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Superior UVA1 for Sclerotic Skin Conditions

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Superior UVA1 for Sclerotic Skin Conditions

For patients with Sclerotic skin conditions (Scleroderma) and severe dermatitis (atopic, dyshidrotic), UVA1 light therapy is an excellent treatment option. UVA1 is a longer wavelength UVA light, running from 340nm to 400nm, and its effects are quite different from UVA2 or UVB light, most notably that it is far less erythemal, and deeper penetrating.  The mechanisms of action of UVA1 in all disease indications are not completely understood, but often relate to its ability to induce production of matrix metallopeptidases (MMPs), in particular MMP12. Daavlin’s ML24000 takes UVA1 phototherapy to a new level, using a combination of high pressure lamps and special filters to produce an extremely pure UVA output, free of virtually all UVB content. This shortens treatment times and makes the use of medium and high dose protocols practical for the first time ever. A proprietary lamp and filtering system absorbs infrared output and limits spectral emission to the UVA1 range (340-400nm). High dose protocols can be delivered without the worry of UVB induced erythema as often seen in fluorescent UVA1 devices. ML24000 uses 24 high intensity lamps, arranged vertically, to deliver a 30 to 40 percent boost in-patient throughput while using half the space of conventional UVA1 units. Specially designed reflectors behind the lamps diffuse the output and enhance the uniformity of therapeutic radiation to the patient. The ML24000 is operated by the time tested Daavlin Flex Controller, which can be remotely located for ease of physician access. The unique, four-column design of the ML24000 makes efficient use of valuable floor space, taking up half the space of typical lie-down models. It also separates into modular sections for easy installation in small offices. Thanks to the unit’s size and the positioning of the lamps, treatments take significantly less time than in bed-type units, allowing for 30-40 percent higher patient through-put. It is worth noting that, with the exception of lupus, most UVA1 treatments are done with extremely large doses (medium dose at 40-60J, high dose at 90-120J). Such high doses are only possible with filtered HID or LED light sources that do not emit UVB and UVA2. Unfortunately, UVA1 fluorescent lamps have a significant contamination of UVB from mercury spectral lines, erythemally limiting doses to the medium range. Click here to learn more about the ML24000.     Posted in Uncategorized | Leave a comment

Adding Phototherapy to a Clinic? Start Here!

Daavlin recently helped sponsor a webinar for the National Psoriasis Foundation.  The webinar features Dr. Colby Evans, M.D. and Dr. Iltefat H. Hamzavi, M.D., and shares their thoughts and experiences on adding phototherapy to a dermatology clinic.

Items to consider before offering phototherapy:

  • Increase in patient volume
  • Convenient access for patients to clinic and parking
  • Space and power needs in the office for the phototherapy units
  • Staff that can handle the flow of treatments
  • Time needed to manage the process and patients
  • Goggle provision and storage
  • Dosing protocols
  • Administration and tracking of treatments and documentation of outcomes.
There are a couple of services and products that Daavlin provides that can help you manage your phototherapy practice with ease.  Daavlin’s proprietary SmartTouchTM control system features permanent patient records, built-in treatment protocols, operator tracking and monitoring systems that prevent errors in dosing. The system makes it next to impossible to administer the wrong treatment by keeping track for you of all treatments and the outcomes.  There is no need to have the patients fill out a sheet each visit.  SmartTouch will help make sure that all billing codes and information are correct for each treatment type.  SmartTouch can help you avoid many of the phototherapy pitfalls. If you are interested in learning more, including how to navigate insurance for reimbursement for in-office phototherapy units, the full webinar as presented byColby Evans, M.D. and Iltefat Hamzavi, M.D., can be accessed using the link below.  They also share their knowledge of dosing efficacy and other possible side effects of phototherapy. https://cme.psoriasis.org/content/navigating-phototherapy-demand-webinar Daavlin would be happy to answer any questions or concerns you might have about dosing and protocols for treatment. Contact Daavlin today at 1-800-322-8546 or info@Daavlin.com.       Posted in Uncategorized | Leave a comment

New Hope for Vitiligo Treatment

Daavlin Phototherapy for VitiligoVitiligo, like many skin ailments, can have a devastating effect on patients’ mental state and self-image. Many patients will withdraw from social interactions and stop going out. So, what can be done to treat patients and also help with the psychological impact. Pearl E. Grimes, M.D. director of the Vitiligo and Pigmentation Institute of Southern California and clinical professor of dermatology at The University of California Los Angeles David Geffen School of Medicine states, that when a patient comes in with vitiligo, "It's probably the longest and most detailed consultation I do. We take a very detailed history—looking at family history, time of disease onset, disease progression, associated symptoms, associated autoimmune illnesses and medications—to tease out any other causative factors that may be contributing to pigment loss. Thanks to recent genetic research, Grimes says that "We now know that probably 90% of the genes that have been identified in vitiligo are immune-susceptibility genes; 10% are pigment-related genes." This genetic predisposition can lead to "sick melanocytes," she says. "Melanocytes from people with vitiligo do not grow as well in culture. There are probably some inherent defects in these melanocytes that may tie back to the genetics of the disease." Patients who present with more than 10% to 15% coverage often will need phototherapy, which helps with both stabilizing the disease and repigmentation, phototherapy treatments will need to continue for 6 to 12 months, and can continue on if patient has a positive response. Phototherapy is safe and easy to perform, she says. Although complications can include erythema, "We are not seeing any skin cancers—melanoma or nonmelanoma. Vitiligo is probably protective for melanoma." Phototherapy stimulates melanoblasts in the outer root sheaths of hair follicles to migrate to areas that need repigmentation, Dr. Grimes says. "But it's also immunosuppressive in that it decreases the inflammatory immune response. It also has the ability to upregulate growth factors for melanocytes, such as alpha-melanocyte-stimulating hormone (α- MSH), basic fibroblast growth factor, endothelin* and others. And it decreases production of pro-inflammatory cytokines. It creates a more favorable environment for repigmentation." Home phototherapy is ideal for patients who can't get to the office two or three times weekly, she says. "That's the situation for many adults," especially if they have children with vitiligo and otherwise busy lives. Dr. Grimes' practice possesses 15 years' experience with home-based Narrowband UVB phototherapy, which in one study proved superior to clinic excimer laser treatment. "Home phototherapy is safe and extremely well-tolerated. We've had very few complications. But you must teach patients how to use the unit. The key value is that they are more consistent" with treatment than they would be if they had to go to the office. "I'm not going to say it's better than what we can achieve in the office. But there's enough efficacy to suggest that it's clearly value added for someone who can't come into the office regularly." If you want to discuss which treatment is right for your patients, clinical or home phototherapy, Daavlin is happy to help find the option that fits best. Contact Daavlin today at 1-800-322-8546 or info@Daavlin.com to find out more about phototherapy treatment options for vitiligo patients. Daavlin will also help deal with your patients’ insurance company from start to finish.         Jesitus, John, New thoughts, therapies for vitiligo. Dermatology Times. August 4, 2016. Boissy RE, Liu YY, Medrano EE, Nordlund JJ. Structural aberration of the rough endoplasmic reticulum and melanosome compartmentalization in long-term cultures of melanocytes from vitiligo patients. J Invest Dermatol. 1991;97(3):395-404. Tien Guan ST, Theng C, Chang A. Randomized, parallel group trial comparing home-based phototherapy with institution-based 308 excimer lamp for the treatment of focal vitiligo vulgaris. J Am Acad Dermatol. 2015;72(4):733-5.     Posted in Uncategorized | Leave a comment

Coming Soon… To a City Near You!

20160304_094055 One of the most important things we can do as a company to promote awareness and education about treatments for psoriasis and other photoresponsive diseases is to travel to areas where thought leaders and innovators in our field are gathering.  We make every effort to attend as many tradeshows and educational programs as possible. Here is a list where you can view Daavlin’s products and/or interface with our representatives first hand:
  • Dermatology Foundation - Naples, FL
    • January 18-21, 2017
  • Association of Dermatology Administrators and Managers - Orlando, FL
    • February 27-28, 2017
  • Dermatology Nurses Association - Orlando, FL
    • March 1-2, 2017
  • 26th Annual Meeting of the Photomedicine Society - Orlando, FL
    • March 2, 2017
  • American Academy of Dermatology (Winter) - Orlando, FL
    • March 3-5, 2017
  • Dermatology Nurses Association Phototherapy Workshop - Orlando, FL
    • March 4, 2017
  • Atlantic Dermatology Conference - Toronto, ONT Canada
    • May 5-7, 2017
  • National Academy of Dermatology Nurse Practitioners - W. Palm Beach, FL
    • May 10-12, 2017
  • Society of Dermatology Physician Assistants - San Diego, CA
    • June 1-4, 2017
  • American Academy of Dermatology (Summer) - New York, NY
    • July 28-29, 2017
  • American College of Allergy, Asthma & Immunology - Boston, MA
    • October 26-30, 2017
  • Society of Dermatology Physician Assistants - San Juan, Puerto Rico
    • November 8-11, 2017
  We enjoy meeting our clients face-to-face whenever possible, but if none of these venues work for you, we do offer telephone in-service, WebEx or on-site training and education as well.  Contact us for more information at info@daavlin.com.     Posted in Uncategorized | Leave a comment

Phototherapy Dosing in Vitiligo Patients

shutterstock_352871207Of all the conditions treated by narrowband UVB phototherapy, vitiligo presents the most confusing choices in protocol selection. Traditionally, many U.S. vitiligo patients have been started at conservative doses with small incremental dose increases, since a significant number of patients do not tolerate as much UVB as the general population of phototherapy patients undergoing treatment for other issues (psoriasis, atopic dermatitis, pruritus, etc). A review article published a few months ago in Photodermatology, Photoimmunology & Photomedicine[1] gives analysis of numerous previously published studies as well as survey results. (This is an excellent article and is well worth the time to read in its entirety.) The article analyzed previously published studies where starting narrowband UVB doses ranged from 75mJ to 700mj, with most falling between 250mJ and 280mJ, and a minority using minimal erythemal dose (MED) based starting doses. The majority of protocols used percentage based increases of 10-30%, with several of the low starting dose protocols also using very conservative 25mJ-50mJ increases. The article also had some nice additional discussion of two closely related issues: MED of depigmented lesions, and what effect skin type has on photoadaptation curves. With respect to MED of lesions, in the past it was common to hear justifications of low starting doses for vitiligo patients based on the theory that a depigmented lesion is inherently Fitzpatrick Skin Type I.  The article points out, however that the MED of a vitiligo lesion is actually only 25-35% less than unaffected skin, justifying more aggressive protocols.  In addition, although less common than a fixed increment or percentage, some protocols have included significantly different increases by skin type, which is likely unnecessary due to relatively similar rates of photoadaptation among skin types. Overall, it seems reasonable that the conservative protocols are a response to the subset of vitiligo patients that are slow photoadaptors, which, possibly due to patient demographics, are less of an issue for those using more aggressive protocols.  Additionally, the newer, more aggressive protocols tend to have a “safety valve” where patients not adapting rapidly are given reduced doses, with the goal of slight, transient erythema. It appears that, over time, more aggressive protocols are becoming more prevalent.     [1]   Madigan, et al. Exploring the gaps in the evidence-based application of narrowband UVB for the treatment of vitiligo. Photodermatol Photoimmunol Photomed 2016; 32: 66–80       Posted in Uncategorized | Leave a comment

Treating Hyperhidrosis Can Prevent Anxiety

Hyperhidrosis (HH), excessive sweating beyond what is typical (based on the environment or what the body physiologically requires), afflicts an estimated 2.8% of Americans. It can affect localized parts of the body, such as hands, feet and underarms, or the entire body. Either way, those suffering from HH struggle daily to keep the condition from impacting their livelihoods and relationships. However, for approximately 25% of those suffering from hyperhidrosis, the impact goes deeper than embarrassment or a nuisance – the disease causes anxiety and depression. According to a recent article published in the Journal of the American Academy of Dermatology*, anxiety and depression were reported in 21.3% and 27.2% of patients, respectively, with HH compared to 7.5% and 9.7% in patients, respectively, without HH. According to the National Institute of Mental Health, depressive episodes can also be amplified in late fall and early winter with Seasonal Affective Disorder (SAD), a type of depression displaying a recurring seasonal pattern. Patients can find relief from HH, and thus avoid episodes of anxiety and depression, with Daavlin’s Aquex, a “tap water iontophoresis” (TWI) system. TWI treatment consists of introducing the treatment area (hands or feet, for example) to water which has a mild and safe electrical current for short periods of time. Treatments only take about 15 minutes, and a reduction of symptoms will begin after just a few uses. Although many treatment methods are available for HH, TWI is widely considered to be one of the most effective, safest, and cost-effective treatment options available. It has been used to effectively manage hyperhidrosis for over 40 years. It is a superior option for long-term patient satisfaction, safety and treatment sustainability at a fraction of the cost of other options. TWI is drug-free, safe and proven and has an effectiveness of 98% for hyperhidrosis sufferers. There is only a moderate initial cost for the device with very little maintenance. Ongoing costs are minimal. Contact Daavlin today at 1-800-322-8546 to find out more about Aquex.     *Rayeheh Bahar, MD, et al. The prevalence of anxiety and depression in patients with or without hyperhidrosis (HH), Journal of the American Academy of Dermatology, Oct. 2016.     Posted in Uncategorized | Leave a comment

The Facts: Narrowband UVB for Psoriasis

PsoriasisDealing with chronically itchy, red and scaly skin can be a way of life for psoriasis sufferers.  Epidemiological studies assert that as many as 4.6% of the population worldwide suffers from some degree of psoriasis; approximately 20% of those have moderate-to-severe disease. Topical medications have long been considered the standard treatment for psoriasis, but those with moderate-to-severe disease -- defined as a body surface area (BSA) of >5% or a Psoriasis Area Severity Index (PSAI) >7-12 – often do not respond to traditional biologic treatment. Narrowband UVB phototherapy, defined as wavelengths between 311 and 313 nm, is a preferred treatment for patients who suffer from extensive moderate-to-severe plaque psoriasis due to its ease, effectiveness and low incidence of side effects. An important consideration prior to initiating phototherapy treatment is the patient’s commitment to the therapy. Accepted guidelines recommend a total of 15-30 treatments, which will require 2-4 office visits per week for several weeks. The American Academy of Dermatology (AAD) and other dermatological groups provide dosing guidelines that are based on the patient’s minimal erythema dose (MED) or skin type. Treatment is only effective when administered regularly and accurately. Patients who require long-term treatment and are committed to the light therapy regimen may benefit from home light therapy units that they can use at their convenience. Narrowband UVB is a preferred treatment for guttate or plaque psoriasis among pregnant and nursing patients. Patients may see an increase in melasma, but no teratogenic effects are reported. Some practitioners recommend a folic acid supplement during phototherapy treatments. There are very few contraindications to Narrowband UVB therapy. Side effects are generally mild, but can include erythema, itching, burning, dryness, blistering, discoloration and stinging. Reactivation of herpes simplex virus infection may occur. Long-term effects may include risk of photocarcinogenesis as well as actinic damage, photoaging and dermatoheliosis features such as wrinkling, lentigines and telangiectasia. Patients should always wear eye protection during phototherapy to prevent risk of UVB-related cataracts, and male patients should wear a genital shield to protect against genital tumors. If you have a question that you would like answered regarding Narrowband UVB or Daavlin, please email info@daavlin.com or call 1-800-322-8546.   1     Vassantachart, et al. Comparison of Phototherapy Guidelines for Psoriasis: A Critical Appraisal and Comprehensive Review. J Drugs in Dermatology. 2016 Aug; 15(8): 995–1000. Posted in Uncategorized | Leave a comment

Increasing Patient Adherence to Phototherapy

It is well known that phoTalk to your patient about phototherapytotherapy is a safe, effective and cost conscience option for treating many dermatologic diseases, but what issues affect patient adherence to the treatment? Some factors that negatively affect adherence to phototherapy treatment include insurance coverage, copays and distance to travel to a clinic. According to a recent study in the Journal of American Academy of Dermatology*, the primary reason for early non-adherence was attending phototherapy sessions in a clinic.  And of the early non-adherent patients 67.3% of them did not attend any phototherapy sessions. The analysis reveals that distance from the clinic where the phototherapy treatment is given is associated with this non-adherence. The findings in this study point out that one way to help increase adherence to phototherapy treatment is to consider adding phototherapy centers in surrounding areas. Another option is prescribing home phototherapy for your patients who live outside of a 5-mile radius of your clinic or treatment centers. Patient adherence to home phototherapy appears to also be positively influenced by follow up visits shortly after the patient begins home treatment. In addition to saving your patients a trip to the office you can also save them on their co-pays. Daavlin will also help deal with your patients’ insurance company from start to finish with the home phototherapy reimbursement program. Contact us today to find out more. Call Daavlin at 1-800-322-8546       *Qing Yu Weng, BS, Elizabeth Buzney, MD, Cara Joyce, PhD, Arash Mostaghimi, MD, MPA, MPH, Distance of travel to phototherapy is associated with early nonadherence: A retrospective cohort study. Journal of American Academy of Dermatology. June 2016 Vo 74, Issue 6. Pages 1256 – 1259. Posted in Uncategorized | Leave a comment

Does a Maximum Phototherapy Dose Exist?

shutterstock_53347117One of the most common questions in phototherapy is what maximum dose should patients be exposed to.  Over the course of phototherapy treatments, patients photoadapt, which can be thought of as a form of tachyphylaxis where due to a variety of mechanisms (thickening of the stratum cornea, DNA repair enzyme upregulation, pigmentation), increasing doses are needed. Generally, Daavlin's answer to this question has been that a fixed maximum dose per Fitzpatrick skin type isn't particularly useful, as a huge range of maximum tolerable doses are seen within each skin type. An interesting way to look at maximum dose is to consider what multiple of a patient’s minimal erythemal dose (MED) occurs over treatment.  In other words the final dose a patient can tolerate without erythema after a course of therapy, divided by the initial MED would be the patients adaptation factor (AF) A recent study published in the British Journal of Dermatology[1] attempts to address this question, and found that narrowband UVB AF after 20 treatments to range from 1.1 to 6.0, with the mean AF at 2.7.  The extreme AFs were found in Fitzpatrick Skin Type III patients.  Interestingly, although the initial MED per skin type varied greatly, there was no correlation between skin type and overall AF. Another interesting result of this research is to note that broadband UVB adaptation factors have been reported to be much higher, even to the point of 17.5 in one study.[2]  Given Broadband UVB lamps much higher UVA content compared to Narrowband UVB lamps, it seem reasonable to suggest that some of this difference is related to increased pigmentation induction in Broadband UVB phototherapy. Practically speaking, one could generally take this information to design protocols, but they would only be of value when starting from an accurate MED test, which in turn supports the position that a universal fixed maximum dose is generally unworkable when starting from a Fitzpatrick skin type derived starting dose.     [1]  Darne, et al. Investigation of cutaneous photoadaptation to narrowband ultraviolet B.Br J Dermatol. 2014 Feb;170(2):392-7. doi: 10.1111/bjd.12662. [2]  Taylor CR, Stern RS. Magnitude and duration of UV-B induced tolerance.Arch Dermatol1991;127:673 Posted in Uncategorized | Leave a comment

Holistic Help for Psoriasis

shutterstock_64519015Wouldn’t it be great if there were a food that would stop or even reverse psoriasis… like an edible flower found deep in the Amazon or some strange little exotic that takes away all the symptoms? We think so too, but, unfortunately, there isn’t one. While there is no evidence that says any particular food can prevent or cure psoriasis, there are many reports that suggest certain foods can help alleviate psoriatic symptoms. Many of these foods are already a part of existing smart diet plans. If you share holistic approaches you’re your patients, we recommend that you suggest four key foods that may help keep their next flare-up in check.   Pumpkin Seeds Tell your patients not to throw out those pumpkin seeds when they’re carving jack o’lanterns! The primary nutritional element found in pumpkin seeds is vitamin E. In addition to being a premier antioxidant, vitamin E offers a wide range of benefits to the skin.   Foods rich in Omega-3 Fatty Acids Oils found in fish are thought to reduce inflammation and strengthen the immune system. Omega-3 fats are the “good fats” that help reduce risk of heart attack and stroke. Tuna, salmon, mackerel and even sardines are great sources of natural Omega-3 fatty acids.  Psoriasis is an inflammatory condition, so including these foods in the diet may help.   High Fiber Fruits and Veggies Mom always said to eat your veggies at supper, and she was absolutely right.  Many studies show that fruits and vegetables that are high in fiber have inflammation-fighting properties. Carrots, squash, yams, spinach, kale and even broccoli are on the good list for helping with psoriasis. What common fruits or veggies are on the bad list? Tomatoes, potatoes and peppers. Because tomatoes are part of the nightshade family, they can severely aggravate skin conditions. While there is no direct scientific evidence to support this, it is a great idea to cut back on such foods if psoriasis symptoms worsen.   Whole Grain Breads, Cereals and Pasta That’s right, spaghetti can be good for you! Whole grain flour contains many of the same anti-inflammation antioxidants found in fruits and vegetables. Whole grains help regulate blood sugar and inflammation levels. Legumes such as beans and lentils also fall into this category. Just make sure your patients lay off the homemade tomato sauce when they boil up a pot.   So, what is one of the worst things that a person with psoriasis can consume?  Despite what you may hear about a glass of wine a day, alcohol can be one of the worst things to drink when psoriasis is in full swing. Not only can alcohol increase inflammation in the body, it can also directly interfere with certain psoriasis-treating drugs like methotrexate. It is best to just stay clear of alcohol altogether.         Posted in Uncategorized | Leave a comment ← Older posts