Phototherapy of This Presentation



Diffey B.L. 'Ultraviolet phototherapy of skin diseases'. Physics and Engineering in Medicine in the New Millennium, IPEM 2000, 65-67.



Is This Scenario Changing Now?


Phototherapy Developements



Or is all this an old dog with new tricks?



Conventional Phototherapy



Conventional Phototherapy-disadvantages



Targeted Phototherapy


Delivery of UV/laser light through handheld devices focused at specific areas. The definition includes laser, UV and Monochromatic ( intense pulse) light

Targeted Phototherapy-advantages



Targeted Phototherapy-modalities



Excimer laser



Initial Studies


J Am Acad Dermatol May 2002, part 1 • Volume 46 Treatment of vitiligo with the 308-nm excimer laser: A pilot study James M. Spencer, Robert Nossa,Jyotendra Ajmeri



After 5 Treatments


After 12 Sessions


Thirteen patches of vitiligo from 5 patients had previously received and failed to respond to PUVA therapy Eight of these 13 patches showed at least some response

J Am Acad Dermatol May 2002, part 1 • Volume 46 Treatment of vitiligo with the 308-nm excimer laser: A pilot study James M. Spencer, Robert Nossa,Jyotendra Ajmeri



Int J Dermatol. 2003 Aug;42(8):658-62.   308-nm excimer laser for the treatment of localized vitiligo.


Taneja A, Trehan M, Taylor CR.



Arch Dermatol. 2000;136:619-624 308-nm Excimer Laser for the Treatment of Psoriasis A Dose-Response Study Pravit Asawanonda, R. Rox Anderson et al



Lasers Surg Med. 2002;31(3):202-6. Follow-up survey of 308-nm laser treatment of psoriasis. Rodewald EJ, Housman TS, Mellen BG, Feldman SR.



Lasers Surg Med. 2003;33(3):158-60.  Treatment of oral lichen planus with the 308-nm UVB excimer laser--early preliminary results in eight patients. Kollner K, Wimmershoff M, Landthaler M, Hohenleutner U.



James Ferguson, MD, FRCP Journal Watch Dermatology January 14, 2003



Has TPT technology lived up to it promise?


Exhimer laser


Treatment of vitiligo by 308-nm excimer laser: an evaluation of variables affecting treatment response Lasers Surg Med. 2004;35(2):152-6

Tacrolimus with exhimer



Arch Dermatol. 2004 Sep;140(9):1065-9. Topical tacrolimus and the 308-nm excimer laser: a synergistic combination for the treatment of vitiligo Passeron T et al

Comparison of the 308-nm excimer laser and a 308-nm excimer lamp with 311-nm narrowband ultraviolet B in the treatment of psoriasis Kollner KBr J Dermatol. 2005 Apr;152(4):750-4.



Treatment of vitiligo using the 308-nm excimer laser. Hadi S et al


Photomed Laser Surg. 2006 Jun;24(3):354-7

Treatment of Vitiligo with 308-nm xenon-chloride excimer laser: therapeutic efficacy of different initial doses according to treatment areas. J Dermatol. 2004 Apr;31(4):284-92 Choi KH,



Expereince with exhimer laser in 34 pts


Rivort J J Drugs Dermatol. 2006 Jun;5(6):550-4

Is exhimer laser worth the cost?


  • Advantages
  • Localized delivery
  • Quicker results??marginal?
  • Disadvantages
  • High cost
  • Maintanance problems
  • Not effective in acral vitiligo

I am constrained to state that exhimer has not lived up to its Expectations-the only advantage seems to be avoidance of Carcinogenity with some benefits in no of sessions

Other advances-monochromatic excimerlight (IPL) machines


  • Excilite( 304 nm), Pxlite( 308 nm)
  • Use monochromatic light (intense pulse light)
  • LARGE TREATMENT SURFACE:
  • 36*14 cm

Monochromatic excimer light 308 nm in the treatment of vitiligo: a pilot study. Leone G, Iacovelli P, Paro Vidolin A, Picardo M.J Eur Acad Dermatol Venereol. 2003 Sep;17(5):531-7



308 nm Monochromatic light in vitiligo



Light based targeted phototherapy



UV- TPT vs excimer laser


  • Excimer laser
  • Very quick delivery
  • 308nm
  • Easy to administer
  • Very bulky( over 100 kgs)
  • Difficult to handle
  • Frequent breakdowns
  • Very expensive>130000 $
  • High Maintanance cost(XeCl2 gas)
  • TPT
  • Quick
  • 304-318 nm(SUP)
  • Easy
  • Small desktop machines
  • Easy to handle
  • No breakdowns
  • Less expensive(25,000-50,000 $)
  • Maintanance free

Dualight





TPT-Daavlin






B Clear and Relume from Lumenis





TPT( Bclear) in psoriasis-C.Derreicks(AAD presentation)





Saalman CUP Device




Feature Dualight B clear Saalman
Av.UVB range: 304 318 nm SUP RANGE PEAK311 NM
Delivery system liquid guided Fibre optic waterguided
UVApeak at 360 nm None 360 nm
Spot size 3.63 sq cm 2.56 sq cm 1 sqcm
Automatic calibration Yes Yes no
Rapid delivery 100mj in o.7sec ??? 100MJ IN 5 SECS
Wt size 8 kgs cm17*42*29 15 kgs Cm 38*43*51 9.3 kg kgs CM 26*30*12







Bioskin- Narrow-Band UV-B Micro-Phototherapy: A New Treatment for Vitiligo- Menchini G, Tsoureli-Nikita E, Hercogova J Eur Acad Dermatol Venereol. 2003;17:171-177



TPT-our limited Experience


  • 45 patients


Our experiencewith Sallman machine



Vitiligo



Difficult lesions can be Treated



Our Experience



Vitiligo-3 exposures

Vitiligo-3 exposures

Vitiligo after 12

Vitiligo

Psoriasis-5 Exposures

Strech marks-3 exposures



Summary: Role of TPT

Gives an option; great add on to your practice; creates a niche

Indications-TPT