for lichen planus
Retrospective studies and case series
TL01 UVB
PUVA
acitretin

18. Pityriasis lichenoides
Adolescents and young adults, usually appearing before the age of 30.
More common in males. Rare in infants and in old age.

19. Pityriasis lichenoides
Pityriasis lichenoides acuta
Pityriasis lichenoides chronica

20. Pityriasis lichenoides acuta
Red patches that quickly evolve into papules.
They are often covered with a fine mica-like adherent scale.
The centre of the papules often becomes filled with pus and blood, or eroded with overlying red-brown crust.

21. Pityriasis lichenoides chronica (PLC)
Low-grade clinical course.
Lesions may appear over the course of several days, weeks or months. Lesions at various stages may be present at any one time.
Small pink papule occurs - turn a reddish-brown colour - fine mica-like adherent scale attached to the central spot develops.
Lesion flattens out spontaneously and leaves behind a brown mark, which fades over several months.

22. Pityriasis lichenoides acuta

23. Pityriasis lichenoides chronica

24. PLC - aetiology 3 major theories
An inflammatory reaction triggered by infectious agents
Benign form of T-cell lymphoproliferative disorder
An immune-complex-mediated hypersensitivity vasculitis

25. Phototherapy for PLC No RCT 5 studies broad band UVB
9 studies TL01 UVB
2 studies PUVA

26. Granuloma annulare
Granuloma annulare is a delayed hypersensitivity reaction to some component of the dermis.

27. Granuloma annulare
Granuloma annulare affects the skin of children, teenagers or young adults
Older adults, less commonly

28. Granuloma annulare
Most cases of granuloma annulare, no treatment is required
Some cases persist for years.
Treatment is not always successful

29. Granuloma annulare Papules forming annular shape. Local or widespread
Clinical patterns

31. Diffuse Granuloma annulare

32. Phototherapy for granuloma annulare
No RCT
Case series & retrospective studies
TL01 UVB
UVA1
PUVA

33. Granuloma annulare and PUVA
Photodermatol Photoimmunol Photomed
Browne F, Turner D, Goulden V.
66% response
1/3 long term remission