A study of histopathological changes seen in chronic plaque psoriasis, before and after treatment with narrow band Ultraviolet B
Keywords:
Histopathology, narrow band ultraviolet B, PASI score, psoriasis
Abstract
Backgorund: Psoriasis is amultipfactorial chronic inflammatory skin disease characterized by infiltration of T cells and hyperproliferation of keratinocytes in focal skin areas. Narrow band ultraviolet B utilizes the narrow band ultraviolet B(UVB) light frequencies peaking around 311-313nm. Very few histopathological tudies have been done, especially on Asian skins which are predominently that of Fitzpatric type III-V to assess the effectiveness of narrow band ultraviolet B for psoriasis.Method: Severity of psoriasis was graded clinically using psoriasis ara severity index(PASI) score and the success rate and effective rate of UVB therapy were calculated. two skin punch biopsies were taken from each patient. Each patient was given a histopathological score. The difference between pre and post treament histopathological score was calculated. The changes in histopathological parameters among the responders were compared with that of nonresponders.Result: Success rate of UVB therapy in our study was 91.52%. The mean(+/-SD) PASI score before and after treatment were 9.25+/-0.44 and 1.81+/-1.93 respectively.These differences in the scores were statistically significant(p<0.001).Conclusions: A significant difference was observed between the responders and nonresponders in mean change in PASI score and histopathological scores. Percentage of parkeratosis, thickness of granular layer and mitotic figures per mm of surface can be used as markers of progressions to remission following therapy.References
1. Hiong HLT, Shih-Wee LK. Narrow band ultra violet B for psoriasis: A preliminary report of a prospective study performed at national skin centre. Bulletin for medical practitioners. 2002; 13(2). National Skin Centre.htm (5.1.2002)
2. Dogra S, Kanwar AJ. Narrow band UVB phototherapy in dermatology Indian Journal of Dermatology, Venereology, Leprology, 2004;70:205-209.
3. Bedi TR. Clinical profile of psoriasis in North India. Indian J Dermatol Venereol Leprol 1995;61:202-5
4. Kaur I, Handa S, Kumar B. Natural history of psoriasis: a study from the Indian subcontinent. J Dermatol. 1997; 24:230-4.
5. Bedi TR. Clinical profile of psoriasis in North India. Indian J Dermatol Venereol Leprol 1995;61:202-5.
6. Farber EM., Bright RD, Nall ML. Psoriasis: A Questionnaire Survey of 2,144 Patients.1968; 98:248 -259.
7. Domyati M E, Barakat M, Abdel-Razek R, Expression of Apoptosis Regulating Proteins, P53 and Bcl-2 in Psoriasis. J Egypt wom Dermatol Soc, 2006; 3:46-50.
8. Bos JD. The pathomechanisms of psoriasis; the skin immune system and cyclosporine. British journal of dermatology, 1988; 18: 141-155.
9. Yuehua Y, Khalaf A T, Xiaoxiang Z, Xinggang W. Narrow-band ultraviolet B and Conventional UVB phototherapy in Psoriasis: A Randomised Controlled Trial. American Journal of Applied Sciences 2008; 5 (8): 905-908.
10. Velazquez EF, Murphy GF. Histology of the Skin. In:Elder D E, Murphy G. F, Elenitsas R, Johnson B.L, Xiaowei Xu editors. Lever’s Histopathology of the Skin: Tenth edition, Philadelphia: Lippincott Williams & Wilkins, 2008; pp: 8- 69.
11. Mckee P.H, Colonje E, Granter S, R. Pathology of the skin with clinical correlations. China: Elsevier Mosby, An imprint of Elsevier Limited, 3rd edition. Volume 1, 2005; pp:195-205.
12. Trozak D.J. Histologic grading system for psoriasis vulgaris. International Journal of Dermatology. 1994; 33:380-381.
13. Fry L, McMinn M.H. N. Observations on mitosis in psoriatic epidermis. British Journal of Dermatology. 1970; 82:19-22
14. Griffin TD, Lattanand A, Van Scott E. Clinical and histological heterogeneity of psoriatic plaques: therapeutic relevance. Arch Dermatol 1988; 124:216-220.
15. Markham T, Rogers S, Collins P. Narrowband UV-B (TL-01) Phototherapy vs Oral 8-Methoxypsoralen Psoralen–UV-A for the Treatment of Chronic Plaque Psoriasis. Arch Dermatol. 2003; 139:325-328.
16. Green C, Lakshmipathy T, Johnson B, E, Ferguson J. A comparison of the efficacy and relapse rates of narrow band UVB (TL01) monotherapy vs. etretinate (re- TL-01) vs. etretinate –PUVA (re-PUVA) in the treatment of psoriasis. 1992; 127:5-9.
17. Tanew A, Radakovic-Fijan S, Schemper M, Honigsmann H. Narrow band UVB phototherapy vs. photochemotherapy in treatment of chronic plaque psoriasis. Archives of dermatology. 1999; 135: 519-524.
18. Coven T R. Burack LH, Gilleaudeau R, Keogh M, Ozawa M, Krueger JG. Narrow band UV-B produces superior clinical and histopathological resolution of moderate to severe psoriasis in patients compared with the broad band UV-B. Archives of Dermatology 1997; 133 (12): 1514 – 22.
19. Picot E, Meuinier L, Picot MC – Debeze, Peyron JL, Meynadier. Treatment of psoriasis with a 311 –nm UVB lamp. British journal dermatology1992; 127:509-512.
20. Gordon M, Johnson WC. Histopathology and histochemistry of psoriasis. Archives of dermatology 1967; 95:402-407.
21. Soltani K, Van Scott E.J. Patterns and sequences of tissue changes in incipient and evolving lesions of psoriasis. Arch Dermatol.1972; 106: 484 – 490.
22. Walters IB, Ozawa M, Cardinale I, Trepicchio, Kruger JG. Narrowband UVB (312-nm) suppresses Interferon Gamma and Interleukin 12 and increases Interleukin 4 transcripts. Archives of dermatology.2003; 139:155-161.
23. Cox AJ, Watson W. Histological variations in lesions of psoriasis. Arch Dermatol. 1972; 106:503- 506.
2. Dogra S, Kanwar AJ. Narrow band UVB phototherapy in dermatology Indian Journal of Dermatology, Venereology, Leprology, 2004;70:205-209.
3. Bedi TR. Clinical profile of psoriasis in North India. Indian J Dermatol Venereol Leprol 1995;61:202-5
4. Kaur I, Handa S, Kumar B. Natural history of psoriasis: a study from the Indian subcontinent. J Dermatol. 1997; 24:230-4.
5. Bedi TR. Clinical profile of psoriasis in North India. Indian J Dermatol Venereol Leprol 1995;61:202-5.
6. Farber EM., Bright RD, Nall ML. Psoriasis: A Questionnaire Survey of 2,144 Patients.1968; 98:248 -259.
7. Domyati M E, Barakat M, Abdel-Razek R, Expression of Apoptosis Regulating Proteins, P53 and Bcl-2 in Psoriasis. J Egypt wom Dermatol Soc, 2006; 3:46-50.
8. Bos JD. The pathomechanisms of psoriasis; the skin immune system and cyclosporine. British journal of dermatology, 1988; 18: 141-155.
9. Yuehua Y, Khalaf A T, Xiaoxiang Z, Xinggang W. Narrow-band ultraviolet B and Conventional UVB phototherapy in Psoriasis: A Randomised Controlled Trial. American Journal of Applied Sciences 2008; 5 (8): 905-908.
10. Velazquez EF, Murphy GF. Histology of the Skin. In:Elder D E, Murphy G. F, Elenitsas R, Johnson B.L, Xiaowei Xu editors. Lever’s Histopathology of the Skin: Tenth edition, Philadelphia: Lippincott Williams & Wilkins, 2008; pp: 8- 69.
11. Mckee P.H, Colonje E, Granter S, R. Pathology of the skin with clinical correlations. China: Elsevier Mosby, An imprint of Elsevier Limited, 3rd edition. Volume 1, 2005; pp:195-205.
12. Trozak D.J. Histologic grading system for psoriasis vulgaris. International Journal of Dermatology. 1994; 33:380-381.
13. Fry L, McMinn M.H. N. Observations on mitosis in psoriatic epidermis. British Journal of Dermatology. 1970; 82:19-22
14. Griffin TD, Lattanand A, Van Scott E. Clinical and histological heterogeneity of psoriatic plaques: therapeutic relevance. Arch Dermatol 1988; 124:216-220.
15. Markham T, Rogers S, Collins P. Narrowband UV-B (TL-01) Phototherapy vs Oral 8-Methoxypsoralen Psoralen–UV-A for the Treatment of Chronic Plaque Psoriasis. Arch Dermatol. 2003; 139:325-328.
16. Green C, Lakshmipathy T, Johnson B, E, Ferguson J. A comparison of the efficacy and relapse rates of narrow band UVB (TL01) monotherapy vs. etretinate (re- TL-01) vs. etretinate –PUVA (re-PUVA) in the treatment of psoriasis. 1992; 127:5-9.
17. Tanew A, Radakovic-Fijan S, Schemper M, Honigsmann H. Narrow band UVB phototherapy vs. photochemotherapy in treatment of chronic plaque psoriasis. Archives of dermatology. 1999; 135: 519-524.
18. Coven T R. Burack LH, Gilleaudeau R, Keogh M, Ozawa M, Krueger JG. Narrow band UV-B produces superior clinical and histopathological resolution of moderate to severe psoriasis in patients compared with the broad band UV-B. Archives of Dermatology 1997; 133 (12): 1514 – 22.
19. Picot E, Meuinier L, Picot MC – Debeze, Peyron JL, Meynadier. Treatment of psoriasis with a 311 –nm UVB lamp. British journal dermatology1992; 127:509-512.
20. Gordon M, Johnson WC. Histopathology and histochemistry of psoriasis. Archives of dermatology 1967; 95:402-407.
21. Soltani K, Van Scott E.J. Patterns and sequences of tissue changes in incipient and evolving lesions of psoriasis. Arch Dermatol.1972; 106: 484 – 490.
22. Walters IB, Ozawa M, Cardinale I, Trepicchio, Kruger JG. Narrowband UVB (312-nm) suppresses Interferon Gamma and Interleukin 12 and increases Interleukin 4 transcripts. Archives of dermatology.2003; 139:155-161.
23. Cox AJ, Watson W. Histological variations in lesions of psoriasis. Arch Dermatol. 1972; 106:503- 506.
Published
2016-12-12
Section
Original Article
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