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Phototherapy And Photodiagnostic Methods For The Practitioner

Phototherapy And Photodiagnostic Methods For The Practitioner

Chong Wei Sheng | Pan Jiun Yit | Tan Eugene Sern Ting


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Phototherapy, or the usage of light to treat diseases, is an important modality in a physician's therapeutic armamentarium. It is effective for a number of common skin conditions like atopic dermatitis, psoriasis and vitiligo. The accurate diagnosis of a photodermatosis or light-related skin disorder relies on a good clinical history and physical examination, supported by diagnostic investigations such as phototesting.Phototherapy and Photodiagnostic Methods for the Practitioner is the first published set of practical guidelines for Asian skin, drawing upon our cumulative clinical experience with phototherapy for various conditions at the National Skin Centre in Singapore, amalgamated with up-to-date evidence from the scientific literature. It is designed to serve as a concise and comprehensive reference manual for dermatologists, as well as clinicians, medical physicists and nurses with an interest in photodiagnostic investigations and phototherapy for the evaluation and treatment of skin disorders.

Table of Contents

Section Title Page Action Price
Contents v
Editors vii
Contributors ix
Forewords xi
Foreword xiii
Preface xv
Chapter 1 Introduction to Phototherapy 1
Chapter 2 Nursing Considerations in Phototherapy 3
Pre-Phototherapy Advice 3
NBUVB Treatment Procedure 4
Oral PUVA Treatment Procedure 5
Bath/Soak/Paint PUVA Treatment Procedure 7
Chapter 3 Narrowband Ultraviolet B Phototherapy 9
Background 9
Indications of NBUVB Phototherapy 10
Contraindications to NBUVB Phototherapy 11
Treatment Regimen and Dosimetry 12
Retinoid-NBUVB (Re-NBUVB) Treatment Regimen and Dosimetry [C, IV] 17
Skin Cancer Surveillance for Patients on Long-Term NBUVB Phototherapy [C, IV] 17
Further Reading 18
Chapter 4 Combined Ultraviolet A/Narrowband Ultraviolet B Phototherapy 19
Background 19
Indications of Combined UVA/NBUVB Phototherapy 20
Contraindications to Combined UVA/NBUVB Phototherapy 21
Adverse Effects of Combined UVA/NBUVB Phototherapy 21
Treatment Regimen and Dosimetry 22
Further Reading 25
Chapter 5 Psoralen-Ultraviolet A Photochemotherapy 27
Background 27
PUVA Modalities: Practical Aspects 28
Indications of PUVA Photochemotherapy 32
Contraindications to PUVA Photochemotherapy 32
Adverse Effects of PUVA Photochemotherapy 33
Screening and Monitoring (Oral PUVA Photochemotherapy) 34
Treatment Regimen and Dosimetry 34
Retinoid-PUVA (Re-PUVA) Treatment Regimen and Dosimetry [C, IV] 41
Skin Cancer Surveillance for Patients on Long-Term PUVA Photochemotherapy [C, IV] 42
Further Reading 42
Chapter 6 Ultraviolet A-1 Phototherapy 45
Background 45
Delivery of UVA-1 45
Indications of UVA-1 Phototherapy 47
Contraindications to UVA-1 Phototherapy 47
Adverse Effects of UVA-1 Phototherapy 48
Dosimetry Regimens 48
Skin Cancer Surveillance for Patients on Long-Term UVA-1 Phototherapy [C, IV] 50
Further Reading 51
Chapter 7 Excimer Light Phototherapy 53
Background 53
Excimer Light 54
Indications of Excimer Light Phototherapy [B, IIA] 55
Contraindications to Excimer Light Phototherapy 56
Adverse Effects of Excimer Light Phototherapy 56
Psoriasis Protocol [C, IV] 57
Vitiligo Protocol [C, IV] 59
Treatment of Specific Dermatoses 62
Further Reading 64
Chapter 8 Photodynamic Therapy 65
Background 65
Indications of PDT 67
Contraindications to PDT 67
Adverse Effects of PDT 67
Treatment Procedure 68
Summary of Treatment Evidence for the Main Indications 70
Further Reading 71
Chapter 9 Phototesting 73
Background 73
Indications of Phototesting 73
General Principles in Phototesting 74
Therapeutic Phototesting Procedure for NBUVB Phototherapy and PUVA Photochemotherapy [C, IV] 77
NBUVB Test Site Reactions 79
Oral PUVA Test Site Reactions 79
Bath PUVA Test Site Reactions 80
Diagnostic Phototesting Procedure for UVA and UVB [C, IV] 80
UVA and UVB Test Site Reactions 82
Diagnostic Phototesting Procedure for VIS [C, IV] 83
Important Note on Solar Urticaria 84
Normal Ranges of MED-UVA and MED-UVB [C, IV] 85
Expected Phototesting Responses in Common Photodermatoses 85
Further Reading 86
Chapter 10 Photopatch Testing 87
Background 87
Indications of Photopatch Testing 87
Patient Preparation 88
Procedure for Photopatch Testing [B, IIb] 89
Interpretation of Results 92
Documentation of Clinical Relevance 93
Complications 93
Photopatch Testing in UVA-Sensitive Individuals [C, IV] 94
Further Reading 95
Chapter 11 Photoprovocation Testing 97
Background 97
Indications of Photoprovocation Testing 97
Patient Preparation 98
Procedure for Photoprovocation Testing [C, IV] 98
Systemic Drug Photochallenge [C, IV] 101
Interpretation of Readings 102
Complications 103
Further Reading 103
Annexes 105
Annex A Minimal Erythema Dose Testing Dosimetry 105
Annex B Minimal Phototoxic Dose Testing Dosimetry 109
Annex C Photopatch Testing Series 111
Annex D Evidence Grading for Recommendations 115
Index 117