Photochemotherapy Health Dictionary

Photochemotherapy: From 2 Different Sources


A form of treatment in which deliberate exposure to a photosensitising drug and ultraviolet light bene?ts certain skin diseases, particularly PSORIASIS and T-cell LYMPHOMA. A psoralen is the photoactive agent which reacts with long-wave ultraviolet light (UVA), giving the acronym, PUVA therapy.
Health Source: Medical Dictionary
Author: Health Dictionary

Puva

See PHOTOCHEMOTHERAPY; PSORIASIS.... puva

Angelica Archangelica

Linn. var. himalaica (C. B. Clarke) Krishna and Badhwar

Family: Umbelliferae; Apiaceae.

Habitat: Native to Syria; now grown in Kashmir at 1,000-3,900 m.

Ayurvedic: Chandaa, Chandaam- shuka, Kathachoraa.

Action: Expectorant, carminative, digestant, cholagogue, antispas- modic, diaphoretic, diuretic, anti-inflammatory, smooth muscle relaxant, antifungal, antibacterial.

Key application: In flatulence and peptic discomforts. The root is a component in numerous gastrointestinal, cholagogue and biliary remedies in Germany. (Angelica root is an approved herb, whereas the seed and above-ground parts have been included among unapproved herbs by German Commission E.)

Chinese angelica root, Dong Quai, is equated with Angelica sinensis. It is prescribed internally for menstrual irregularity, lack of menstruation and painful menstruation.

The roots from Kashmir yield furo- coumarins, phenol compounds and flavonoids.

Xanthotoxol exhibited antihista- mintic and antinicotinic activities on guinea-pig ileum. The dry extract has been shown to have anti-inflammatory activity

The root is reported to inhibit bacterial and fungal growth.

Furocoumarins, especially psoralen and 8-methoxypsoralen, are used in the photochemotherapy of psoriasis and vitiligo. The biological activity is due to covalent linkage formed with DNA by irradiation with long- wavelength UV light.

Most of the coumarins have shown significant calcium antagonistic activity in vitro.

Angelicin, a resin, is stimulating to the lungs and skin. contraindicated in bleeding disorders, peptic ulcers and pregnancy. (Sharon M. Herr.)

Dosage: Root—1-3 g powder. (CCRAS.)... angelica archangelica

Mycosis Fungoides

An old term for a chronic eruption of the skin characterised by erythematous (see ERYTHEMA) itching plaques (raised patches on the skin resulting from the merging or enlargement of papules – see PAPULE), which, if left untreated, eventually form tumours and ulcers. The disease is now known to be a form of cancer of lymphocytes (see LYMPHOCYTE) called T-cell LYMPHOMA. It may be responsive to PHOTOCHEMOTHERAPY in its early stages and to RADIOTHERAPY when more advanced.... mycosis fungoides

Photodermatoses

Diseases of the SKIN for which sunlight is partially or wholly responsible. In su?cient dosage, short-wave ultraviolet light (UVB – see ULTRAVIOLET RAYS (UVR)) always causes ERYTHEMA. Higher doses progressively cause OEDEMA and blistering; this is acute sunburn. Graduated exposure to UVB causes pigmentation (tanning). Prolonged chronic exposure to sunlight eventually accelerates ageing of the exposed skin with LENTIGO formation and loss of COLLAGEN and elastic tissue. After decades of such exposure, epidermal DYSPLASIA and CANCER may supervene.

Drugs given orally or topically may induce phototoxic reactions of various types. Thus, TETRACYCLINES exaggerate sunburn reactions. and the diuretic FRUSEMIDE may cause blistering reactions. Psoralens induce erythema and pigmentation. AMIODARONE also induces pigmentation. (See also PHOTOCHEMOTHERAPY.)

Phytophotodermatitis is a streaky, blistering photodermatosis typically seen on the limbs of children playing in grassy meadows in summer. The phototoxic reaction is caused by psoralens in weeds.

Berlocque dermatitis is a pattern of streaky pigmentation usually seen on women’s necks, caused by a reaction to psoralens in perfumes.

Certain rare metabolic diseases may lead to photosensitisation. They include the PORPHYRIAS and PELLAGRA. Other skin diseases such as lupus erythematosus (see under LUPUS) and ROSACEA may be aggravated by light exposure. Sometimes, in the absence of any of these factors, some people spontaneously develop a sensitivity to light causing various patterns of DERMATITIS or URTICARIA. The most common pattern is ‘polymorphic light eruption’ which typically appears within a day or two of arrival at a sunny holiday destination and persists until departure. Continuously exposed areas, such as the hands and face, may be ‘hardened’ and unaffected.

Treatment Appropriate clothing and headgear, sunscreen creams and lotions are the main preventative measures.... photodermatoses

Psoralens

See PHOTOCHEMOTHERAPY; PHOTODERMATOSES.... psoralens

Psoriasis

This chronic, relapsing in?ammatory skin disease is extremely common, affecting about 2 per cent of the UK population. Frequently it is mild and trivial, affecting only the points of the elbows or knees and the scalp, but in a substantial minority of sufferers the disease is much more widespread and causes considerable discomfort and social embarrassment. Rarely, it can be universal and even life-threatening.

The predisposition to psoriasis is genetic, multiple genes being involved, but postnatal factors such as acute infection, hormonal disturbance, pregnancy and drugs can in?uence or provoke it. The sexes are equally affected and onset is most common in the second or third decade of life.

The psoriatic lesion is dull red, scaly and well de?ned. Scale is shed constantly, either in tiny pieces or as large plaques. The scalp is usually affected but the disease does not cause signi?cant hair loss. The ?ngernails may be pitted or ridged and the toenails grossly thickened. Several clinical patterns occur: in guttate psoriasis, a sudden explosion of multiple tiny lesions may follow a streptococcal throat infection, especially in children. Larger lesions are characteristic of discoid (plaque) psoriasis, the usual adult form. In the elderly the plaques may be mainly in the large body folds – ?exural psoriasis. Rarely, psoriasis may be universal (psoriatic erythroderma), or a sterile pustular eruption may supervene (pustular psoriasis).

Mucous membranes in the mouth and elsewhere are not affected. Psoriasis does not affect internal organs, but in about 1 per cent of subjects an in?ammatory joint disease (psoriatic arthritis) may be associated with the condition.

Treatment There is no absolute cure, but several agents used topically are of value including coal-tar extracts, DITHRANOL, CORTICOSTEROIDS and synthetic derivatives of vitamins A and D. Ultraviolet B phototherapy (and natural sunlight) bene?ts most but not all psoriatics. Systemic therapy, including PHOTOCHEMOTHERAPY, is reserved for severe forms of psoriasis. METHOTREXATE, CICLOSPORIN A and oral RETINOIDS are the most e?ective drugs, but they are potentially dangerous and require expert monitoring.

Patient information may be obtained through the Psoriasis Association.... psoriasis

Skin, Diseases Of

They may be local to the SKIN, or a manifestation of systemic disorders – inherited or acquired. Some major types are described below.

Others appear under their appropriate alphabetical headings: ACNE; ALBINISM; ALOPECIA; ALOPECIA AREATA; APHTHOUS ULCER; BASAL CELL CARCINOMA; BOILS (FURUNCULOSIS); BOWEN’S DISEASE; CALLOSITIES; CANDIDA; CHEILOSIS; CHEIRAPOMPHOLYX; DANDRUFF; DERMATOFIBROMA; DERMATOMYOSITIS; DERMATOPHYTES; DERMOGRAPHISM; ECTHYMA; ERYSIPELAS; ERYTHEMA; ERYTHRASMA; ERYTHRODERMA; ESCHAR; EXANTHEM; FUNGAL AND YEAST INFECTIONS; HAND, FOOT AND MOUTH DISEASE; HERPES GENITALIS; HERPES SIMPLEX; HERPES ZOSTER; IMPETIGO; INTERTRIGO; KELOID; KERATOSIS; LARVA MIGRANS; LICHEN; LUPUS; MADURA FOOT; MELANOMA; MILIARIA; MOLLUSCUM CONTAGIOSUM; MOLE; MYCOSIS FUNGOIDES; NAEVUS; ORF; PEDICULOSIS; PEMPHIGUS; PHOTOCHEMOTHERAPY; PHOTODERMATOSES; PITYRIASIS; PORPHYRIAS; PRURITUS; PSORIASIS; RINGWORM; ROSACEA; SARCOIDOSIS; SCABIES; SCLERODERMA; URTICARIA; VITILIGO; WARTS; XANTHOMATA.

Skin cancer Primary cancer is common and chronic exposure to ultraviolet light is the most important cause. BASAL CELL CARCINOMA is the most common form; squamous cell carcinoma is less common and presents as a growing, usually painless nodule which may ulcerate. Squamous cancer may spread to regional lymph glands and metastasise, unlike basal cell cancer. Occupational exposure to chemical carcinogens may cause squamous carcinoma – for example, cancer from pitch warts or the scrotal carcinoma of chimney sweeps exposed to coal dust in earlier centuries. Squamous carcinoma of the lip is associated with clay-pipe smoking.

Cancer may arise from the population of melanocytes of the skin (see MELANOCYTE; MELANOMA).

Apart from these three most frequent forms of skin cancer, various forms of cancer can arise from cells of the dermis, of which LYMPHOMA is the most important (see also MYCOSIS FUNGOIDES).

Lastly, secondary deposits from internal cancer, particularly from the breast, may metastasise to the skin.

Dermatitis and eczema These are broadly synonymous, and the terms are frequently interchangeable. Eczema is a pattern of in?ammation with many potential causes. Dermatitis is commonly used to suggest an eczema caused by external factors; it is a common pattern of in?ammation of the skin characterised by redness and swelling, vesiculation (see VESICLE), and scaling with intense itching and often exudation (weeping). Fissuring, thickening (licheni?cation – see LICHEN) and secondary bacterial infection may follow. Dermatitis can affect any part of the body. It may be genetically detemined or due to other ‘internal’ factors, such as venous HYPERTENSION in a leg, or stress. Often it is ‘external’ in origin – due to strong irritants or chemical allergens. (See also ALLERGY; ALLERGEN.) ATOPIC DERMATITIS is genetic in origin and usually begins in infancy. It may persist for years, and ASTHMA, allergic RHINITIS and conjunctivitis (see under EYE, DISORDERS OF) – ‘hay fever’ – may be associated. Atopic children tend to have multiple allergies, especially to inhaled allergens such as house-dust mite, cat and dog dander and pollens. Allergy to foods is less common but potentially more dangerous, especially if to nuts, when it can cause acute URTICARIA or even ANAPHYLAXIS. Atopic subjects are particularly prone to persistent and multiple verrucae (see WARTS) and mollusca (see MOLLUSCUM CONTAGIOSUM) and to severe HERPES SIMPLEX infections. (See also ATOPY.)

EXFOLIATE DERMATITIS (PITYRIASIS RUBRA)

Generalised exfoliation and scaling of the skin, commonly with ERYTHEMA. Drugs may cause it, or the disorder may be linked with other skin diseases such as benign dermatoses and lupus erythematosus (see under LUPUS). SUMMER POMPHOLYX is an acute vesicular eczema of the palms and soles recurring every summer. Inhaled allergens are a frequent cause. VENOUS (STASIS) DERMATITIS begins on a lower calf, often in association with PURPURA, swelling and sometimes ulceration. Chronic venous hypertension in the leg, consequent on valvular incompetence in the deep leg veins owing to previous deep vein thrombosis (see VEINS, DISEASES OF), is the usual cause. NEURODERMATITIS A pattern of well-de?ned plaques of licheni?ed eczema particularly seen on the neck, ulnar forearms or sides of the calves in subjects under emotional stress. IRRITANT CONTACT DERMATITIS Most often seen in an industrial setting (occupational dermatitis), it is due to damage by strong chemicals such as cutting oils, cement, detergents and solvents. In almost all cases the hands are most severely affected. ALLERGIC CONTACT DERMATITIS, in contrast, can affect any part of the body depending on the cause – for example, the face (cosmetics), hands (plants, occupational allergens) or soles (rubber boots). Particularly common allergens include metals (nickel and chromate), rubber addititives, and adhesives (epoxy resins).

Treatment Avoidance of irritants and contact allergens, liberal use of EMOLLIENTS, and topical application of corticosteroid creams and ointments (see CORTICOSTEROIDS) are central.... skin, diseases of

Cancer – Skin

There is strong evidence that sunlight plays a major role in the development of human skin cancers. Skin malignancy usually takes the form of Basal Cell carcinoma, squamous cell carcinoma and melanoma that may develop from pre-existing naevi.

Basal Cell Cancer. Strong sunlight on fair skins. Common on face and hands and other exposed areas. Commences as a tiny hard nodule. See – RODENT ULCER.

Squamous Cell Cancer. The role of sunlight in this type of cancer is even more positive. Other causes: photosensitisers such as pitch and PUVA photochemotherapy. Commences as a raised scaly rapidly- growing nodule.

Malignant Melanoma. Rare, but incidence rising. Four different kinds. Incidence is increased in individuals with fair or red hair who tend to burn rather than tan in the sun.

Causes may be numerous: genetic, occupational hazards or exposure to low-level radiation. Heavy freckling in youth doubles the risk. (Western Canada Melanoma study)

A study carried out by the New York’s Memorial-Sloan Kettering Cancer Centre refers to damage to the ultra violet-blocking ozone layer by supersonic jet exhaust and aerosol propellants that can also raise the malignant melanoma rate. A University of Sydney study links fluorescent lighting with the disease. Symptoms. Itching lesion increases in size and with growing discoloration. Colours may present as brown, black, red, blue, white, with a red inflammatory border. May progress to a dry crust, with bleeding.

Study. A study conducted by a team from Melbourne University, Anti-Cancer Council and St Vincent’s Hospital, Australia, describes a summer-long experiment that showed that people who used a sun-screen lotion (in this case SPF-17) cut their chances of developing the first signs of skin cancer.

Study. Patients who receive blood transfusions are more likely to develop malignant lymphomas and non- melanomatous skin cancers. (European Journal of Cancer (Nov 1993))

Eclectic physicians of the 19th century reported success from the use of American Mandrake (podophylum peltatum). Recent experience includes a 76 per cent cure rate achieved in 68 patients with carcinoma of the skin by treatment twice daily for 14 days with an ointment consisting of Podophyllum resin 20 per cent, and Linseed oil 20 per cent, in lanolin, followed by an antibiotic ointment. (Martindale 27; 1977, p. 1341) Podophyllum is an anti-mitotic and inhibits cell-division and should not be applied to normal cells.

Aloe Vera. Fresh cut leaf, or gel, to wipe over exposed surfaces.

Vitamin E oil. Applying the oil to the skin can reduce chances of acquiring skin cancer from the sun. (University of Arizona College of Medicine)

Red Clover. “I have seen a case of skin cancer healed by applying Red Clover blossoms. After straining a strong tea, the liquid was simmered until it was the consistency of tar. After several applications the skin cancer was gone, and has not returned.” (May Bethel, in “Herald of Health”, Dec. 1963)

Clivers. Equal parts juice of Clivers (from juice extractor) and glycerine. Internally and externally.

Thuja. Internal: 3-5 drops Liquid Extract, morning and evening.

Topical. “Take a small quantity powdered Slippery Elm and add Liquid Extract Thuja to make a stiff paste. Apply paste to the lesion. Cover with gauze and protective covering. When dry remove pack and follow with compresses saturated with Thuja.” (Ellingwood’s Therapeutist, Vol 10, No 6, p. 212) Echinacea and Thuja. Equal parts liquid extracts assist healthy granulation and neutralise odour.

Rue Ointment. Simmer whole fresh leaves in Vaseline.

Poke Root. An old physician laid great stress on the use of concentrated juice of green leaves. Leaves are bruised, juice extracted, and concentrated by slow evaporation until the consistency of a paste, for persistent skin cancer. Care should be taken to confine to the distressed area. (Ellingwood’s Therapeutist, Vol 8, No 7, p. 275)

Maria Treben. Horsetail poultice.

Laetrile. Some improvement claimed. 1 gram daily.

Cider vinegar. Anecdotal evidence: external use: small melanoma.

Diet. See: DIET – CANCER. Beta-carotene foods.

Treatment by skin specialist or oncologist. ... cancer – skin

Photodynamic Therapy

(PDT, photoradiation therapy, phototherapy, photochemotherapy) 1. a treatment for some types of superficial cancers. A light-sensitive agent (porfimer sodium [Photofrin] or temoporfin [Foscan]) is injected into the bloodstream and remains in cancer cells for a longer time than in normal cells. Exposure to laser radiation produces an active form of oxygen that destroys the treated cancer cells. The laser radiation can be directed through a fibreoptic bronchoscope into the airways, through a gastroscope into the oesophagus, or through a cystoscope into the bladder. PDT causes minimal damage to healthy tissue, but as it cannot pass through more than about 3 cm of tissue, it is restricted to treating tumours on or just under the skin or on the lining of internal organs. Photodynamic therapy makes the skin and eyes sensitive to light for six weeks or more after treatment. 2. a treatment for wet age-related *macular degeneration that involves the intravenous injection of a light-sensitive agent (verteporfin, Visudyne) which passes to the abnormal leaking blood vessels in the retina. The agent is activated when a cold laser light is directed at the macula, sealing the abnormal vessels and thus preventing further leakage and macular damage. The effect is to limit visual loss and stabilize vision.... photodynamic therapy



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