© 2015 Wiley Periodicals, Inc.
Mild burn over axilla None None None None None None None None Burning and pain Itch Itch, erythema, pain 6 No relapse Discontinued 60 No relapse No relapse Discontinued 36 No relapse No relapse 12 No relapse 1,631 2,133 1,155 1,000 1,027 1,129 1,412 1,095 1,783 2,333 2,333 380 24 6 1 5 4 30 1 17 17 10 17 1 60 57 12 18 25 125 12 136 95 73 66 9 100 70 Discontinued 87 100 97 Discontinued 80 90 83 91 38 0 3 Discontinued 2 0 1 Discontinued 1 2 5 6 25 BSA, body surface area.
8 11 13 11 10 6 8 9 7 11 12 11 1 2 3 4 5 6 7 8 9 10 11 12
Sex
2 10 10 15 15 30 10 5 20 30 70 40
Maximum dose, mJ/cm2 Length of treatment before improvement, months Treatment sessions, n BSA improvement, % Patient
DOI: 10.1111/pde.12632
BSA after treatment, %
This was a retrospective study involving children younger than 18 years of age with clinically diagnosed psoriasis who had undergone NBUVB at the National Skin Centre, Singapore, over a 5-year period between 2004 and 2008. Ethics approval for the study was obtained before medical records were assessed. The data collected are summarized in Table 1. Treatment with NBUVB was determined according to Fitzpatrick skin phototype and the dose was increased according to study protocol. Treatment frequency was two to three times per week. An excellent treatment response was defined as a reduction of more than 90% in body surface area (BSA) involved, a good response as a 70% to 90% reduction, a moderate response as a 50% to 70% reduction, and a poor response as a less than 50% reduction.
BSA before treatment, %
METHODS AND STUDY DESIGN
Age, years
Psoriasis and its treatment in children pose a unique challenge to physicians. The aim of this study was to evaluate the efficacy and safety of narrowband ultraviolet B (NBUVB) in the treatment of childhood psoriasis in an East Asian population in Singapore.
TABLE 1. Clinical Characteristics of Children with Psoriasis Who Underwent Narrowband Ultraviolet B Therapy
Abstract: Narrowband ultraviolet B (NBUVB) phototherapy is a well-established treatment modality for psoriasis. We performed a retrospective analysis of children of East Asian descent with psoriasis treated with NBUVB phototherapy at the National Skin Centre, Singapore, over a 5-year period between 2004 and 2008 and found that NBUVB phototherapy is safe and effective for the treatment of psoriasis in children of East Asian descent.
Length of time before recurrence, months
Role of Narrowband Ultraviolet B Phototherapy in the Treatment of Childhood Psoriasis in Asian Children
Female Male Female Female Female Female Female Female Female Female Female Male
Complications
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e222 Pediatric Dermatology Vol. 32 No. 5 September/October 2015
TABLE 2. Narrowband Ultraviolet B Treatment in Children with Psoriasis: Literature Review Reference
Patients, n
Outcome
Side effects
Pasic et al (1)
20
None reported
Zamberk et al (2)
20
Pavlovsky et al (3)
79
45% (n = 9) of patients had excellent response (>90% reduction in PASI score), 20% (n = 4) had good response (70%–90% reduction in PASI score), 20% (n = 4) had moderate response (50%–70% in PASI score), 15% (n = 3) did not improve after treatment (90% improvement of initial PASI, and median remission period was 8 mos, with 6 patients needing new treatment course due to relapse 51% (n = 40) achieved clearance and 41% (n = 39) had good response of >75% improvement
Jury et al (4)
35
63% (n = 22) of patients had cleared or had minimal residual disease, 9% (n = 13) were not better by the end of the treatment
Tan et al (5)
38
Wong et al (this study)
12
90% of patients had response to treatment (>75% improvement or clearance) 50% (n = 5) of patients had excellent response (>90% improvement in BSA), 40% (n = 4) had good response (70%–90% improvement in BSA), 10% (n = 1) had no improvement
35% erythema 15% mild erythema, 1% pruritus, 3% burn 30% erythema, 5 had blisters, 1 had varicella zoster virus reactivation, 2 had herpes simplex virus reactivation, 5 had anxiety 36% erythema 4 experienced burning sensation, itch, or erythema
PASI, Psoriasis Area and Severity Index; BSA, body surface area.
RESULTS Over the 5 years we identified 12 patients (6 Malay, 4 Chinese, 1 Indian, and 1 of mixed Eurasian parentage; mean age 9.75 years, with a preponderance of girls) who fulfilled our study criteria. The indications for treatment were suboptimal response to appropriate topical therapy or extensive BSA involvement and consequent risk of side effects from topical steroids. BSA involvement before NBUVB phototherapy ranged from 2% to 70%. Eleven patients presented with chronic plaque psoriasis and one with guttate psoriasis. During phototherapy, patients were allowed topical treatment. The highest doses administered ranged from 380 to 2,333 mJ/cm2 (mean 1,451 mJ/cm2). The number of treatments ranged from 9 to 136 (mean 57.3 treatments). The duration of phototherapy ranged from 1 to 30 months (mean 11 mos). Response to NBUVB was excellent in five patients and good in four. One patient reported poor improvement and stopped treatment after nine sessions because of increased erythema. Two patients discontinued treatment after 12 sessions of phototherapy for unknown reasons. Four patients experienced worsening of their psoriasis after stopping NBUVB. The length of time
between stopping phototherapy and worsening ranged from 6 months to 5 years (mean 28.5 mos). All four had good response after recommencement of phototherapy. None of the patients required systemic therapy during or after treatment with NBUVB. All patients were followed up for at least 1 year. Four patients experienced a mild burning sensation, pain, erythema, or itching, none of which resulted in discontinuation of treatment. DISCUSSION Table 2 summarizes past studies that examined the use of NBUVB in childhood psoriasis. We have included our study for comparison. Although NBUVB has been shown to be safe and effective in children with psoriasis, long-term photocarcinogenicity has yet to be evaluated. Therefore patients should be closely followed. CONCLUSION NBUVB is a safe and effective treatment for childhood psoriasis and should be considered in children with suboptimal response to topical therapy.
Brief Report e223
REFERENCES 1. Pasic A, Ceovic R, Lipozencic J et al. Phototherapy in pediatric patients. Pediatr Dermatol 2003;20:71–77. 2. Zamberk P, Velazquez D, Campos M et al. Paediatric psoriasis—narrowband UVB treatment. J Eur Acad Dermatol Venereol 2010;24:415–419. 3. Pavlovsky M, Baum S, Shpiro D et al. Narrow band UVB: is it effective and safe for paediatric psoriasis and atopic dermatitis? J Eur Acad Dermatol Venereol 2011;25:727–729. 4. Jury CS, McHenry P, Burden AD et al. Narrowband ultraviolet B (UVB) phototherapy in children. Clin Exp Dermatol 2006;31:196–199.
5. Tan E, Lim D, Rademaker M. Narrowband UVB phototherapy in children: a New Zealand experience. Australas J Dermatol 2010;51:268–273. Yisheng Wong, M.B.B.S.* Mark Jean-Aan Koh, M.B.B.S.† Wei-Sheng Chong, M.B.B.S.* *National Skin Centre, Singapore, †Dermatology Service, KK Women’s and Children’s Hospital, Singapore Address for correspondence to Mark Jean Aan Koh, Dermatology Service, KK Women’s & Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, or e-mail: mark.koh.ja@ kkh.com.sg.
Mild burn over axilla None None None None None None None None Burning and pain Itch Itch, erythema, pain 6 No relapse Discontinued 60 No relapse No relapse Discontinued 36 No relapse No relapse 12 No relapse 1,631 2,133 1,155 1,000 1,027 1,129 1,412 1,095 1,783 2,333 2,333 380 24 6 1 5 4 30 1 17 17 10 17 1 60 57 12 18 25 125 12 136 95 73 66 9 100 70 Discontinued 87 100 97 Discontinued 80 90 83 91 38 0 3 Discontinued 2 0 1 Discontinued 1 2 5 6 25 BSA, body surface area.
8 11 13 11 10 6 8 9 7 11 12 11 1 2 3 4 5 6 7 8 9 10 11 12
Sex
2 10 10 15 15 30 10 5 20 30 70 40
Maximum dose, mJ/cm2 Length of treatment before improvement, months Treatment sessions, n BSA improvement, % Patient
DOI: 10.1111/pde.12632
BSA after treatment, %
This was a retrospective study involving children younger than 18 years of age with clinically diagnosed psoriasis who had undergone NBUVB at the National Skin Centre, Singapore, over a 5-year period between 2004 and 2008. Ethics approval for the study was obtained before medical records were assessed. The data collected are summarized in Table 1. Treatment with NBUVB was determined according to Fitzpatrick skin phototype and the dose was increased according to study protocol. Treatment frequency was two to three times per week. An excellent treatment response was defined as a reduction of more than 90% in body surface area (BSA) involved, a good response as a 70% to 90% reduction, a moderate response as a 50% to 70% reduction, and a poor response as a less than 50% reduction.
BSA before treatment, %
METHODS AND STUDY DESIGN
Age, years
Psoriasis and its treatment in children pose a unique challenge to physicians. The aim of this study was to evaluate the efficacy and safety of narrowband ultraviolet B (NBUVB) in the treatment of childhood psoriasis in an East Asian population in Singapore.
TABLE 1. Clinical Characteristics of Children with Psoriasis Who Underwent Narrowband Ultraviolet B Therapy
Abstract: Narrowband ultraviolet B (NBUVB) phototherapy is a well-established treatment modality for psoriasis. We performed a retrospective analysis of children of East Asian descent with psoriasis treated with NBUVB phototherapy at the National Skin Centre, Singapore, over a 5-year period between 2004 and 2008 and found that NBUVB phototherapy is safe and effective for the treatment of psoriasis in children of East Asian descent.
Length of time before recurrence, months
Role of Narrowband Ultraviolet B Phototherapy in the Treatment of Childhood Psoriasis in Asian Children
Female Male Female Female Female Female Female Female Female Female Female Male
Complications
Pediatric Dermatology Vol. 32 No. 5 e221–e223, 2015
e221
e222 Pediatric Dermatology Vol. 32 No. 5 September/October 2015
TABLE 2. Narrowband Ultraviolet B Treatment in Children with Psoriasis: Literature Review Reference
Patients, n
Outcome
Side effects
Pasic et al (1)
20
None reported
Zamberk et al (2)
20
Pavlovsky et al (3)
79
45% (n = 9) of patients had excellent response (>90% reduction in PASI score), 20% (n = 4) had good response (70%–90% reduction in PASI score), 20% (n = 4) had moderate response (50%–70% in PASI score), 15% (n = 3) did not improve after treatment (90% improvement of initial PASI, and median remission period was 8 mos, with 6 patients needing new treatment course due to relapse 51% (n = 40) achieved clearance and 41% (n = 39) had good response of >75% improvement
Jury et al (4)
35
63% (n = 22) of patients had cleared or had minimal residual disease, 9% (n = 13) were not better by the end of the treatment
Tan et al (5)
38
Wong et al (this study)
12
90% of patients had response to treatment (>75% improvement or clearance) 50% (n = 5) of patients had excellent response (>90% improvement in BSA), 40% (n = 4) had good response (70%–90% improvement in BSA), 10% (n = 1) had no improvement
35% erythema 15% mild erythema, 1% pruritus, 3% burn 30% erythema, 5 had blisters, 1 had varicella zoster virus reactivation, 2 had herpes simplex virus reactivation, 5 had anxiety 36% erythema 4 experienced burning sensation, itch, or erythema
PASI, Psoriasis Area and Severity Index; BSA, body surface area.
RESULTS Over the 5 years we identified 12 patients (6 Malay, 4 Chinese, 1 Indian, and 1 of mixed Eurasian parentage; mean age 9.75 years, with a preponderance of girls) who fulfilled our study criteria. The indications for treatment were suboptimal response to appropriate topical therapy or extensive BSA involvement and consequent risk of side effects from topical steroids. BSA involvement before NBUVB phototherapy ranged from 2% to 70%. Eleven patients presented with chronic plaque psoriasis and one with guttate psoriasis. During phototherapy, patients were allowed topical treatment. The highest doses administered ranged from 380 to 2,333 mJ/cm2 (mean 1,451 mJ/cm2). The number of treatments ranged from 9 to 136 (mean 57.3 treatments). The duration of phototherapy ranged from 1 to 30 months (mean 11 mos). Response to NBUVB was excellent in five patients and good in four. One patient reported poor improvement and stopped treatment after nine sessions because of increased erythema. Two patients discontinued treatment after 12 sessions of phototherapy for unknown reasons. Four patients experienced worsening of their psoriasis after stopping NBUVB. The length of time
between stopping phototherapy and worsening ranged from 6 months to 5 years (mean 28.5 mos). All four had good response after recommencement of phototherapy. None of the patients required systemic therapy during or after treatment with NBUVB. All patients were followed up for at least 1 year. Four patients experienced a mild burning sensation, pain, erythema, or itching, none of which resulted in discontinuation of treatment. DISCUSSION Table 2 summarizes past studies that examined the use of NBUVB in childhood psoriasis. We have included our study for comparison. Although NBUVB has been shown to be safe and effective in children with psoriasis, long-term photocarcinogenicity has yet to be evaluated. Therefore patients should be closely followed. CONCLUSION NBUVB is a safe and effective treatment for childhood psoriasis and should be considered in children with suboptimal response to topical therapy.
Brief Report e223
REFERENCES 1. Pasic A, Ceovic R, Lipozencic J et al. Phototherapy in pediatric patients. Pediatr Dermatol 2003;20:71–77. 2. Zamberk P, Velazquez D, Campos M et al. Paediatric psoriasis—narrowband UVB treatment. J Eur Acad Dermatol Venereol 2010;24:415–419. 3. Pavlovsky M, Baum S, Shpiro D et al. Narrow band UVB: is it effective and safe for paediatric psoriasis and atopic dermatitis? J Eur Acad Dermatol Venereol 2011;25:727–729. 4. Jury CS, McHenry P, Burden AD et al. Narrowband ultraviolet B (UVB) phototherapy in children. Clin Exp Dermatol 2006;31:196–199.
5. Tan E, Lim D, Rademaker M. Narrowband UVB phototherapy in children: a New Zealand experience. Australas J Dermatol 2010;51:268–273. Yisheng Wong, M.B.B.S.* Mark Jean-Aan Koh, M.B.B.S.† Wei-Sheng Chong, M.B.B.S.* *National Skin Centre, Singapore, †Dermatology Service, KK Women’s and Children’s Hospital, Singapore Address for correspondence to Mark Jean Aan Koh, Dermatology Service, KK Women’s & Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, or e-mail: mark.koh.ja@ kkh.com.sg.
