Narrow-Band ultraviolet B phototherapy for the treatment of Iraqi patients with uremic pruritus
Keywords:
phototherapy uremic pruritusAbstract
Objective We aimed to assess the efficacy and safety of NB-UVB phototherapy in relieving uremic pruritus. Patients and Methods Over a period of 12 months, we recruited 17 patients with uremic pruritus having skin phototype III and more, aged from 21 to 67 years, 19(52.9%) females and 8(47.1%) male. They received NB-UVB, 2 sessions per week for 10 weeks. The response was assessed using 5-D itch scale. Results There was a 60.7±29.2% reduction of 5D-itch score compared to baseline (19.53±3 versus 7.59±5.8, p<0.001). The mean cumulative dose of NB-UVB for one patient was 24.99 joule/ cm2 (1.25 ± 0.6 j/ cm2 per session). At the end of the trial, according to 5-D itch score criteria, 82.4% of patients were considered as a responder (good in 47.1%, very good in 35.3%) and after the treatment at follow up for 8 weeks, 35.7% developed pruritus again. Transient erythema was observed in 2 patients (10.5%) on phototherapy. Conclusion In our population, with Fitzpatrick s skin phototypes 3-5, NB-UVB phototherapy seems to be safe and effective choice for uremic pruritus, albeit tentative in some patients. High doses were required to achieve a satisfactory response.References
- Mathur VS, Lindberg J, Germain M, Block G, Tumlin J, Smith M et al. A longitudinal study of uremic pruritus in hemodialysis patients. Clin J Am Soc Nephrol 2010; 5:1410–1419.
- Dyachenko P, Shustak A, Rozenman D. Hemodialysis-related pruritus and associated cutaneous manifestations. Int J Dermatol 2006; 45:664–667.
- Yosipovitch G, Zucker I, Boner G, Gafter U, Shapira Y, David M. A questionnaire for the assessment of pruritus: validation in uremic patients. Acta Derm Venereol 2001; 81:108–111.
- Patel TS, Freedman BI, Yosipovitch G. An update on pruritus associated with CKD. Am J Kidney Dis 2007; 5:11-20.
- Okada K, Matsumoto K. Effect of skincare with an emollient containing a high water content on mild uremic pruritus. Therap Apher Dialy 2004;8:419-422.
- Manenti L, Vaglio A, Costantino E, Danisi D, Oliva B, Pini S et al. Gabapentin in the treatment of uremic itch: an index case and a pilot evaluation. J Nephrol 2005; 18:86-91.
-Gilchrest BA, Rowe JW, Brown RS, Steinman TI, Arndt KA. Relief of uremic pruritus with ultraviolet phototherapy. N Engl J Med. 1977;297:136–138.
-Gilchrest BA. Ultraviolet phototherapy of uremic pruritus. Int Dermatol. 1979;18:741–748.
-Tan JK, Haberman HF, Coldman AJ. Identifying effective treatments for uremic pruritus. J Am Acad Dermatol. 1991;25:811–818.
- Shintani Y, Yasuda Y, Kobayashi K, Maeda A, Morita A. Narrowband ultraviolet B radiation suppresses contact hypersensitivity. Photodermatol Photoimmunol Photomed. 2008; 24:32-37.
- Lugon JR. Uremic pruritus: a review. Hemodial Int 2005; 9:180-188.
- Szepietowski JC, Morita A, Tsuji T. Ultraviolet B induces mast cell apoptosis: a hypothetical mechanism of ultraviolet B treatment for uraemic pruritus. Medic hypoth 2002;58:167-170.
- Wallengren J, Sundler F. Phototherapy reduces the number of epidermal and CGRP-positive dermal nerve fibers. Acta Derm Venereol 2004; 84:111-115.
- Ada S, Seçkin D, Budakoğlu İ, Özdemir FN. Treatment of uremic pruritus with narrowband ultraviolet B phototherapy: an open pilot study. J Am Acad Dermatol 2005; 53:149-151.
- Seckin D, Demircay Z, Akin O. Generalized pruritus treated with narrowband UVB. Inter J Dermatol 2007; 46:367-370.
- Wang TJ, Lan LC, Lu CS, Lin KC, Tung HH, Wu SF et al. Efficacy of narrowband ultraviolet phototherapy on renal pruritus. J Clin Nurs 2014; 23:1593-602.1
- Samson Yashar S, Gielczyk R, Scherschun L, Lim HW. Narrowband
ultraviolet B treatment for vitiligo, pruritus, and inflammatory dermatoses. Photodermatol Photoimmunol Photomed, 2003;19: 164-168.
- Ko MJ, Yang JY, Wu HY, Hu FC, Chen SI, et al. Narrowband ultraviolet B phototherapy for patients with refractory uremic pruritus: a randomized controlled trial. Br J Dermatol, 2011; 165: 633-639.
-Ibbotson SH, Bilsland D, Cox NH, Dawe RS, Diffy B, Edward C et al. An update and guidance on narrowband ultraviolet B phototherapy: a British Photodermatology Group Workshop Report. Br J Dermatol 2004;151:283– 297.
- Lai JW, Chen HC, Chou CY, Yen HR, Li TC, SUN MF, et al. Transformation of 5-D itch scale and numerical rating scale in chronic hemodialysis patients. BMC Nephrol ,2017;18, 56 . DOI:10.1186/s12882-017-0475-z.
- Elman S, Hynan LS, Gabriel V, Mayo MJ. The 5-D itch scale: a new measure of pruritus. Br J Dermatol. 2010; 162:587- 593.
- Jin JO, Kwon HH, Choi MR, Youn JI. No evidence for increased skin cancer risk in Koreans with skin phototypes III-V treated with narrowband UVB phototherapy. Acta Dermatol Venereol 2011; 91:40-43.
- Dawe RS. A quantitative review of studies comparing the efficacy of narrow‐band and broad‐band ultraviolet B for psoriasis. Br J Dermatol 2003;149:669-672.
- Zanolli M. Phototherapy treatment of psoriasis today. J Am Acad Dermatol 2003; 49: S78–86.
- Hearn RM, Kerr AC, Rahim KF, Ferguson J, Dawe RS. Incidence of skin cancers in 3867 patients treated with narrow-band ultraviolet B phototherapy. Br J Dermatol 2008; 159:931– 935.