198 Flashcards
(174 cards)
1
Q
UVB radiation
A
290-320nm
2
Q
Most UVB radiation (290 to 320 nm) is absorbed superficially by the
A
epidermis and superficial dermis
3
Q
UVB produces many different types of DNA damage, including _ and _
A
pyrimidine dimers and 6,4-pyrimidine-pyrimidone photoproducts
4
Q
Originally considered to be a natural photoprotectant, there is now substantial evidence that ____ is a mediator of UVB-induced immunosuppression.5
A
cis-urocanic acid
5
Q
UVA radiation
A
(320 to 400 nm)
6
Q
can reach the mid- or lower dermis to a depth of 140 microns
A
UVA radiation
It is therefore more effective than UVB for skin diseases in which the cuta- neous pathology lies deeper than the superficial der- mis.
7
Q
has immunoprotec- tive properties via the generation of heme oxygenase-1, which exerts antioxidant and antiinflammatory effects while also decreasing UVB-induced damage.
A
UVA’s longer wavelength (UVA1, 340-400 nm)
8
Q
direct effects of UVB on __ and indirectly through the production of __and ___, both of which diminish the capac- ity of dendritic cells to present antigen to effector T cells leading to suppressed T-cell responses.
A
dendritic cells
interleukin (IL)-10 and prostaglandin E2
9
Q
Increased levels of__have been found after UVB, UVA1, and PUVA exposure.
A
IL-10
10
Q
UVB is an inductive stimulus for _, which is important for prostaglandin E2 production.
A
cyclooxygenase-2
11
Q
UV exposure also signifi- cantly lowers levels of immunomodulatory factors such as __ possibly reflecting a loss of Langer- hans cells
A
prostaglandin D2,
12
Q
increased following UVB expo- sure include
A
agonists of the platelet activating factor receptor,20 melanocyte-stimulating hormone, and cal- citonin gene–related peptide
13
Q
UVA1 appears to increase
A
IL-4 and thymus-regulated and activation-regulated chemo- kine messenger RNA expression,
14
Q
phototherapy causes cell death by
A
apoptosis of T cells in cutaneous lymphoid infiltrates.
15
Q
UVB, UVA1, and PUVA all interfere with keratinocyte expression of,
A
CD54
16
Q
effect on mast cells:
PUVA does and,
In contrast, chronic therapy with UVA1 results in
A
stabilize mast cell membranes as a result, limits the release of histamine
apoptosis of mast cells with a marked reduction in their concentrations
17
Q
UVA-induced gener- ation of reactive oxygen intermediates is activation of
A
matrix metalloproteinase (MMP)-1,-> degradation of collagen)
18
Q
UVA radiation increases the production of __ and __ which are stimuli for MMPs
A
IL-1 and IL-6,
19
Q
phototherapy treatment doses must be pro- gressively increased due to ___ in epidermis
A
acanthosis and thickening of the stratum corneum
20
Q
the stimulatory effects on melanogenesis__ the efficacy of phototherapy unless the doses of UVR are increased,
A
decrease
21
Q
NBUVB and PUVA mechanism in vitiligo
A
stimulation of hair follicle melanocyte proliferation and migration
Cytokines and other inflammatory mediators are thought to stimulate inactive melanocytes in the outer root sheath
22
Q
Increased expres- sion of ___ markers for stem cell activation
A
cytokeratins 15 and 19,
23
Q
generate UVR through a thin tungsten filament
A
Incandescent lamps
24
Q
inefficient light sources and have relatively short life span
A
Incandescent lamps
25
Employed in situations that require visible light such as phototesting and photodynamic therapy.
quartz halogen lamps- sealing the tungsten filament in a quartz envelope that contains a halogen
26
in arc lamps,in high pressures, the peak wavelength output __
broadens.
27
1st effective artificial UVR sources
Arc or gas discharge lamps
28
The use of __ can then further refine the output of these lamps such that only the desired wavelengths are emit- ted.
optical filters
29
The advantage of metal halide lamps
high output that allows for shorter treatment times.
30
One example of a metal halide lamp
UVA1 light source.
31
are the most commonly used sources of therapeutic UVR.
Fluorescent lamps
32
modified fluores- cent lamp that emits largely at __
311 nm
33
The most commonly employed devices that deliver BB-UVB
fluorescent lamps
34
BB-UVB and NB-UVB devices are specifically designed to limit output below
290 nm
35
wavelengths that most efficiently clear pso- riasis are
approximately around 313 nm
36
wavelengths___ are the most efficient at causing erythema and nonmelanoma skin cancer.
less than 300 nm
37
NB- UVB emit only wavelengths between
308 and 313 nm,
38
The initial starting dose of both BB-UVB and NB- UVB is determined in one of two ways
minimal erythema dose (MED) and skin phototype based
39
MED: exposing__ areas of skin on the inner aspect of the ___ to gradually increasing amounts of UV radiation
six 1-cm2
forearm or lower back
40
__ hours later, the UV-exposed areas of skin are examined and phototherapy is initiated at ___ of the smallest UV dose that results in uniform erythema over the entire area
Twenty-four
50% to 70%
41
Fitzpatrick skin phototype - Subsequent expo- sures are given __ times per week
2 to 5
42
If an erythema response has occurred, then, depending on its severity, the dose is either__ or __
reduced or the treatment is delayed
43
NBUVB UB initial dose
I
II
III
IV
V
VI
130
220
260
330
350
400
44
BBUVB UB initial dose
I
II
III
IV
V
VI
20
25
30
40
50
60
45
NB-UVB is considerably ___ in comparison to BB- UVB,
less photoadaptive
46
___ subsequent MEDs when treated with BB-UVB in comparison to NB-UVB.
higher
47
The maximum NB-UVB dose that should be administered is
2000 to 5000 mJ/cm2
48
hree forms of psoralen are used in photoche- motherapy regimens:
8-methoxypsoralen (8-MOP), 5-methoxypsoralen (5-MOP), and 4,5′,8-trimethylpsoralen.
49
8-MOP, a micronized form that is typically given at a dose of
0.6 mg/kg 120 minutes prior
50
8-MOP, dissolved form that is given at a dose of
0.4 to 0.6 mg/kg 90 minutes before
51
micronized or dissolved
which preparation is absorbed faster and yields higher and more reproduc- ible serum levels,
dissolved
52
The most common sources of radiation for PUVA therapy are UVA fluorescent lamps, which have a maximum emission at
352 nm
53
UVA radiation is usually initiated at a dose that corresponds to either ___ or ___
the skin phototype or to 50% to 70% of the minimum phototoxic dose
54
The minimum phototoxic dose is evaluated __ hours after UVA exposure and is the __ amount of UVA that produces a uniform erythema over the entire area.
72, lowest
55
Treatments are usually given__ times per week, avoiding__
2 to 4,
consecutive days.
56
UVA dose modifications are made if __ OR __
`an erythema response devel- ops or if treatments are missed
57
Delivery of psoralens in___ is popular in some areas of the world because it provides a uniform drug distribution with very low psoralen plasma levels, and results in a rapid elimination of free psoralens from the skin
bathwater
58
Delivery of psoralens in BATHWATER decreases these SIDE EFFECTS
GI side effects and possible phototoxic hazards to the eyes
59
Bath PUVA consists of __ of whole-body immersion in solutions of__per liter of body temperature bath- water
15 to 20 minutes
1 mg 8-MOP
60
Bath PUVA is started at __of the minimum phototoxic dose. Treatments are typi- cally given __ weekly.
30%
twice
61
patients are exposed to UVA irradiation ____minutes following the application of a psoralen-containing cream, .
30
62
are the most common short- term adverse effect of phototherapy
Sunburn-like reactions
63
UVB phototoxicity usually peaks at __hours and PUVA reaction manifest at ___ hour
12 to 24
24-28 or even 72
64
Severe burns over a large portion of the skin surface produce sys- temic toxicity with ___
fever and malaise in addition to pain
65
indication for admission to a burn care
epidermal sloughing
66
Burns over limited body areas can be managed by
sunscreen
67
tolerance is rapidly lost when exposures cease, requiring downward adjustments of dose after as little as
1 week
68
UVA1 phototherapy (__ nm) can penetrate deeper into the skin than ___
340 to 400
UVB or UVA2 (320-340nm_
69
UVA1 is administered___times per week. Three dosing regimens have been used: low dose___ , medium dose ___, and high dose__
3 to 5
(10 to 30 J/cm2),
(40 to 70 J/cm2)
(130 J/cm2).
70
patients are started at ___ and increased to the full dose within __ treatments.
20 to 30 J/cm2
3 to 5
71
The risk of burns in UVA1 is far (more/less) than with UVB or PUVA therapy
less
72
Targeted therapy can be used on treatment-___ lesions and in
resistant
difficult anatomic locations
73
not be practical to treat for patients with greater than__ body surface area
10% to 20%
74
Mono- chromatic light sources, which includes
excimer lasers, monochromatic UVA1 lasers, and nonlaser device
75
monochromatic excimer light devices deliver monochromatic irradiation to a larger area but with a ____
lower power density
76
A novel cream that selectively filters solar UVB may be a cheaper and more conve- nient alternative to traditional phototherapy in certain cases. This cream has been shown to improve symp- toms of chronic pruritus after __ months of treatment (_ sessions per week).
3, 3
77
PUVA therapy for which formal long- term followup studies established an increased risk of __,___ and __
lentigines, squamous cell carcinoma, and possibly melanoma,
78
Repeated exposure of the skin to UV irradiation does result in cumulative ___regardless of the source.
actinic damage
79
More than ___ BB-UVB treatments is associated with a modest, but signifi- cant, increase in __ and ___
300, squamous cell carcinoma (SCC) and basal cell carcinoma
80
single PUVA treatment is approximately __times greater than a single UVB treatment.
7
81
has emerged as a leading therapy for a number of skin diseases.
NB-UVB
82
Oral 8-MOP may cause ___ (10% of patients) and ___, which occasionally necessitates discontinuation of treatment. These side effects are more common with ___ than with crystalline preparations,
nausea, vomiting
liquid preparations
83
The nausea may be minimized or avoided by instructing the patient to take 8-MOP with ___ or to___
milk, food, or ginger, or to divide the dose into 2 portions, taken approximately 30 minutes apart.
84
unlike in 8 MOP, nausea with ___ is rare
5-MOP, nausea is rare,
85
pruritus can be alleviated by
bland emollients.
86
Any area showing erythema with tenderness or blistering should be ___ during subsequent UVA exposures until the erythema has resolved
shielded
87
erythema appearing within 24 hours may signal ___ and may worsen progressively over the next 24 hours,
a potentially severe phototoxic reaction,
protected from further UVA exposures and sunlight, and should be monitored closely until the erythema has resolved.
88
peak erythema with PUVA characteristi- cally occurs at least __ hours after the treatment.
48
89
PUVA lentigines are ___ and are histologically characterized by ___
small brown macules with irregular borders and uneven pigmentation
proliferation of large melanocytes
90
____mutations have been found to be present in PUVA lentigines
BRAF (v-raf murine sarcoma viral oncogene homolog B)
91
The absence of PUVA lentigines serves as a useful indi- cator of a
lower risk of PUVA malignancy
92
PUVA lentigines directly related to the __ and__
number of PUVA treat- ments and total UVA dose
93
The risk of nonmelanoma skin cancer and possibly malig- nant melanoma increases in a __-dependent man- ner.
dose-
94
___ is contraindicated in individu- als who have been treated with PUVA.
cyclosporine
95
____ used concurrently with PUVA, on the other hand, reduce the risk of SCC.
Oral retinoids
96
Individuals treated with PUVA are at increased risk of cutaneous malignancies of the __
genitalia
97
individuals with at least __ treatments and at least __ years from the first PUVA treatment were at increased risk of developing ___
250
15
melanoma
98
___ or ___ treatments is considered to be a relative contraindication to further PUVA therapy
personal or family history of melanoma or a history of more than 200 PUVA
99
In patients employing PUVA therapy in combination with __ for at least___months, the incidence of lymphoma was more than 7 times higher
methotrexate
36
100
___does not appear to affect plasma HIV levels nor does it have an effect on CD4 counts.
BB-UVB phototherapy
101
in HIV-positive patients, __ and __ are the recommended first-line therapeutic agents.115
photother- apy and antiretrovirals
102
preferred in children for most skin condition
NB-UVB
103
NB-UVB in a high mean cumulative dose (>118.16 J/cm2 in 36 treatments) and BB-UVB (110 to 220 mJ/cm2 in 7 to 22 treatments) can cause a proportionate decrease in
serum folic acid levels
104
in elderly, UVB-induced erythema lasts ___ and __ , also __may be decreased
longer and peaks later
photoadaptation [inititate phototx at lower dose and ↑ dose slowly
105
Patients who have had__ exposure are at increased risk for cutaneous malignancies and should avoid phototherapy.
arsenic exposure
106
There are reports of an association between chronic use of ___ and the development of aggressive cutane- ous malignancies, including melanoma.
voriconazole
107
wavelengths in the range of__ nm are most effective at clearing psoriasis have led to broad use of NB-UVB for psoriasis
313
108
____increase efficacy, particularly in patients with chronic plaque-type psoriasis
Oral retinoids, such as acitretin
109
___administered 3 weeks before starting NB-UVB can also enable quicker results in fewer phototherapy sessions.
Metho- trexate (15 mg/week)
110
___increases the MED in patients, sug- gesting that it has a photoprotective effect.
calcipotriene
111
__has an additive or synergistic effect when combined with NB-UVB.1
Tazarotene 0.1% gel
112
initiate phototherapy at 50% to 75% of the usual starting dose when___ is used w/ UVB
tazarotene
113
improve transmission of UVB By decreasing scatter from scales in the stratum corneum, -> increasing efficacy
lubricants
114
blocks UVB penetration.
topical salicylic acid
115
___ compared to cream PUVA has been found to have equivalent efficacy for palmoplantar psoriasis``
monochromatic excimer
116
At least a __ improve- ment in the Psoriasis Area and Severity Index score can be expected after 12 weeks of PUVA treatments in 60% of patient
75%
117
has been observed to be more efficacious in clearing plaque psoriasis than NB-UVB, and the duration of remission is more prolonged,
oral PUVA
118
A combination of _ and _ can reduce the duration of treatment, number of expo- sures, and total UVA dose required for clearing
PUVA and methotrexate
119
long-term methotrexate, defined as 36 or more months of use, in combination with PUVA may increase the risk of
lymphoma.
120
PUVA therapy is more efficacious when com- bined with a___ a treatment regimen that has been referred to as ___
daily oral retinoid (etretinate, acitretin, isotretinoin; 1 mg/kg),
RePUVA
121
oral retinoid is typically administered___before initiat- ing PUVA, and is continued throughout the clearing phase.
5 to 10 days
122
___ when com- bined with PUVA have been shown to reduce the risk of SCC by 30%,
Oral retinoids
123
T/F
it does not alter the incidence of basal cell carcinoma.87
T
124
___combined with oral PUVA accelerates the response to treatment
Topical tazarotene gel 0.1%
125
when ___is used with PUVA, it should not be applied within 2 hours of phototherapy.
calcipotriol
126
PHOTOSENSITIVE PSORIASIS is linked to certain __, __ and __
genetic traits, female gender and susceptibility to photosensitive disorders such as polymorphous light eruption.
127
Tx for PHOTOSENSITIVE PSORIASIS
temporarily discontinue phototherapy until the lesions resolve and to restart at a much lower NB-UVB dose. NB-UVB should be increased slowly,
128
EXCIMER is useful for atopic dermatitis involving the
hands,
129
is a highly effective, nonsteroidal, therapeutic alternative for treatment of acute exacer- bations
UVA1 phototherapy
130
____provided a greater therapeutic effect than ___for chronic atopic dermatitis.
NB-UVB
UVA1
131
___exhibit a high rate of early recurrences, which require permanent main- tenance treatment.
tumor-stage CTCL (IIB or greater)
132
Prolonged remissions in CTCL have been observed with combinations of PUVA and __
interferon-α2a or low-dose interferon-α2b.
133
may be as effective as PUVA for early stage CTCL.
NB-UVB
with bexarotene
134
NB-UVB decreases__ and __levels that are usually elevated in vitiligo and also increases FoxP3-expressing cells, restoring the balance between Th17 and regulatory T cells
IL-17 and IL-22
135
The earliest sign of response to therapy is
perifollicular repigmentation.
136
Fitzpatrick skin types IV and V, vitiliginous areas have been noted to ___than the surrounding skin.
repigment slightly darker
137
When NB-UVB is used in combination with __ the therapeutic efficacy is higher than with NB-UVB alon
topi- cal tacrolimus 0.3% ointment,
138
considered first-line therapy in localized vitiligo.
Targeted phototherapy with a 308-nm excimer laser
139
___respond better than those on the extremities
face, neck, and trunk
140
PUVA and a ___ is 3 times more effective than either treatment alone
medium-potency topical corticosteroid
141
does not cause repigmen- tation
UVA1
142
has been reported to decrease lesional skin thick- ness, improve skin elasticity, reduce sclerotic plaques, and increase passive range of motion in localized scleroderma
UVA1
143
UVA1 in scleroderma has been administered at a dose of
60 to 130 J/cm2 5 times per week,
144
The recurrence after successful UVA1 treatment was dependent on the ___
duration of morphea prior to treat- ment
145
MOA of UVA1 in. scleroderma
induction of MMP-1,263 and downregulation trans- forming growth factor-β through the SMAD (Sma- and Mad-related protein)
146
has been used to treat disabling, extensive morphea in children.
Oral PUVA
147
second-line treatment in children w/ chronic graft-versus-host disease
NB-UVB
148
Bath PUVA in combination with__ is another option for sclerodermoid graft-versus-host disease.2
isotretinoin
149
is an option for the pruritus asso- ciated with chronic renal failure. Approximately 80% to 90% of patients improve within 2 to 5 weeks
UVB phototherapy
150
t/f improves pru- ritus in exposed sites only
F-ALL site
151
is considered by some to be the most effective treatment for cholestatic pruritus
Phototherapy
152
has resulted in improvement in aquagenic pruritus
PUVA
153
have been reported to improve the pruritus associated with poly- cythemia vera.
UVA in combination with UVB, and PUVA
154
have been used safely and effectively to treat eosinophilic folliculitis in HIV- positive patients.
NB-UVB, BB-UVB, and PUVA
155
should be considered in patients who have failed first-line antihistamine regimens in chronic urticaria
NB-UVB
156
has a higher relapse rate in chronic urticaria
BB-UVB
157
are useful methods for preventing outbreaks of moderate to severe poly- morphous light eruption
NB-UVB and oral PUVA
158
, which has effects on mast cells, is not particularly effective in pre- venting solar or other forms of urticaria.
UVA1
159
disadvantage of phototx in photodermatoses is that
tolerance is lost quickly
160
has been used for recalcitrant lichen planus and is typically administered 3 times per week
NB-UVB therapy
161
lichen planus tends to be more resistant to
PUVA
162
has been reported to induce lichen planus and lichen planus pemphigoides
PUVA
163
has successfully treated erosive oral lichen planu
excimer laser
164
may be less effective in smokers with dyshidrotic eczema.
Bath PUVA
165
have been successful treatments for dyshidrotic eczema and chronic palmo- plantar eczema.
NB-UVB and local bath PUVA
166
Oral PUVA is preferable for patients with
hyperkeratotic eczema
167
and bath PUVA is more beneficial for
dyshidrotic eczema,
168
w/ response in pityriasis lichenoides et varioliformis acuta patients
NB UVB
169
has been used for patients with lympho- matoid papulosis, but relapse may occur upon cessation of therapy.
Oral PUVA
170
is effective in lym- phomatoid papulosis in children
Bath PUVA
171
is reserved for telangiectasia macularis erup- tiva perstans patients with severe diseas
Oral PUVA
172
ameliorates both the objective and subjective symptoms of urticaria pigmentosa
UVA1 phototherapy
173
resulted in complete and long-term remission of systemic mastocytosis
NB-UVB phototherapy
174
Patients with widespread granuloma annulare treated with __have had complete clearance of their disease
PUVA
