The Czech Photodermatology Day

 Part I
Photobiology of the skin and environmental exposure


 The Value of Minimal Erythema Dose UVB in the Eastern Bohemia Region
Ettler K.
Dept. of Dermatology, Faculty of Medicine, Charles University, Hradec Králové, Czech Republic

The effects of ultraviolet radiation (UV) on the human skin are being widely discussed. Special attention has been paid to skin phototype which plays a key role in the individual susceptibility to UV. Estimation of the minimal erythema dose (MED) served as a diagnostic tool for such a susceptibility.

The investigation of skin type incidence in Hradec Králové and determining their mean MED for UVB was the aim of the practical work. We investigated 118 healthy Caucasians. A SUP device was used as a light source. The SUP spectrum was controlled by Brewer spectrophotometer using erythemal effectivity curve.

The skin type III was the most frequent (52.5%). The other skin phototypes were as follows: I. 11.9 %, II. 19.5 %, IV. 16.1 %. The UVB MED was on average 23.4 mJ/cm2.

Data obtained in this study will be used for further photo-dermatological investigations and for "save sun exposure time" counselling in media.


Solar Ultraviolet Radiation Exposures and the Public in the Czech Republic
Vaníček K., Ettler K.
Czech Hydrometeorological Institute, Hradec Králové, Czech Republic,  Dept. of Dermatology, Faculty of Medicine, Charles University, Hradec Králové, Czech Republic

A information system on actual and forecasted levels of the ultraviolet solar radiation has been implemented by the Czech Hydrometeorologivcal Institute (CHMI) in the recent years. The system includes both regular monitoring of the UV erythemal radiation performed with standardized instruments and presentation of actual and forecasted UV-Index values for the territory of the Czech Republic and for the European region. To support application of UV-Index values by the public for active control of sun exposures, sunburning times for different skin types are also calculated and presented. Daily UV reports are published through mass media in CR and at the web site of CHMI from April to September (see: https://www.chmi.cz/meteo/ozon/o3uvb.html). The information system is a part of the European integrated network for health security of the public now being created under several projects of the 5th Framework Programme of the European Commission. An investigation campaign performed by the Dept. of Dermatology, Faculty of Medicine, Charles University, Hradec Králové and CHMI in 2001 showed that the Czech public is fairly informed about health risks of high UV exposures but still need to be more educated on application of passive and active UV protection habits and tools.


UV exposition in malignant melanoma patients of the Eastern Bohemia Region
Ettler K.
Dept. of Dermatology, Faculty of Medicine, Charles University, Hradec Králové, Czech Republic

The incidence of malignant melanoma has been steadily increasing even in the Czech Republic (now is about 12 new cases/100000 inhabitants per year). UV radiation is suggested to be a main risk factor in the development of malignant melanoma on the Caucasian skin. Fair skin type, sunburning episodes, sunbeds exposition, outdoor activities, etc., were discussed in many papers often with controversial results.

We investigated 81 patients with histologically confirmed melanoma and 120 controls without skin troubles. We did not found any statistically significant changes in the occurence of above mentioned properties between melanoma patients and controls.

We suppose UV radiation is not a main etiopathogenetical factor in melanoma occurence in this country. However in spite of this moment we still support public education on photoprotection.


The usefulness of detailed information to patients with photosensitization
Nožičková M., Ettler K.
Dept. of Dermatology, Faculty of Medicine, Charles University, Hradec Králové, Czech Republic

To find out if patients with skin photosensitivity symptoms are helped by information lists, a retrospective study was carried out on 84 patients with abnormal skin sensitivity to UV light, traced through our local database. All were sent a questionnaire about their usage of the information list, clearance of their photosensitivity troubles, their education and other details. Clearance of the patient´s skin photosensitivity symptoms was found to correlate with use of the information list. It was also found that the effectiveness of the information depend on the factors such as education, family circumstances social background and, most of all, how and where the information list was used.


 Protective effects of cosmetic ingredients against photodamage – detection by alternative in vitro method
Kejlová K., Jírová D., Bendová H., Ditrichová D.
NRC for cosmetics, State Health Institute,  Prague, Czech Republic

As a consequence of increasing contamination of the environment and deteriorating living conditions the human skin is exposed to number of toxic substances and radicals. The natural detoxification mechanisms are limited and easily overloaded. The justified aim of modern cosmetology is the identification of substances with protective effect against noxes from the environment Current activities are focused on natural substances capable of scavenging toxic radicals resulting from UV damage and photodynamic effects of chemicals.

The protective effects may be clearly demonstrated using in vitro methods in cell culture. The modified 3T3 Neutral Red Uptake Phototoxicity Test was applied. A number of plant extracts were tested to evaluate their protective and regenerating effects on the cell viability following photodamage. Two promising highly effective substances were identified – Pronalen Bioprotect and Pronalen Cereal. In combination with UV filters their beneficial effect against UVA was proved. Their possible use along with UV filters in cosmetic formulations is suggested.


 The Examination of Photoallergic Contact Reaction in the Eastern Bohemia Region
Ettler K., Nožičková M., Vaněčková J.
Dept. of Dermatology, Faculty of Medicine, Charles University, Hradec Králové, Czech Republic

The epidemiology of contact photoallergy in the Czech Republic is not well known at present. Using the photo-patch tests method we tested some substances enrolled in the Trolab set. The UVA dose was 5 J/cm2. This study enrolled two groups of the probands according to the presence or absence of any photosensitivity symptoms. Photosensitivity troubles were present in 17 persons, 10 persons (controls) had no symptoms of previous photosensitivity. Though a higher incidence of contact sensitivity was detected in 5 controls (50 %), contact sensitization was present in 8 cases (47 %) in photosensitive group as well. Photoallergic reaction was provoked on healthy skin in 2 subjects within the group of controls. The incidence of positive photoallergic responders within the photosensitive group was 5 persons (29.4 %). The results of the study conducted with sunscreens showed that propanedione, cinnamates and oxybenzone were most frequent photoallergenic substances. These data suggest that some photosensitive troubles could be caused by a skin response against photoactivated sunsreen´s ingredients.


 Part II
Phototherapy in Dermatology


Phototherapy - the Treatment of Chronic Renal Insufficiency pruritus ?
Jiraskova, M., Štork, J.
Dept.of Dermatology, Faculty of Medicine, Charles University, Prague, Czech Republic

 The chronic renal insufficiency (CHRI) has frequently accompanying problem - generalized pruritus, which is difficult to palliate. One of the treatments with favorable effect on pruritus seems to be UV radiation. We tryied to compare the phototherapy with UVB and UVA. We were exposed 25 patients to UVB radiation in doses from 0.09-0.18 J/cm2 to 1.9 – 4.30 J/cm2. Nineteen of the treated patients reported a marked regression of pruritus, 4 a slight relief and two of them did notice any change in the intensity of itching. Another four patients were exposed to the UVA radiation from 0,5 J/cm2 to 10.0 J/cm2. With exception of one female patients non-of them revealed any improvement in the intensity of pruritus the irradiation. We suppose the UVB is probably high effective on inhibition of pruritus and thus can be used as an efficient method, which extends contemporary antipruriginous treatment of patients with CHRI. However, so far it is difficult to explain its favorable effect.


TOMESA Synchronous Balneophototherapy
Novotný  F.,  Junášek  M.
PRO SANUM, a.s. Sanatorium prof. Novotného, Prague, Czech Republic

 The TOMESA treatment simulates a therapeutic sojourn to the Dead Sea. The patients bathe in Dead Sea salt solution (1%, 8%, 15% concentration) and are continuously irradiated by rays of narrowband UVB 311nm. The treatment is recommended for patients suffering from: psoriasis, atopic dermatitis, vitiligo, parapsoriasis, ichthyosis and prurigo. The treatment procedure is divided into two phases. Basic therapy is for 24 procedures, given five times a week. Maintenance therapy (which follows basic), is for 20 procedures given three, and later two times a week. Insurance companies cover the cost of the TOMESA treatment once a year. The results are proven effective – the average success in healing psoriasis is 90%; for atopic dermatitis, 87%; for vitiligo, 70% (three phases therapy); and the other diagnoses' success rate is about 85%. Side effects of the treatment, like light erythema, are minimal. Another benefit to the TOMESA treatment consists in lower UVB exposure of the patients compared to UVB-only treatments, and in longer time of remission. Finally, this treatment allows a sharp reduction of other therapy like steroid ointments.


 Our Experience with UVB 311 nm Phototherapy in Psoriasis and Parapsoriasis
Ettler K., Vaicová M., Nožičková M.
Dept. of Dermatology, Faculty of Medicine, Charles University, Hradec Králové, Czech Republic

Twenty seven psoriatics and six patients with parapsoriasis (18 males, 15 females) have been treated by narrow band UVB (311 nm) in cabine EMLY (Dixwell) during the period of 3 years. Their skin disease was lasting from six weeks till 55 years. Intensive phase (3-5 times weekly) of phototherpay was given to each patient, only 4 patients with psoriasis and 4 patients with parapsoriasis received also maintenance therapy ranging from twice in a week till once in a fortnights. Total sum of therapeutical sessions varried from 5 up to 26. A cumulative dose for clearing therapy was from 1.58 till 27.4 J/cm2 (average 16.8 J/cm2). None of the single dose was over 1.5 J/cm2.

The average PASI of psoriatics after cleraing phase of therapy decreased 45.4%. Twenty two percents of patients with psoriasis was returned to our department with an early relaps (within two months). All the patients with parapsoriasis striktly improved thought an early relaps within two months appeared in a half of patients.


 Photo- and photochemotherapy as monotherapy  or in combined treatment in CTCL
Vašků V., Semrádová V.
I. Dept. of Dermatovenereology, St Ann’s University Hospital, Brno, Czech Republic

Phototherapy is an old modality in cutaneous T-cell lymphoma (CTCL) treatment. Since 1978 PUVA has been some of the principal methods of treating mycosis fungoides and the death rate in this disease after the introduction of  PUVA significantly decreased with increasing quality of life. According to the mode of action, the principal effect of PUVA is near or in epidermis and in the superficial vascular plexus in dermis. Curative or paliative effect of PUVA in CTCL is discussed.

We report our patients in patch and plaque stage of mycosis fungoides with typical course of treatment with PUVA and combinations with immune response modifiers neither in plaque nor in tumour stage or in Sézary syndrome.


Cosmetic aspects of Photodynamic Therapy
Jirásková M.*, Štork  J.*,  Jirásek L.***, Jirsa M.**
2nd  Dept.of Dermatology*,1st  Dep. of Medicine**, 1st  Faculty of Medicine, Charles University, ČVUT FEL *** Prague, Czech Republic

  Photodynamic therapy (PDT) is used at about 15 last years for the treatment of malignant and nonmalignant diseases on the skin and in the cavities only in clinical studies. Local application meso-tetra-para-sulfonato-phenyl-porphin (TPPS4) and aminolevulinic acid (δ-ALA) with over six hours (three hours) followed by irradiation with the non-coherent light (wavelength over 600 nm) was used for treatment warts, basaliomas, m.Bowen keratoacanthoma, solar keratomas and metastases of malignant melanomas. The administration of fotosenzitizers in the tissue was controlled with UV light. Red fluorescence of affected lesions was the condition of next lighting. We saw slow disappearance of the lesions mainly without necrosis. Any of them were later covered with crusts. Large necroses were present in malignant melanoma metastases at the end of first week after application. The cosmetic effect depends on the diagnosis and the form of skin efflorescence. Good cosmetic response we can see in flat lesions, bad react nodules and fibrous lesions and efflorescence repeatedly treated previously (by cryotherapy or surgery etc.). It could be say, the photodynamic therapy is better tolerated compared to cryotherapy for smaller pains.