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Published byGregory Washington Modified over 6 years ago
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Phototherapy in the treatment of inflammatory dermatoses
Dr V Goulden
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Conditions Prurigo Pityriasis lichenoides Lichen planus Granuloma annulare
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Prurigo Intensely itchy papules/nodules. Sleep disturbance
Severe impact on quality of life Sub-acute prurigo Nodular prurigo
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Subacute prurigo
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Nodular prurigo
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Prurigo - aetiology Atopic background Idiopathic Pruritus
Iron deficiency Throid dieases Malignancy Liver/renal impairement Drugs Atopic background Idiopathic
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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
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Lichen Planus T cell-mediated autoimmune disease Immune inflammatory reaction within skin and mucosal keratinocytes.
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Lichen planus Flat topped violaceous papules and plaques
Plaques crossed with fine white scale (Wickham striae) Post-inflammatory hyperpigmentation Hypertrophic lesions - legs
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Lichen Planus
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Lichen planus
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Lichen planus
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Hypertrohic lichen planus
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Lichen planus – aetiology
Genetic predisposition Physical and emotional stress Injury to the skin (Koebnerisation) Systemic viral infection, such as hepatitis C Drugs
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Phototherapy for lichen planus
Retrospective studies and case series TL01 UVB PUVA acitretin
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Pityriasis lichenoides
Adolescents and young adults, usually appearing before the age of 30. More common in males. Rare in infants and in old age.
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Pityriasis lichenoides
Pityriasis lichenoides acuta Pityriasis lichenoides chronica
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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.
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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.
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Pityriasis lichenoides acuta
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Pityriasis lichenoides chronica
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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
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Phototherapy for PLC No RCT 5 studies broad band UVB
9 studies TL01 UVB 2 studies PUVA
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Granuloma annulare Granuloma annulare is a delayed hypersensitivity reaction to some component of the dermis.
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Granuloma annulare Granuloma annulare affects the skin of children, teenagers or young adults Older adults, less commonly
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Granuloma annulare Most cases of granuloma annulare, no treatment is required Some cases persist for years. Treatment is not always successful
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Granuloma annulare Papules forming annular shape. Local or widespread
Clinical patterns
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Diffuse Granuloma annulare
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Phototherapy for granuloma annulare
No RCT Case series & retrospective studies TL01 UVB UVA1 PUVA
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Granuloma annulare and PUVA
Photodermatol Photoimmunol Photomed Browne F, Turner D, Goulden V. 66% response 1/3 long term remission
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