Consensus guidelines for the management of plaque psoriasis.

The Canadian Guidelines for the Management of Plaque Psoriasis were reviewed by the entire National Psoriasis Foundation Medical Board and updated to include newly approved agents such as ustekinumab and to reflect practice patterns in the United States, where the excimer laser is approved for psoriasis treatment. Management of psoriasis in special populations is discussed. In the updated guidelines, we include sections on children, pregnant patients or pregnant partners of patients, nursing mothers, the elderly, patients with hepatitis B or C virus infections, human immunodeficiency virus-infected patients, and patients with malignant neoplasms, as well as sections on tumor necrosis factor blockers, elective surgery, and vaccinations.

From the Medical Board of the National Psoriasis Foundation: monitoring and vaccinations in patients treated with biologics for psoriasis.

Background: Biologics are widely used in the treatment of psoriasis and psoriatic arthritis.

Objective: Our aim was to arrive at a consensus on the kind of monitoring and the vaccinations that should be performed before and during biologic therapy.

Methods: Medical literature and data presented at meetings were reviewed and a consensus conference was held by members of the Medical Board of the National Psoriasis Foundation.

Effective treatment of scalp psoriasis using the excimer (308 nm) laser.

Background: Psoriasis of the scalp can be a major therapeutic challenge as response to topical medication is often inadequate. The excimer laser has potential for providing local phototherapy as its high irradiance makes treatment at this site a practical option.

Objectives: To analyze retrospectively results of treating scalp psoriasis with the excimer (308 nm) laser.

Photoaging: mechanisms and repair.

Unlabelled: Aging is a complex, multifactorial process resulting in several functional and esthetic changes in the skin. These changes result from intrinsic as well as extrinsic processes, such as ultraviolet radiation. Recent advances in skin biology have increased our understanding of skin homeostasis and the aging process, as well as the mechanisms by which ultraviolet radiation contributes to photoaging and cutaneous disease.

The effect of clinical UVA/B exposures on urinary urocanic acid isomer levels in individuals with caucasian type (II/III) skin types.

Terrestrial ultraviolet radiation (UVR) exposure, consisting of ultraviolet A (320-40 nm) and B (290-320 nm), results in the photoisomerizion of epidermal trans-urocanic acid (trans-UCA) to cis-urocanic acid (cis-UCA), a potential suppressor of local and systemic immune responses. This study examines urinary UCA isomers as biomarkers of UVA/B exposure. It presents results measuring both cis- and trans-UCA in human urine samples collected from a group of study subjects (skin types II/III) that underwent controlled UVA/B exposures similar to those administered in commercial suntanning parlors.

Chronic stress accelerates ultraviolet-induced cutaneous carcinogenesis.

Background: Physical and emotional stressors have been found to mediate a wide variety of biological changes including the facilitation of tumor progression; however most of these paradigms utilized artificial sources of neoplasms and stress.

Methods: Skh mice were exposed to carcinogenic doses of ultraviolet light (UV). The stressed group was subjected to the close proximity of fox urine as a source of stress from the presence of the odor of their natural predator, while the control group remained stress free.

Clinical and epidemiologic characterization of photosensitivity in HIV-positive individuals.

Background: An increased prevalence and severity of cutaneous photosensitivity has been recognized in association with human immunodeficiency virus (HIV) infection. However, this disorder remains poorly characterized in terms of its epidemiology, predisposing factors, clinical, and environmental associations.

Methods: To define the risk factors associated with the presence of photosensitivity among HIV-positive individuals, a cross-sectional study of 631 primary patient visits to an urban HIV Dermatology clinic between January 1997 and August 2001, inclusive, was conducted.

Photoprotection by clothing.

Wearing of clothing, hats, and sunglasses to protect from exposure to sunlight should be part of a package of protection. Clothing specifically designed to avoid exposure is now available and recently standards have been published in several countries to measure the degree of protection. The ultraviolet protection factor (UPF) is likely to be as ubiquitous in clothing aisles as the sun protection factor (SPF) is now in the sunscreen aisle of your local department store.

Standardized protocols for photocarcinogenesis safety testing.

Solar ultraviolet radiation (UVR) is recognized as a major cause of non-melanoma skin cancer in man. Skin cancer occurs most frequently in the most heavily exposed areas and correlates with degree of outdoor exposure. The incidence of skin cancer is also increased by contact with photosensitizing drugs and chemicals such as psoralens, coal tars and petroleum stocks.

Efficacy of the 308-nm excimer laser for treatment of psoriasis: results of a multicenter study.

Objective: Our purpose was to demonstrate the efficacy of the 308-nm excimer laser for treatment of psoriasis.

Methods: This study was a multicenter open trial from 5 dermatology practices (one university-based and 4 private practices). Up to 30 patients per center with stable mild to moderate plaque-type psoriasis constituted the study population.