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      THE USE OF NARROW BAND ULTRAVIOLET LIGHT B IN THE PREVENTION AND TREATMENT OF POSTHERPETIC NEURALGIA (A PILOT STUDY)

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          Abstract

          Background:

          Postherpetic neuralgia (PHN) is a common complication of herpes zoster that is frequently unresponsive to most of the available treatment modalities. Broad band ultraviolet B radiation (UVB) has a well-known anti-inflammatory effect. Moreover, it decreases neural damage and cutaneous nerve density. It was found that broad band UVB might have a role in the prevention and treatment of PHN.

          Aim:

          This study was carried out to evaluate the effect ofnarrow band UVB (nbUVB) in the treatment PHN.

          Patients and Methods:

          The study included 17 patients with distressing post herpetic neuralgia. Patients were evaluated using the Verbal Rating Scale (VRS). The patients received nbUVB sessions, three times a week, for a total of 15 sessions or until the pain disappeared. Patients were followed up for a period of 3 months after the end of therapy.

          Results:

          Using intention to treat analysis, more than 50% improvement was achieved in 6 (35.29%) and 8 (47.06%) patients, at the end of therapy and after 3 months follow up, respectively. An improvement less that 50% was achieved in 11 (64.71%) and 9 (52.94%) patients, at the end of therapy and after 3 months follow up, respectively. The pain severity assessed by the VRS significantly improved both at the end of sessions ( P = 0.005) and after 3 months follow up ( P = 0.005).

          Conclusion:

          nbUVB may be of beneficial use in the treatment of PHN.

          Limitation:

          Small number of patients and limited follow-up period.

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          Most cited references20

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          Postherpetic neuralgia--pathogenesis, treatment, and prevention.

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            An overview of neuropathic pain: syndromes, symptoms, signs, and several mechanisms.

            An overview is presented of neuropathic pain syndromes, their characteristic symptoms and signs, and recent approaches to identifying their pathophysiologic mechanisms. The results of recent clinical studies of neuropathic pain are reviewed. Chronic neuropathic pain syndromes are emphasized because these long-lasting and often disabling conditions present a much greater challenge for the clinician than acute pain. Peripheral neuropathic syndromes have received greater attention in the research literature than central pain, and studies of syndromes such as postherpetic neuralgia and painful diabetic neuropathy provide the basis for current knowledge of neuropathic pain. Precise estimates of the prevalence of neuropathic pain are not available, but chronic neuropathic pain may be much more common than has generally been appreciated and its prevalence can be expected to increase in the future. There is considerable agreement that both peripheral and central processes contribute to many chronic neuropathic pain syndromes, and that these different mechanisms may explain the qualitatively different symptoms and signs that patients experience. The limitations of existing treatments for neuropathic pain and the inability to provide relief for many patients has stimulated ongoing studies that examine different approaches to preventing neuropathic pain.
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              Mechanisms of UV-induced immunosuppression.

              Ultraviolet radiation (UV), in particular the UVB range, suppresses the immune system in several ways. UVB inhibits antigen presentation, induces the release of immunosuppressive cytokines and causes apoptosis of leukocytes. UVB, however, does not cause general immunosuppression but rather inhibits immune reactions in an antigen-specific fashion. Application of contact allergens onto UV-exposed skin does not cause sensitization but induces antigen-specific tolerance since such an individual cannot be sensitized against the very same allergen later, although sensitization against other allergens is not impaired. This specific immunosuppression is mediated by antigen-specific suppressor/ regulatory T cells. UVB-induced DNA damage is a major molecular trigger of UV-mediated immunosuppression. Reduction of DNA damage mitigates UV-induced immunosuppression. Likewise interleukin-12 which exhibits the capacity to reduce DNA damage can prevent UV-induced immunosuppression and even break tolerance. Presentation of the antigen by UV-damaged Langerhans cells in the lymph nodes appears to be an essential requirement for the development of regulatory T cells. Studies addressing the molecular mechanisms underlying UV-induced immunosuppression will contribute to a better understanding how UV acts as a pathogen but on the other hand can be also used as a therapeutic tool.
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                Author and article information

                Journal
                Indian J Dermatol
                IJD
                Indian Journal of Dermatology
                Medknow Publications (India )
                0019-5154
                1998-3611
                Jan-Feb 2011
                : 56
                : 1
                : 44-47
                Affiliations
                [1] From the Department of Dermatology, Faculty of Medicine, Cairo University, Egypt.
                Author notes
                Address for correspondence: Eman El-Nabarawy, Lecturer, Department of Dermatology, Faculty of Medicine, Cairo University, 1007 Korneich El-Nile, Cairo, Egypt E-mail: e mannabarawy@ 123456gmail.com
                Article
                IJD-56-44
                10.4103/0019-5154.77551
                3088934
                21572791
                2dab1669-57c5-4f6c-b42c-ae2f32caf0ec
                Copyright: © Indian Journal of Dermatology

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : December 2009
                : July 2010
                Categories
                Dermatosurgery Round

                Dermatology
                neuropathic pain,narrow band ultraviolet b,postherpetic neuralgia
                Dermatology
                neuropathic pain, narrow band ultraviolet b, postherpetic neuralgia

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