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Photosensitivity Associated With Combined UV-B and Calcipotriene Therapy

Photosensitivity Associated With Combined UV-B and Calcipotriene Therapy Abstract Background: Ultraviolet B phototherapy is an effective agent for the treatment of psoriasis; its most frequent acute side effect is burning of the skin. It has been combined with various other topical or systemic agents to augment therapeutic effect. Recently, UV-B therapy has been used with calcipotriene ointment (Dovonex, Westwood-Squibb, Buffalo, NY), a new vitamin D analogue. Observations: We report four cases of chronic plaque psoriasis that developed in patients who used UV-B phototherapy for a substantial period without ill effects and in whom photosensitivity reactions within psoriatic plaques developed after calcipotriene ointment was added, without changes in their UV-B dosage or frequency of treatment. The time from starting calcipotriene therapy to the development of bertosensitivity ranged from 4 to 28 days, and the number of UV-B exposures during this period varied between one and 12 treatments. The mean UV-B dose at burning was 1114 mJ/cm2. Twenty-two patients had used calcipotriene in combination with UV-B therapy of a total of 103 UV-B-treated patients during the period when the adverse events occurred. Half these patients started calcipotriene therapy prior to starting treatment with UV-B. However, cases of photosensitivity occurred only in the remaining half of the patients in whom calcipotriene therapy was added during UV-B therapy. Combined therapy was able to be continued or resumed in two patients by reduction of the UV-B dose. In three cases, phototesting confirmed greater photosensitivity to calcipotriene-treated skin than to skin to which hydrated petrolatum was applied. Conclusions: Calcipotriene ointment should be introduced with caution in patients already receiving UV-B phototherapy, particularly those receiving high doses of UV-B. The mechanism of this photosensitivity reaction is unknown. This increased sensitivity to UV-B may be a result of the effect of calcipotriene on stratum corneum thickness, epidermal melanization, a result of its effect on the inflammatory reaction to UV-B irradiation, or, possibly, because it is a phototoxic agent.(Arch Dermatol. 1995;131:1305-1307) References 1. Levine MJ, Parrish JA. Outpatient phototherapy of psoriasis . Arch Dermatol. 1980;116:552-554.Crossref 2. Adrian RM, Parrish JA, Momtaz TK, Karlin MJ. Outpatient phototherapy for psoriasis . Arch Dermatol. 1981;117:623-626.Crossref 3. Lebwohl M, Berman B, France DS. Addition of short contact anthralin therapy to an ultraviolet B phototherapy regimen: assessment of efficacy . J Am Acad Dermatol. 1985;13:780-784.Crossref 4. Park YK, Kim HJ, Koh YJ. Combination of photochemotherapy (PUVA) and ultraviolet B (UV-B) in the treatment of psoriasis vulgaris . J Dermatol. 1988;15:68-71. 5. Kragballe K. Treatment of psoriasis by the topical application of the novel cholecalciferol analogue calcipotriol (MC 903) . Arch Dermatol. 1989;125:1647-1652.Crossref 6. Kragballe K. Combination of topical calcipotriol (MC 903) and UVB radiation for psoriasis vulgaris . Dermatology. 1990;181:211-214.Crossref 7. Kerscher M, Volkenandt M, Plewig G, Lehmann P. Combination phototherapy of psoriasis with calcipotriol and narrow-band UVB . Lancet. 1993;342:923.Crossref 8. Murdoch D, Clissold SP. Calcipotriol: a review of its pharmacological properties and therapeutic use in psoriasis vulgaris . Drugs. 1992;43:415-429.Crossref 9. Hansen AB, Bech-Thomsen N, Wulf HC. Erythema after irradiation with ultraviolet B from Philips TL12 and TL01 tubes . Photodermatol Photoimmunol Photomed. 1994;10:22-25. 10. Vilaplana J, Mascaro JM, Lecha M, Romaguera C. Low irritancy of 2-day occlusive patch test with calcipotriol cream . Contact Dermatitis. 1994;30:45-46.Crossref 11. LeVine M, White HAD, Parrish JA. Components of the Goeckerman therapy . J Invest Dermatol. 1979;73:170-173.Crossref 12. Belsito DV, Kechijian P. The role of tar in Goeckerman therapy . Arch Dermatol. 1982;118:319-321.Crossref 13. Yip J, Goodfield M. Contact dermatitis from MC 903, a topical vitamin D3 analogue . Contact Dermatitis. 1991;25:139-140.Crossref 14. Bruynzeel DP, Hol CW, Nieboer C. Allergic contact dermatitis to calcipotriol . Br J Dermatol. 1992;127:66.Crossref 15. DeGroot AC. Contact allergy to calcipotriol . Contact Dermatitis. 1994;30:242-243.Crossref 16. Harber LC, Bickers DR, Armstrong RB, Kochevar IE. Drug photosensitivity: phototoxic and photoallergic mechanisms . Semin Dermatol. 1982;1:183-195. 17. Bruls WA, Slaper H, van der Leun JC, Berrens L. Transmission of human epidermis and stratum corneum as a function of thickness in the ultraviolet and visible wavelengths . Photochem Photobiol. 1984;40:485-494.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Photosensitivity Associated With Combined UV-B and Calcipotriene Therapy

Archives of Dermatology , Volume 131 (11) – Nov 1, 1995

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1995.01690230085013
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Ultraviolet B phototherapy is an effective agent for the treatment of psoriasis; its most frequent acute side effect is burning of the skin. It has been combined with various other topical or systemic agents to augment therapeutic effect. Recently, UV-B therapy has been used with calcipotriene ointment (Dovonex, Westwood-Squibb, Buffalo, NY), a new vitamin D analogue. Observations: We report four cases of chronic plaque psoriasis that developed in patients who used UV-B phototherapy for a substantial period without ill effects and in whom photosensitivity reactions within psoriatic plaques developed after calcipotriene ointment was added, without changes in their UV-B dosage or frequency of treatment. The time from starting calcipotriene therapy to the development of bertosensitivity ranged from 4 to 28 days, and the number of UV-B exposures during this period varied between one and 12 treatments. The mean UV-B dose at burning was 1114 mJ/cm2. Twenty-two patients had used calcipotriene in combination with UV-B therapy of a total of 103 UV-B-treated patients during the period when the adverse events occurred. Half these patients started calcipotriene therapy prior to starting treatment with UV-B. However, cases of photosensitivity occurred only in the remaining half of the patients in whom calcipotriene therapy was added during UV-B therapy. Combined therapy was able to be continued or resumed in two patients by reduction of the UV-B dose. In three cases, phototesting confirmed greater photosensitivity to calcipotriene-treated skin than to skin to which hydrated petrolatum was applied. Conclusions: Calcipotriene ointment should be introduced with caution in patients already receiving UV-B phototherapy, particularly those receiving high doses of UV-B. The mechanism of this photosensitivity reaction is unknown. This increased sensitivity to UV-B may be a result of the effect of calcipotriene on stratum corneum thickness, epidermal melanization, a result of its effect on the inflammatory reaction to UV-B irradiation, or, possibly, because it is a phototoxic agent.(Arch Dermatol. 1995;131:1305-1307) References 1. Levine MJ, Parrish JA. Outpatient phototherapy of psoriasis . Arch Dermatol. 1980;116:552-554.Crossref 2. Adrian RM, Parrish JA, Momtaz TK, Karlin MJ. Outpatient phototherapy for psoriasis . Arch Dermatol. 1981;117:623-626.Crossref 3. Lebwohl M, Berman B, France DS. Addition of short contact anthralin therapy to an ultraviolet B phototherapy regimen: assessment of efficacy . J Am Acad Dermatol. 1985;13:780-784.Crossref 4. Park YK, Kim HJ, Koh YJ. Combination of photochemotherapy (PUVA) and ultraviolet B (UV-B) in the treatment of psoriasis vulgaris . J Dermatol. 1988;15:68-71. 5. Kragballe K. Treatment of psoriasis by the topical application of the novel cholecalciferol analogue calcipotriol (MC 903) . Arch Dermatol. 1989;125:1647-1652.Crossref 6. Kragballe K. Combination of topical calcipotriol (MC 903) and UVB radiation for psoriasis vulgaris . Dermatology. 1990;181:211-214.Crossref 7. Kerscher M, Volkenandt M, Plewig G, Lehmann P. Combination phototherapy of psoriasis with calcipotriol and narrow-band UVB . Lancet. 1993;342:923.Crossref 8. Murdoch D, Clissold SP. Calcipotriol: a review of its pharmacological properties and therapeutic use in psoriasis vulgaris . Drugs. 1992;43:415-429.Crossref 9. Hansen AB, Bech-Thomsen N, Wulf HC. Erythema after irradiation with ultraviolet B from Philips TL12 and TL01 tubes . Photodermatol Photoimmunol Photomed. 1994;10:22-25. 10. Vilaplana J, Mascaro JM, Lecha M, Romaguera C. Low irritancy of 2-day occlusive patch test with calcipotriol cream . Contact Dermatitis. 1994;30:45-46.Crossref 11. LeVine M, White HAD, Parrish JA. Components of the Goeckerman therapy . J Invest Dermatol. 1979;73:170-173.Crossref 12. Belsito DV, Kechijian P. The role of tar in Goeckerman therapy . Arch Dermatol. 1982;118:319-321.Crossref 13. Yip J, Goodfield M. Contact dermatitis from MC 903, a topical vitamin D3 analogue . Contact Dermatitis. 1991;25:139-140.Crossref 14. Bruynzeel DP, Hol CW, Nieboer C. Allergic contact dermatitis to calcipotriol . Br J Dermatol. 1992;127:66.Crossref 15. DeGroot AC. Contact allergy to calcipotriol . Contact Dermatitis. 1994;30:242-243.Crossref 16. Harber LC, Bickers DR, Armstrong RB, Kochevar IE. Drug photosensitivity: phototoxic and photoallergic mechanisms . Semin Dermatol. 1982;1:183-195. 17. Bruls WA, Slaper H, van der Leun JC, Berrens L. Transmission of human epidermis and stratum corneum as a function of thickness in the ultraviolet and visible wavelengths . Photochem Photobiol. 1984;40:485-494.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Nov 1, 1995

References