Light-Based Procedures in Pediatric Dermatology

Therapy

Blue light

Green light

Turquoise light

Therapy protocol

Protective eyewear

Daily until safe bilirubin levels are established

Table 27.1

First line

Neonatal hyperbilirubinemia

Light-Emitting Diode (LED)

LED is considered a single-color light therapy. The distinctive feature of LED is that it is a broad-spectrum continuous wave of visible light. Blue light is within the spectral range of 407–425 nm (peak 420 nm) and red light 550–700 nm (660 nm). Blue or red light phototherapy can also be considered as second-line acne treatment in pregnant or lactating females [3].

Therapy

Blue-light (B) [4]

Red-light

Blue-red light (A) [5]

Therapy protocol

Twice daily × 4 weeks

Table 27.2

Second line

Acne, mild to moderate inflammatory

B [4]

Intense Pulsed Light (IPL)

IPL uses broad spectrum, pulse-delivered polychromatic light. Considerations for the use of IPL in the pediatric population include pain, edema, erythema, crusting and blistering.

Therapy

IPL

IPL + PDT (photodynamic therapy) [6]

Therapy protocol

Not established (typically three sessions with 3- to 4-week intervals in between)

Table 27.3

Third line

Acne, non-inflammatory and inflammatory

Photodynamic Therapy (PDT)

PDT utilizes a photosensitizing agent, commonly 5-aminolevulinic acid (ALA), to increase the effect of an ensuing light- (or laser-) based therapy [7]. Considerations for the use of PDT in the pediatric population include pain, burning, swelling, redness, transient hyperpigmentation, and superficial exfoliation. PDT can be considered as an alternative treatment of extensive viral warts in immunosuppressed individuals.

Therapy ALA–PDT

ALA+ Red-light (B)

ALA + Blue-light (C)

ALA + IPL (C) [8]

Therapy protocol

20 % ALA moisturizing cream

0.5 % ALA liposomal spray

Short (15–30 min) or longer (3 h) incubation time

Table 27.4

Third line

Acne, moderate to severe inflammatory	B [6, 9]
Hidradenitis suppurativa	C [10]
Viral warts, recalcitrant	A [11–14]
Facial flat warts	C [15, 16]

Phototherapy

Phototherapy is utilized to treat a variety of photodermatoses, including photoresponsive inflammatory and autoimmune conditions.

UVA Phototherapy

UVA utilizes ultraviolet light in the 320–400 nm wavelength (UVA₁ 340–400 nm). This long-wave ultraviolet light is often combined with the oral drug psoralen (PUVA). Considerations for the use of PUVA in the pediatric population include the ability of the child to comply with safety procedure and to hold still in a closed booth, ingesting a systemic psoralen and tolerating any associated nausea, and the cumulative risk for the potential development of skin cancer.

Therapy

UVA

UVA₁ (B) [17]

UVA + psoralen (PUVA)

Therapy protocol

Requires strict 24 h of protective eyewear

Once to twice weekly treatment sessions; at least 48–72 h apart

Psoralens can be delivered topically, given as a bath, or orally

Psoralen is taken 45–60 min prior to UVA exposure

Table 27.5

First line

Morphea (generalized)	[18–21]
GVHD	D [22]
Granuloma annulare (generalized)	E

Table 27.6

Second line

Psoriasis	A [23]
Morphea	B
Atopic dermatitis	B [24]
Pityriasis lichenoides	C [25–27]
Alopecia areata	B [28, 29]
Solar urticaria	E [30, 31]
Mastocytosis	E [32, 33]
Vitiligo	B [34–36]
CTCL/Mycosis fungoides	B [37–39]

UVB Phototherapy

UVB is ultraviolet light that falls in the 280–320 nm wavelength spectrum of light. UVB has been found to be an effective, safe, well-tolerated, and practical alternative treatment modality in the pediatric population, and has surpassed PUVA as the phototherapy of choice in some immune mediated skin diseases.

Therapy

UVA/UVB

Broadband UVB (bUVB)

Excimer laser (308 nm)

Narrowband UVB (311–312 nm)

Therapy protocol

Two to three times weekly protocol

Table 27.7

Second line

Atopic dermatitis	B [40, 41]
Psoriasis	A [23, 42]
Vitiligo	A [43]
Pityriasis lichenoides	B [44]
Morphea	E [45]
Alopecia areata	D [46]
Mycosis fungoides	B [47]
Pruritus (generalized)	B [48]
Nodular prurigo	D [49]
Hydroa vacciniforme	E [50, 51]
Granuloma annulare	E [52, 53]
Lichen planus	B [54]
Pityriasis rosea	B [55]

Photopatch Testing

Photopatch testing is used to further investigate patients with a history of photosensitivity. Ultraviolet radiation is employed while undergoing patch testing with various allergens. Before undergoing photopatch testing, it is prudent to rule out the possibility of the patient having another endogenous photosensitivity, such as polymorphous light eruption (PLE).

Therapy

UVA

Therapy protocol

Back is exposed to UV light following patch take down on day 2 (after 24–48 h)

Table 27.8

First line

Photoallergic contact dermatitis	[56]
Photoallergic drug eruption	[56]

Extracorporeal Photochemotherapy

Extracorporeal photopheresis (ECP) is used mainly to treat autoimmune diseases by removing abnormal cells from the bloodstream via lymphocyte activation and cell death. The blood is first separated and treated with a photosensitizing agent, and then irradiated with UV light. Following this photodynamic therapy, the blood is then returned to the patient.

Therapy

8-MOP + UVA

Therapy protocol

4 h per day on two consecutive days, each month

Table 27.9

First line

Mycosis fungoides (erythrodermic) Sezary’s syndrome

Table 27.10

Second line

SLE	C [57]
Lichen planus (erosive)	D [58]
Chronic GVHD	E [59]
CTCL Only gold members can continue reading. Log In or Register to continue Share this: Click to share on Twitter (Opens in new window) Click to share on Facebook (Opens in new window) Related Related posts: Disorders of the Sebaceous and Sweat Gland Vascular Disorders and Anomalies Genodermatoses and Basement Membrane Zone Diseases Cutaneous Manifestations of Systemic Disease Infectious Diseases: Bacterial Infections Viral Diseases and Exanthems of the Skin Stay updated, free articles. Join our Telegram channel Tags: Therapy in Pediatric Dermatology Jul 13, 2017 \| Posted by admin in Dermatology \| Comments Off on Light-Based Procedures in Pediatric Dermatology Full access? Get Clinical Tree Get Clinical Tree app for offline access Get Clinical Tree app for offline access