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The following skin diseases are treatable
with Phototherapy and PUVA Therapy. Click below for a description
of the disease or scroll down.
- Pityriasis
Lichenoides
- Pityriasis
Rosea
- Photosensitivity
- Pruritus
- Itch
- Urticaria
- Hives
- Alopecia
Areata
- Mycosis
Fungoides
- Lichen
Planus
- Granuloma
Annulare
Pityriasis
Lichenoides - This is an uncommon condition that
occurs in two forms. The acute form consists of red bumps on
the skin that persist for a few weeks or months and heal leaving
a scar. Usually, there is a countable number of lesions. The
chronic form consists of small, pink, scaly bumps, often as
hundreds of lesions that are itchy and persist for long periods.
This form does not scar. The cause of this disease is unknown
and therefore there is no specific treatment. Ultraviolet light
treatment, either phototherapy or PUVA therapy, is very effective
in clearing both forms of the condition. After a successful
course of treatment most patients have a long-term remission.
Pityriasis
Rosea - Pityriasis rosea is a common condition thought
to be caused by a virus. It starts suddenly and spreads as a widespread
scaly, pink to red rash. Usually it runs a brief course lasting
about a month and clears spontaneously but it can persist for months.
Treatment usually consists of applying a cortisone-type ointment
or cream and use of antihistamines for itch. In some patients the
rash is very marked with a lot of inflammation of the skin so that
normal activities are compromised. A more effective treatment in
these patients is a course of ultraviolet light therapy such as
phototherapy or PUVA therapy. This treatment usually clears pityriasis
rosea in a few weeks.
Photosensitivity
- Sensitivity to light, or photosensitivity, refers
to a number of disorders in which people have an abnormal reaction
when exposed to natural sunlight or artificial light indoors. These
conditions are common and affect about 10% of the population regardless
of skin color. The most common condition, so-called polymorphous
light eruption, appears as numerous small red bumps on the exposed
skin several hours after exposure to sunlight and lasts days or
a week or more. It usually starts in early adult life and persists
with a recurrence each spring or summer. Other forms of photosensitivity
can be more persistent and last all year.
Confirmation of a diagnosis of photosensitivity rests on reproducing the rash,
often by specialized testing to various wavelengths of light. Treatment ranges
from simple avoidance of sunlight, protection as with sunscreens or, in severely
affected people, desensitization to eliminate the photosensitivity. This latter
treatment involves deliberate exposure to light as a course of treatment. One
or more of these measures are successful in controlling photosensitivity in most
people.
Pruritus -
Itch - Pruritus or itchiness of the skin is a very common
symptom of many skin disorders but it may also occur by itself
when the skin appears to be otherwise normal. Pruritus of this
type requires thorough investigation because it can indicate an
internal disease is present interfering with function of the kidneys,
liver, bone marrow or other organ. If all investigations are negative
it is usually labeled as idiopathic pruritus - cause unknown.
The first line of treatment of pruritus is use of antihistamines, moisturizing
creams and sedatives. If these treatments are unsuccessful an alternative approach
is the use ultraviolet light treatment, either PUVA therapy or UVB phototherapy.
These treatments suppress itch in most patients regardless of whether it is idiopathic
pruritus or a symptom of an internal disease.
Urticaria -
Hives - Hives or urticaria is a common skin disorder
and is most commonly caused by allergy to a medication or a food.
This type of urticaria is of sudden onset and lasts only a few
days. There is another type of urticaria called chronic urticaria
that lasts for weeks to months or years. The cause of chronic urticaria
is unknown; it is probably not due to an allergy since a trigger
substance is rarely found.
Chronic urticaria is usually treated with various antihistamines and these medications
give some relief until a spontaneous recovery occurs. Ultraviolet light therapy
can suppress chronic urticaria and maintain suppression for long periods. It
is mainly used in patients who have had an inadequate response to antihistamines.
Alopecia Areata
- Alopecia areata is an autoimmune disease in which
hair is lost from the scalp and less commonly from other areas
of the skin. The cause is unknown but it is known that the bodys
own immune system causes inflammation around the hair follicle
resulting in premature loss of hair. The disorder can occur at
any age but is most common in young adults. The natural course
of the condition is variable and ranges from spontaneous recovery
that is common to gradual progression.
Three main types of treatment are used. Cortisone-type medications are injected
into the areas of hair loss, applied topically as lotions or given orally as
tablets. A poison-ivy type dermatitis can be induced at the site of hair loss
by application of various chemicals. Ultraviolet light treatment has also been
used. This treatment is mainly used after failure of response to cortisone. The
response to any treatment is very variable and treatment is unsuccessful in many
patients with progressive disease.
Mycosis Fungoides -
Mycosis fungoides or cutaneous T cell lymphoma (CTCL) as it is
sometimes called is a lymphoma, a type of cancer and is mainly
confined to the skin. The cause of this condition is unknown and
while it is most common in middle life, it can appear at any age.
Most cases of mycosis fungoides are slow in developing and slow
in progression. Frequently a diagnosis of eczema will be made and
then after examination of repeated biopsies of skin, the diagnosis
of mycosis fungoides will be established. In a few patients, the
disease appears more suddenly and progression is more rapid. There
are a number of treatments for mycosis fungoides and the choice
of the best therapy for a patient largely depends on the type and
stage of the disease.
Ultraviolet light treatment in the form of PUVA therapy is most effective in
patients with early disease in whom it can produce a long-term remission with
return of the skin to normal appearance. Long-term maintenance treatment is required
to maintain the remission.
Lichen Planus Lichen
planus is an itchy, purplish rash on the skin of unknown cause.
It usually begins in adult life and runs a chronic course lasting
two years on average but it can be shorter or last many years.
Usually it involves all areas of the body plus it often appears
inside the mouth and this can give rise to the most symptoms.
The main approach to treatment is topical application of cortisone-type preparations
as creams and ointments. These reduce the pruritus or itch and also reduce the
severity of the lesions. Prednisone or some other systemic form of cortisone
is required in patients with extensive disease. Patients who do not respond to
a course of prednisone or who have an immediate relapse when it is stopped, can
be treated with ultraviolet light in the form of PUVA therapy. This treatment
clears about 80% of patients and most remain clear after a brief period of maintenance
treatment.
Granuloma Annulare
- Granuloma annulare is most common in children in
whom it appears as one or a few round lesions often with a clear
center. A much less common form occurs in adults with usually flat
and sometimes itchy lesions widely distributed over many areas
of the skin.
This so-called disseminated granuloma annulare is usually difficult to treat
and, as a consequence, many treatments have been used. Several studies have shown
that it responds to an ultraviolet light treatment called PUVA therapy and this
treatment can produce long-term remissions. Usually about 30 to 50 treatments
are required to clear all lesions but maintenance treatment is usually brief
and relapse is uncommon.
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