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Cpt 96910 covered by carefirst accenture summer internship

Cpt 96910 covered by carefirst

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UV blocking properties may be used to cover uninvolved skin with preparations such as zinc oxide to prevent unnecessary exposure and adverse effect" AAD, The response to phototherapy was monitored subjectively, by interviewing patients after the summer, and objectively by monochromator photo-testing, before and after phototherapy.

Fifteen patients reported that treatment was worthwhile. Monochromator photo-testing after phototherapy revealed a 4-fold increase in the minimal erythema dose MED in those with abnormal photosensitivity to ultraviolet A wavebands. The authors concluded that they now routinely consider narrow-band UVB phototherapy for problem photodermatoses.

Gupta et al stated that hydroa vacciniforme HV is a rare, sporadic, idiopathic photodermatosis characterized by vesicles and crust formation after sunlight exposure. The lesions typically heal with vacciniform scarring. These researchers identified and reviewed the clinical features and follow-up data of Scottish patients with HV and reported on the prevalence of this condition.

They noted that this was the largest recent study of HV patients from a single center. In this retrospective study, patients with HV were identified by means of the diagnostic database from the Photobiology Unit, Dundee. Patients were contacted and details of clinical features, duration of disease, results of investigations, and treatment were recorded. At review, disease progress was assessed.

Between and , a total of 17 patients 9 males and 8 females with a diagnosis of HV were investigated. Data from 15 patients showed a mean age at onset of 7. A bi-modal age distribution was also identified with onsets between the ages of 1 and 7 years and 12 and 16 years. Males had longer disease duration mean of 11 years; range of 5 to 17 years than females mean of 5 years; range of 4 to 7 years.

All patients received broad-spectrum sunscreens with variable results. Of the 5 patients treated with narrow-band UVB TL phototherapy, 3 reported beneficial results with an increase in tolerance to sunlight exposure and associated reduction in disease severity. The authors concluded that the estimated prevalence of HV was at least 0. Males had a later onset and longer duration of disease than females. Dummer et al stated that polymorphous light eruption PLE , a type of idiopathic photodermatoses, is an eruption induced by ultraviolet UV radiation UVR.

These researchers evaluated the clinical aspects, diagnostic criteria of PLE in a major Swiss referral center. A total of 25 patients 22 women and 3 men with PLE were tested with a standardized protocol for the assessment of photodermatoses. Photo-hardening with narrow-band UVB was successful in 8 of 10 patients. These investigators recommended photo-hardening with narrow-band UVB nm. Fesq et al stated that optimal management of patients with PLE, the most frequent photodermatosis, requires knowledge of the individual clinical course of the disease and pathogenic factors.

As PLE often causes problems during leisure-time activities and holidays, resulting in a substantial loss of quality of life, prophylaxis is the most important therapeutic approach. Management of PLE must, therefore, focus on basic preventative measures and additional therapeutic approaches, depending on the clinical condition.

PLE can be classified into 4 severity groups mild, moderate-to-severe, severe and therapy-resistant , which are useful for determining appropriate prophylactic measurements. No specific laboratory tests are available for the diagnosis of PLE, therefore, a clinician must rely on the clinical appearance of the disorder e.

Basic preventative management of PLE consists of adequate sun protection comprising avoidance of sun exposure, the use of textile sun protection and the application of broad-band sunscreens with high UVA protection potential. Topical antioxidants, systemic immunomodulation, photo chemo therapy and systemic immunosuppression may be required in some cases of PLE. Topical antioxidants represent a new treatment approach for moderate-to-severe PLE and are an effective and well-tolerated option for this patient population.

In rare exceptions the authors would consider using oral PUVA therapy. However, in their outpatient department, quality of life of most patients is improved with the treatment regimens that are recommended for patients with moderate-to-severe PLE, without the need for photo chemo therapy. Khaled et al stated that chronic actinic dermatitis CAD is a debilitating photodermatosis with characteristic clinical, histological and photo-biological features reduced MED.

Its management involves various therapeutic approaches, among them there is phototherapy. NB-UVB has already been proven to be effective and safe in several other photodermatoses. The authors concluded that their protocol of NB-UVB with steroids appeared to be effective for the management of CAD with a good short-term safety profile.

Chronic actinic dermatitis -- Low-dose PUVA or narrowband UVB, initially given with oral glucocorticoids to decrease treatment-induced flares, has been effective in small case series . Solar urticaria -- Pharmacologic therapy or photodesensitization with low-dose PUVA or narrowband UVB initially given with oral glucocorticoids is usually required for management . Usually the disease has a benign course with spontaneous remission within a few weeks.

Nevertheless, recurrences are quite frequent and may occur for several years. These investigators reviewed the therapeutic options for Wells syndrome in a systematic manner, which was based on a search on Medline, Embase and Cochrane Central Register for English and German articles from to Advices on the treatment of Wells syndrome were limited predominately to case reports or to small case-series studies. There were no RCTs, and control groups were missing.

As well-designed RCTs are missing, no guidelines for the treatment of this disease can be given. The authors noted that due to the small number of patients and the frequent misdiagnosis of this clinical entity, the aim of this systematic overview was to call attention to this rare condition and to help clinicians to diagnose and treat Wells syndrome effectively.

The authors concluded that due to the good prognosis and tendency to resolve, systemic treatment should be limited to cases resistant to local therapy or with widespread lesions. Miguel and colleagues stated that necrobiotic xanthogranuloma NXG is an uncommon non-Langerhans cell histiocytosis involving skin and extracutaneous tissues. The lesions are usually asymptomatic and commonly appear in the peri-orbital area.

Paraproteinemia is closely associated with NXG and its pathogenesis remains unclear. NXG prognosis is poor with several treatments showing variable results. Treatment of monoclonal gammopathy with alkylating agents does not necessarily influence the activity of the skin disease and vice versa. Mainly individual case reports, small case series and retrospective studies were found.

Therapeutic options include azathioprine, chlorambucil, cladribine, cyclophosphamide, extracorporeal photopheresis, fludarabine, high-dose intravenous immunoglobulin IVIG , hydroxychloroquine, infliximab, interferon alpha, laser therapy, melphalan, methotrexate, plasmapheresis, PUVA, radiotherapy, rituximab, surgery, thalidomide, as well as topical and systemic corticosteroids.

The authors stated that RCTs and studies on long-term outcomes after treatment were not found and are needed to focus on in the future. An UpToDate chapter on scleredema Kreuter, states that, for patients with functionally limiting or symptomatic scleredema that is not expected to resolve spontaneously, initial treatment with phototherapy is suggested. This is a grade 2C recommendation based upon a retrospective study and case reports. The authors stated that, when available, they prefer to use UVA1 phototherapy.

Kalfa and associates noted that scleredema is a rare connective tissue disorder of unknown pathogenesis; and 3 types of scleredema have been described, based on its association with post-infection, monoclonal gammopathy and diabetes mellitus. These investigators reported a case of scleredema in which the diagnosis didn't get specified. The patient was followed regularly for 13 years and did not respond to various combinations of immunosuppressants and PUVA therapy.

The authors concluded that treatment of scleredema is quite difficult and of limited success. At present, there is no proved treatment for this disease.

A total of 50 patients with steroid-dependent CRU 6 months of spontaneous urticaria with no response after 3 consecutive months of anti-histamines and steroid dependence were administered either PUVA group A or NB-UVB group B for 90 days, with a post-treatment follow-up of 90 days. Treatment effectiveness was assessed using the average urticaria activity score 7 aUAS7 and outcome scoring scale OSS every 2 weeks.

The mean values of aUAS7 progressively decreased from 4. This further decreased to 1. The values of OSS progressively increased from baseline 1. The authors concluded that phototherapy, especially NB-UVB, is a safe and effective therapeutic modality for steroid-dependent CU and should be tried prior to 3rd-line treatment options e. Treatments include topical, intralesional, and systemic corticosteroids.

In addition, topical and systemic psoralen plus ultraviolet A light PUVA therapy, topical nitrogen mustard, and radiation therapy have demonstrated some success. Isolated cases document the beneficial responses of dapsone, indomethacin, and interferons. Brazzelli et al stated that mastocytoses represent a heterogeneous group of stem cell disorders marked by an abnormal hyperplasia and accumulation of mast cells in one or more tissues, including bone marrow, gastro-intestinal GI tract, liver, spleen, lymph nodes and skin.

Indolent systemic mastocytosis ISM is characterized by red-brownish and pruriginous maculopapular lesions, a bone marrow infiltration without functional impairment and an indolent clinical course with a good prognosis.

In particular, the most common cutaneous symptoms are urticarial rash and mild-to-high pruritus. These researchers analyzed the clinical outcome of patients affected by ISM with prevalent pruriginous cutaneous symptoms and a scarce response to antihistamines treated using narrowband ultraviolet B NB-UVB phototherapy, which was administered in a UV-irradiation cabin equipped with fluorescent UVB lamps with a peak emission at to nm.

The perception of pruritus severity was examined using the visual analogue scale VAS before starting the treatment and at each control. A complete remission of the cutaneous lesions and pruritus was documented in all patients after a median of The median VAS score at the beginning of the treatment was The authors concluded that the findings of this study provided evidence that NB-UVB phototherapy was useful for the treatment of the cutaneous symptoms and pruritus in ISM.

Brazzelli et al noted that in mastocytosis, the skin is almost invariably involved, and cutaneous symptoms deeply affect patients' quality of life QOL. Skin lesions of each patient were examined, before and after treatment, according to a cutaneous scale score. The number of treatments needed to attain symptom relief was significantly lower in the PUVA group, but the mean exposure dose was significantly higher, if compared to the NB-UVB group.

Serum tryptase levels showed a downward trend. The cutaneous score improved in both groups. The authors concluded that this study provided evidence that both NB-UVB and PUVA represent a safe and useful 2nd-line therapy of the cutaneous symptoms in mastocytosis. However, long-term use is associated with an increased risk of skin cancer, and the skin lesions usually recur after therapy is stopped.

The review states that there are no published randomized clinical trials of therapies for Grover's disease, and that nearly all evidence for therapies comes from case series, case reports, and clinical experience. High-potency topical corticosteroids, moisturizers, and emollients are typically recommended as first-line therapy. The review does not mention narrowband UVB as a therapeutic option. Guidelines from the National Comprehensive Cancer Network NCCN, state that, when managing patients with lymphomatoid papulosis, it is important to be reminded that this is not a malignant disorder, but a recurrent, benign, self-regressing lymphoid proliferation.

Observation is preferred for patients with asymptomatic disease. Topical steroids and phototherapy citing data on PUVA for lymphomatoid papulosis are the most commonly used skin-directed therapies for initial treatment of limited lesions as well as extensive lesions.

Systemtic therapy is indicated only for persons with extensive lesions. Tan and Giam stated that lymphomatoid papulosis is a chronic benign disease that may be associated with malignant lymphomas. This case illustrated the relapsing and remitting nature of both lymphomatoid papulosis and its potential of developing cutaneous T-cell lymphoma; and NB-UVB phototherapy as a new modality of treatment of early-stage mycosis fungoides in these patients.

A year old woman has had recurrent crops of papules and nodules of lymphomatoid papulosis on her limbs for 15 years. Histological features ere consistent with the type B lesions of lymphomatoid papulosis. Eight years after the initial onset of these lesions she developed cutaneous T-cell lymphoma mycosis fungoides.

Since then, she has had recurrence of mycosis fungoides following the cessation of phototherapy; but had no evidence of systemic involvement. The lesions of lymphomatoid papulosis responded to intermittent courses of oral methotrexate. Mycosis fungoides was treated with oral psoralen and UVA phototherapy with good response. Unfortunately, the lesions relapsed, whenever phototherapy was discontinued.

The papules of lymphomatoid papulosis continued to appear but she remained free of lesions of mycosis fungoides 10 months following cessation of NB-UVB therapy. The authors concluded that long-term surveillance was essential in all cases of lymphomatoid papulosis as accurate predictors for the development of malignant lymphoma in these individuals are still lacking. Moreover, these researchers stated that it would be interesting to examine the long-term safety and effectiveness of NB-UVB as compared with PUVA in the treatment of mycosis fungoides in individuals with lymphomatoid papulosis.

In one study, UVA1 phototherapy induced a complete response in 5 of 7 patients. Simonsen and colleagues noted that uremic pruritus is a common and burdensome symptom afflicting patients with advanced chronic kidney disease CKD and has been declared a priority for CKD research by patients. The optimal treatments for uremic pruritus are not well defined. In a systematic review, these investigators reviewed the evidence on the various treatments for this condition; eligible subjects were adult patients with advanced CKD stage greater than or equal to 3 or receiving any form of dialysis.

Risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. Any intervention for the treatment of uremic pruritus was included. A quantitative change in pruritus intensity on a visual analog, verbal rating, or numerical rating scale.

A total of 44 RCTs examining 39 different treatments were included in the review. These treatments included gabapentin, pregabalin, mast cell stabilizers, phototherapy, hemodialysis modifications, and multiple other systemic and topical treatments.

The largest body of evidence was found for the effectiveness of gabapentin. Due to the limited number of trials for the other treatments included, these researchers were unable to comment on their efficacy. Risk of bias in most studies was high.

The authors concluded that despite the acknowledged importance of uremic pruritus to patients, with the exception of gabapentin, the current evidence for treatments is weak. They stated that large, simple, rigorous, multi-arm RCTs of promising therapies are urgently needed. Peckruhn and colleagues stated that necrobiosis lipoidica NL is a rare granulomatous disease of unclear etiology and is often seen in patients with diabetes.

Characterized by its potential for ulcerations, it presents a serious burden for the afflicted patients. There are currently neither German nor European guidelines for the treatment of NL. At the same time, standard treatment with topical or intra-lesional corticosteroids does not always show satisfactory results. These researchers examined if the various therapeutic regimens published since have actually expanded the armamentarium in a relevant manner.

Included were all publications that described more than 1 patient being treated with any given therapeutic modality. Overall, these investigators analyzed data for 16 different therapeutic regimens reported in 49 publications. The largest amount of data exists for topical PUVA therapy, photodynamic therapy PDT , and systemic treatment with fumaric acid esters.

However, this analysis showed that with an increase in the number of documented patients treated with a given therapeutic modality, the proportion of those achieving a complete response CR or partial response PR actually decreased.

This was interpreted as publication bias. The authors concluded that no clear recommendation can be rendered for 2nd-line therapy in case topical or intra-lesional corticosteroids fail. Phototherapy -- For patients with widespread disease and for those with recalcitrant disease that does not respond to topical or intralesional corticosteroids, we suggest narrowband ultraviolet B NBUVB phototherapy as first-line therapy.

NBUVB is administered 2 to 3 times weekly for up to 10 weeks in combination with topical corticosteroids. Emollients and topical corticosteroids may also be used as needed. An open left-right comparison study that compared the efficacy of moderate to potent topical corticosteroids with the efficacy of ultraviolet B UVB or psoralen plus ultraviolet A PUVA phototherapy in 20 patients with a clinical diagnosis of lichen amyloidosis found a trend towards greater reductions in patient-reported itch and skin roughness with phototherapy, but the difference was not statistically significant Treatment of primary localized cutaneous amyloidosis is not mandatory.

No treatment is consistently effective for macular amyloidosis and lichen amyloidosis. We suggest interventions to minimize pruritus and scratching as initial treatment Grade 2C. Our initial treatment approach consists of local corticosteroid therapy to reduce pruritus. For patients who are refractory to these agents, ultraviolet B UVB phototherapy is a therapeutic option. Gilchrest et al examined the effect of ultraviolet UV -light phototherapy on severe persistent pruritus in 18 adult patients on hemodialysis.

Patients were randomly assigned to 1 of 2 light sources. The experimental group received conventional sunburn-spectrum light conventionally designated as UVB in gradually increasing doses. The control group received time-matched exposures to long-wave ultraviolet UV light. Of those responding to sunburn-spectrum light, improvement usually occurred 2 to 3 weeks into treatment. Mild sunburn, noted by some patients in this group, was the only side effect.

The response to phototherapy was unaffected by the presence of secondary hyperparathyroidism. The authors concluded that UV phototherapy was a safe, convenient, inexpensive and effective treatment for uremic pruritus. These researchers stated that these findings mandated further study of use of UVB in patients with uremic pruritis.

Ada et al reported the results of a pilot study of narrowband UVB NB-UVB phototherapy for the treatment of 20 patients with uremic pruritus; 10 patients completed the 6-week study period.

A total of 8 patients were found to be responders. Of the remaining 10 patients who left the study before 6 weeks, 6 were satisfied with the response. In the follow-up period, 7 responders could be examined, and 3 were in remission 6 months after completing treatment.

However, pruritus recurred in the remaining 4 responders. The authors concluded that NB-UVB phototherapy may be an effective treatment for patients with uremic pruritus; however, recurrence of pruritus was a frequent problem.

Moreover, these researchers stated that randomized controlled trials RCTs are needed to better define the place of NB-UVB in the treatment protocol of this condition. In a single-blind, randomized, controlled trial, Ko et al examined if NB-UVB phototherapy is an effective treatment for uremic pruritus. The control group received time-matched exposures to long-wave UVA radiation.

A visual analog scale VAS score was evaluated weekly for pruritus intensity for 12 weeks. The characteristics of pruritus were also assessed by a questionnaire at baseline and after 6 weeks of phototherapy.

Both the NB-UVB and control groups had significant and comparable improvement in the pruritus intensity VAS scores during the period of phototherapy and follow-up. More detailed regression and estimating analysis revealed that the patients in the NB-UVB group had lower pruritus intensity scores at week 6, week 10 and week This may indicate a beneficial difference at certain time-points, but the effect appeared marginal.

The authors concluded that NB-UVB phototherapy did not show a significant effect in reducing pruritus intensity compared with a control group for refractory uremic pruritus. These researchers stated that further studies are needed. Reuter et al noted that erythema annulare centrifugum is an acute dermatosis of unclear etiology, which presents with annular erythematous lesions with marginal scale.

Therapeutically, systemic and topical glucocorticoids are used primarily. These investigators treated a patient with large lesions in the area of the thighs resistant to a therapy with topical glucocorticoids, with topical calcitriol in combination with nm narrow band ultraviolet B NB-UVB phototherapy. After 4 weeks of treatment the skin lesions had cleared nearly completely without any side effects. The combination topical vitamin D3-analog calcitriol and nm NB-UVB phototherapy was effective and can be regarded as a useful alternative to glucocorticoids for the treatment of erythema annulare centrifugum.

This was a single-case study; and its findings were confounded by the combined use of topical glucocorticoids, topical calcitriol, and NB-UVB. Petersen et al stated that radiation induced morphea RIM is an increasingly common complication of radiation treatment for malignancy as early detection has made more patients eligible for non-surgical therapeutic options.

In many cases, the radiation oncologist is the first person to learn of the initial skin changes, often months before a dermatologist sees them. These researchers presented the case of a breast cancer patient who developed a rare bullous variant of RIM, which delayed her diagnosis and subsequent treatment. It is imperative to diagnose RIM early as it carries significant morbidity and permanent deformity if left untreated. The lesions typically present within 1 year of radiation therapy and extend beyond the radiated field.

RIM is often mistaken for radiation dermatitis or cellulitis. Bullae, when present, are often hemorrhagic in appearance, which can serve as another clinical clue. It is important to refer these patients for a full gynecologic examination as there can be concurrent anogenital lichen sclerosus et atrophicus, which is both debilitating and carries a long-term risk for squamous cell carcinoma.

Treatment with systemic agents is often necessary, and can be managed by a dermatologist. The most proven regimen in the literature appeared to be methotrexate, with or without concurrent narrow-band UVB phototherapy.

In more than one-third of the cases, the most common clinical correlates are drug eruptions A special and rare subtype is giant cell lichenoid dermatitis, a rare condition considered an unusual variant of lichenoid drug eruption or a manifestation of sarcoidosis. Histopathologic findings include multinucleated giant cells For patients with symptomatic disease involving a limited skin area e.

We generally use a super-potent topical corticosteroid e. Less potent topical corticosteroids, such as mometasone furoate 0. We typically use clobetasol propionate 0.

However, narrow-band UVB is not mentioned as a therapeutic option. In a case report, Tan and Giam reported on the findings of a year-old woman with recurrent crops of papules and nodules of lymphomatoid papulosis and who had early-stage mycosis fungoides. Mycosis fungoides was treated with oral psoralen and ultraviolet A phototherapy with good response. The papules of lymphomatoid papulosis continued to appear but she remained free of lesions of mycosis fungoides 10 months after cessation of NB-UVB therapy.

Both treatments have contraindications including any history of light sensitivity disorders i. The safety for PUVA has also not been established in pregnancy, nursing mothers, or children. There are also contraindications for patients with significant hepatic impairment and for those taking warfarin or phenytoin. UVA1 phototherapy should not be used for patients with UVA-sensitive photodermatoses or photosensitive atopic dermatitis or patients taking photosensitizing drugs.

Guidelines from the American Academy of Dermatology guidelines of care for the management of atopic dermatitis Sidbury, et al. The guidelines state that, although there are no studies that document the efficacy or safety of home light therapy for patients with atopic dermatitis, or that contrast its use to in-office phototherapy, results similar to home phototherapy for psoriasis might be expected. Milstein et al described the findings of 31 patients with early mycosis fungoides MF and 3 patients with parapsoriasis en plaques who were treated with ultraviolet UV phototherapy to nm at home using a commercially available light source containing 4 Westinghouse FS40 lamps.

Although higher complete response rates generally were achieved with other therapeutic modalities, UV phototherapy with its minimal adverse effects may be indicated for selected patients. Moreover, the authors concluded that controlled studies are needed to examine the full potential of conventional phototherapy in the management of MF. Resnik et al noted that in , they reported their preliminary observations on the use of home UV phototherapy for patch and early plaque phase MF.

These researchers presented follow-up data of the original 31 patients, covering an interval of up to 15 years. All patients used a commercially available UV phototherapy unit that contained 4 Westinghouse FS40 fluorescent lamps for daily exposures of their non-sun-exposed skin regions.

This indicated that cure may have been achieved in a minority of patients. Phototherapy was well-tolerated without evidence of significant photo-damage or photo-carcinogenicity.

The authors concluded that these findings indicated that home phototherapy may be a therapeutic option for treatment of selected patients with early MF. However, there are no randomized trials evaluating the relative efficacy of these phototherapy modalities in patients with early-stage MF NBUVB phototherapy is administered in a dermatology office 3 to 5 times per week with gradual incremental dose delivery. Improvement is generally seen after 20 to 40 treatments.

After a complete response is achieved, the frequency of therapy is tapered very slowly during the maintenance period and then discontinued. The tapering schedule is non-standardized and differs by institution.

This UTD review does not mention home phototherapy as a therapeutic option. Review History. Clinical Policy Bulletin Notes. Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. Print Share. There is inadequate evidence in the peer-reviewed medical literature of the effectiveness of PUVA in any of these conditions not an all-inclusive list : Acne; Eosinophilic cellulitis Wells syndrome ; Keratosis follicularis Darier disease or Darier-White disease ; Lichen amyloidosis; Lichen myxedematosus; Melasma; Necrobiotic xanthogranuloma; Necrobiosis lipoidica; To increase skin tolerance to sunlight.

Aetna considers narrow-band UVB phototherapy medically necessary for the following indications: Atopic dermatitis atopic eczema ; Chronic urticaria; Cutaneous mastocytosis after conventional therapies have failed Early-stage mycosis fungoides; Kyrle disease perforating dermatosis that is refractory to topical or intralesional therapy; Morphea circumscribed scleroderma ; Photodermatoses e.

Background Psoralens and ultraviolet A light PUVA therapy is contraindicated in any of the following conditions: history of arsenic exposure; or history of ionizing radiation exposure; or history or presence of melanoma or other skin cancer; or pregnancy.

Fesq and colleagues stated that management of PLE should focus on basic preventative measures and additional therapeutic approaches, depending on the clinical condition. Polymorphous light eruption can be classified into 4 severity groups: mild, moderate-to-severe, severe, and therapy-resistant.

First-line therapies Includes the following: Sun protection - Sun protection is first-line therapy for patients with PMLE and includes sun avoidance, sun protective clothing, and sunscreens. A sunscreen with an SPF sun protection factor of at least 30 should be regularly applied. Sunscreens that contain the non-micronized form of zinc oxide or titanium dioxide also offer photoprotection that extends throughout the UV and into the visible spectrum. Examples of broad spectrum sunscreens containing photostabilized avobenzone or ecamsule, or zinc oxide and titanium oxide are provided.

Topical corticosteroids - No randomized trials have evaluated the efficacy of topical corticosteroids for PMLE. Clinical experience suggests that potent topical corticosteroids groups one to three may be used for symptomatic relief, and may be sufficient pharmacologic therapy for mild cases. Facial lesions should be treated with lower potency topical corticosteroids groups six to seven.

Second-line therapies include the following: Phototherapy - Prophylactic phototherapy with low dose PUVA psoralens plus UVA or UVB in early spring to induce tolerance to sun exposure may be an option for patients who are expected to develop significant symptoms during the spring or summer.

Treatments are usually given 2 to 3 times per week over 5 to 6 weeks. The dose is increased during subsequent treatments as tolerated by the patient. Broad spectrum sunscreens with an SPF of at least 30 should be regularly used For patients with active lesions, we suggest treatment with potent topical corticosteroids groups one to three.

An alternative in patients with infrequent exacerbations, particularly those who require rapid improvement, is a short course of systemic glucocorticoids For patients who develop frequent exacerbations during the spring and summer, we suggest prophylactic phototherapy in early spring Juvenile spring eruption is a variant of PMLE that is manifested by erythematous papules or bullae typically on ears of children or adolescents after sun exposure.

Symptoms are self-limited and resolve within several weeks Note : Regarding UVB in the treatment of prurigo nodularis, Ferrandiz et al reported that an excellent response was obtained after an average of 32 UVB courses. PUVA for Necrobiotic Xanthogranuloma Miguel and colleagues stated that necrobiotic xanthogranuloma NXG is an uncommon non-Langerhans cell histiocytosis involving skin and extracutaneous tissues.

Phototherapy for Scleredema An UpToDate chapter on scleredema Kreuter, states that, for patients with functionally limiting or symptomatic scleredema that is not expected to resolve spontaneously, initial treatment with phototherapy is suggested. Narrow-Band UVB Phototherapy for the Treatment of Cutaneous Mastocytosis Brazzelli et al stated that mastocytoses represent a heterogeneous group of stem cell disorders marked by an abnormal hyperplasia and accumulation of mast cells in one or more tissues, including bone marrow, gastro-intestinal GI tract, liver, spleen, lymph nodes and skin.

Phototherapy for the Treatment of Lymphomatoid Papulosis Guidelines from the National Comprehensive Cancer Network NCCN, state that, when managing patients with lymphomatoid papulosis, it is important to be reminded that this is not a malignant disorder, but a recurrent, benign, self-regressing lymphoid proliferation.

PUVA for the Treatment for Necrobiosis Lipoidica Peckruhn and colleagues stated that necrobiosis lipoidica NL is a rare granulomatous disease of unclear etiology and is often seen in patients with diabetes. NB-UVB Phototherapy for the Treatment of Cutaneous Mastocytosis Brazzelli et al stated that mastocytoses represent a heterogeneous group of stem cell disorders marked by an abnormal hyperplasia and accumulation of mast cells in one or more tissues, including bone marrow, gastro-intestinal GI tract, liver, spleen, lymph nodes and skin.

NB-UVB Phototherapy for the Treatment of Erythema Annulare Centrifugum Reuter et al noted that erythema annulare centrifugum is an acute dermatosis of unclear etiology, which presents with annular erythematous lesions with marginal scale. NB-UVB Phototherapy for the Treatment of Lichen Sclerosus Petersen et al stated that radiation induced morphea RIM is an increasingly common complication of radiation treatment for malignancy as early detection has made more patients eligible for non-surgical therapeutic options.

NB-UVB Phototherapy for the Treatment of Lymphomatoid Papulosis In a case report, Tan and Giam reported on the findings of a year-old woman with recurrent crops of papules and nodules of lymphomatoid papulosis and who had early-stage mycosis fungoides. Home Phototherapy for the Treatment of Cutaneous T-Cell Lymphoma Mycosis Fungoides and Sezary Syndrome Milstein et al described the findings of 31 patients with early mycosis fungoides MF and 3 patients with parapsoriasis en plaques who were treated with ultraviolet UV phototherapy to nm at home using a commercially available light source containing 4 Westinghouse FS40 lamps.

A0 - C A9 Mycosis fungoides and cutaneous T-cell lymphoma C Reticulohistiocytoma giant-cell ; Sinus histiocytosis with massive lymphadenopathy; Xanthogranuloma E A9 Mycosis fungoides and cutaneous T-cell lymphoma L A0 C A9 Mycosis fungoides and cutaneous T-cell lymphoma [early state] D Treatment of uremic pruritus with narrowband ultraviolet B phototherapy: An open pilot study.

J Am Acad Dermatol. Minimal benefit from photochemotherapy for alopecia areata. Int J Dermatol. Guidelines of care for phototherapy and photochemotherapy. Psoriasis: Recommendations for UVB combination therapies. Practice Management Center. Accessed July 19, Efficacy of psoralen UV-A therapy vs. J Eur Acad Dermatol Venereol. Narrow-band ultraviolet B radiation: A review of the current literature.

Beani JC, Jeanmougin M. Ann Dermatol Venereol. UVA1 phototherapy for treatment of necrobiosis lipoidica. Clin Exp Dermatol. Ultraviolet A phototherapy and trimethylpsoralen UVA photochemotherapy in polymorphous light eruption -- a controlled study.

Photodermatol Photoimmunol Photomed. Phototherapy using narrowband ultraviolet B and psoralen plus ultraviolet A is beneficial in steroid-dependent antihistamine-refractory chronic urticaria: A randomized, prospective observer-blinded comparative study.

Br J Dermatol. Bohjanen K, Miller DD. Cutaneous manifestations of amyloidosis. UpToDate [online serial]. Narrow-band UVB phototherapy and psoralen-ultraviolet A photochemotherapy in the treatment of cutaneous mastocytosis: A study in 20 patients.

Indolent systemic mastocytosis treated with narrow-band UVB phototherapy: Study of five cases. Phototherapy and photochemotherapy of sclerosing skin diseases. Medium-dose UVA1 therapy of lymphomatoid papulosis. Castells MC, Akin C. Cutaneous mastocytosis: Treatment, monitoring, and prognosis.

Cather J, Menter A. Novel therapies for psoriasis. Am J Clin Dermatol. Interventions for guttate psoriasis. Cochrane Database Syst Rev. Interventions for treating oral lichen planus. Narrow-band ultraviolet B phototherapy versus broad-band ultraviolet B or psoralen-ultraviolet A photochemotherapy for psoriasis.

Photodynamic therapy for psoriasis. J Dermatolog Treat. Therapy of moderate and severe psoriasis [summary]. HTA Report. Narrowband TL phototherapy for patch-stage mycosis fungoides. Arch Dermatol. Collins P, Ferguson J. Vulvar lichen sclerosus. Darier's disease: Epidemiology, pathophysiology, and management. Cyr PR. Diagnosis and management of granuloma annulare. Am Fam Physician. Topical psoralen-ultraviolet A therapy for palmoplanar dermatoses: Experience with 35 consecutive patients.

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