A novel photo-therapeutic approach to chronic skin diseases [Un nuovo approccio fototerapico alle dermatosi croniche]

308-nm excimer light has been shown to be safe and effective in the treatment of a variety of chronic skin diseases. Objectives of this study were to analyse the efficacy of MEL in vitiligo, mycosis fungoides and alopecia areata, and to examine the potential new indication of genital lichen sclerosus, prurigo nodularis, localized scleroderma and granuloma annulare. 71 patients with common and persistent skin diseases were enrolled in this study: 32 with vitiligo (generalized and acro-facial type); 11 with prurigo nodularis; 9 with mycosis fungoides (MF) stage Ia, 8 with alopecia (2 universalis and 6 areata), 5 with localized scleroderma, 5 with genital lichen sclerosus, and 3 with granuloma annulare. The 308-nm excimer monochromatic non-coherent light was used at a fluence rate of 48 mW/cm2 with a maximum irradiation area of 512 cm2 at 15 cm from the skin. Starting MED was based on a predetermined MED and subsequent doses according to clinical appearance and treatment response. An average of 12 sessions (from 6 to 18) was performed once weekly (range total dose 4-12.5 J/cm2). Clinical response was evaluated using photographs, biopsies and specific clinical score. Follow-up was 6 and 12 months in psoriasis, 12 months in mycosis fungoides and 4 months for all other conditions. We observed complete remission in all patients affected by mycosis fungoides, excellent repigmentation in one third of vitiligo patients, hair re-growth in 3 patients with alopecia areata, an overall improvement in prurigo nodularis, a partial remission in patients affected by localised scleroderma, a complete remission in most patients with genital lichen sclerosus and granuloma annulare. We therefore confirm the use of MEL as a valid choice for the treatment of vitiligo and MF and we report for the first time that MEL produces a therapeutic response in prurigo nodularis, localised scleroderma, genital lichen sclerosus and granuloma a n n u l a re. These findings re p resent an important advance in their tre a t m e n t suggesting MEL as a valid and new therapeutic option.