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morphology of the lesions and results of phototesting&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In many subjects PLE is mild&#44; and can usually be prevented by the use of broad-spectrum topical sunscreens and a gradual increase in sunlight exposure&#46; However&#44; in some individuals&#44; sunlight exposure results in florid PLE and they often benefit from prophylactic desensitization treatment using phototherapy in early spring&#44; an artificial method that induces a &#8220;hardening&#8221; phenomenon&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;7&#44;8</span></a> The mechanism of action of phototherapy in the desensitization process is not fully understood but it seems to be the result of hyperpigmentation&#44; epidermal hyperplasia&#44; thickening of stratum corneum&#44; immunosuppression&#44; an increase in the number of regulatory T cells&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> and a gradual exposure to the main trigger of PLE&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#8211;12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Previous studies have demonstrated that the use of narrow band ultraviolet B phototherapy &#40;NB-UVB&#44; TL-01&#44; 311<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>nm bandwidth&#41; is as effective as psoralen plus ultraviolet &#40;UV&#41; A &#40;PUVA&#41; photochemotherapy in the induction of skin tolerance to sunlight in PLE subjects&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;13&#8211;15</span></a> In some centres desensitization with narrowband UVB &#40;NB-UVB&#41; has gradually replaced PUVA&#44; becoming the treatment of choice&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;10&#44;15</span></a> Advantages of UVB include absence of psoralen and its associated gastrointestinal upset&#44; avoidance of wearing photoprotective glasses in the post-treatment period&#44; the ability to be used in children and pregnancy&#44; and the supposed lower carcinogenic potential of UVB irradiation&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;15&#44;16</span></a> Nevertheless treatment regimens vary greatly between centres&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> and a standardized therapy has still not been implemented&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In this study we describe a short desensitization protocol based on a four-week treatment with narrow band UVB &#40;NB-UVB&#44; TL-01&#44; 311<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>nm bandwidth&#41; that may guide other physicians intending to use these forms of therapy&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Subjects</span><p id="par0025" class="elsevierStylePara elsevierViewall">Inclusion criteria were consecutive subjects 18 years or older diagnosed of PLE between 2014 and 2015 which reported benefit with natural hardening and who accepted the 2 days per week regime during one month period&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The diagnosis of PLE had been previously established by clinical history&#44; phototesting and laboratory tests &#40;including antinuclear antibodies &#40;ANAs&#41; and porphyrins to rule out lupus erythematous &#40;LE&#41;&#44; erythropoietic protoporphyria &#40;EPP&#41; and other sun induced skin diseases&#41;&#46; None of the subjects were taking photosensitizing drugs at the time of diagnosis&#46; All subjects presented frequent episodes of PLE and had not benefited from the use of broad-spectrum sunscreens&#44; oral beta-carotene or antihistaminic drugs&#46; Sex&#44; age&#44; clinical presentation&#44; time since the onset of the disease&#44; serum antinuclear antibodies and vitamin D levels&#44; and the result of phototest were registered in our database&#46; The result of the phototest was classified between normal or pathologic&#44; defined as a decreased Minimal Erythema Dose &#40;MED&#41; to UVB or an abnormal UVA reaction&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Study design</span><p id="par0035" class="elsevierStylePara elsevierViewall">This is a retrospective&#44; open planned and non-randomized study to assess the efficacy of UVB phototherapy in prevention of polymorphic light eruption&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Phototest</span><p id="par0040" class="elsevierStylePara elsevierViewall">Phototesting was performed using a template on uninvolved skin on the patient&#39;s back&#44; and subsequent exposure to different doses of UVA and UVB &#40;Waldmann<span class="elsevierStyleSup">&#174;</span> UVA 700L and UV 801 BL&#41;&#46; Each patient was evaluated 24<span class="elsevierStyleHsp" style=""></span>h later for the development of erythema&#46; The minimal erythema dose &#40;MED&#41; was defined as the lowest dose of UVB&#44; or UVA&#44; that produced perceptible erythema&#44; covering the entire irradiated area&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> Photoprovocation was not performed&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Desensitization treatment</span><p id="par0045" class="elsevierStylePara elsevierViewall">Desensitization treatment courses were offered to each subject once a year in spring in 2014 and in 2015&#46; All subjects were whole body irradiated with Waldmann<span class="elsevierStyleSup">&#174;</span> UV 7001K light stand calibrated annually&#46; The standard treatment protocol for narrowband UVB &#40;TL-01&#41; is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The starting dose was 0&#46;15<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#46; This was followed by a 20&#37; incremental dosage&#44; twice a week&#44; during four weeks&#46; The total number of sessions was eight and the final dose achieved was 0&#46;53<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#46; Each course of treatment was carefully documented including the total number of treatment sessions administered and the frequency of PLE flares&#46; If PLE was provoked&#44; oral corticosteroids were administered without discontinuation of the treatment&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Subjects were told to keep exposing themselves to sunlight through over the summer after the desensitization protocol&#46; As the photo-protective effects of desensitization treatments are temporary with a complete loss of the hardening phenomenon once subjects are no longer exposed to sunlight or the intensity of sunlight decreases &#40;e&#46;g&#46; winter&#41;&#59; we considered each treatment course as an independent one&#44; and did not perform a separate analysis of first and second course&#46; Treatment courses in different years were considered not cumulative and were analyzed separately&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Follow up</span><p id="par0055" class="elsevierStylePara elsevierViewall">Subjects were followed up both after the end of the desensitization treatment and at the beginning of autumn&#46; Each subject&#39;s response to treatment during the subsequent months was tabulated and analyzed&#46; Subjects were asked whether they have had flares during the summer&#44; considering complete responders those who reported from 0 to 1 flare and partial responders those who reported 2 flares&#46; Subjects who had more than 2 flares were considered non-responders&#46; Taking extra treatment during the summer such as oral beta-carotene or antihistaminic drugs was also registered&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Statistical analyses</span><p id="par0060" class="elsevierStylePara elsevierViewall">Statistical analyses were performed with SPSS &#40;version 20&#46;0&#59; SPSS Inc&#46;&#44; Chicago&#44; IL&#41;&#46; Descriptive analysis of the sample was performed&#44; including percentages for categorical variables&#44; and mean&#44; minimum&#44; maximum and standard deviation values for continuous variables&#46; Comparisons of continuous variable means were performed using Student&#39;s exact <span class="elsevierStyleItalic">t</span>-test when variables followed a normal distribution&#46; Comparisons of discrete variable means were performed using the Mann&#8211;Whitney non-parametric test&#46; Comparisons between category variables were performed with tests and Fisher corrections were performed when required&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Subjects</span><p id="par0065" class="elsevierStylePara elsevierViewall">Between 2014 and 2015&#44; 16 subjects with the diagnosis of polymorphic light eruption &#40;PLE&#41; were seen at our Photobiology Unit fulfilled the inclusion criteria for desensitization and agreed to complete the treatment protocol&#46; Desensitization treatment with narrow band UVB &#40;NBUVB&#41; was offered to 15 subjects&#46; The remaining one was not finally included because of personal history of melanoma&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Regarding sex distribution&#44; there were 4 men &#40;26&#46;7&#37;&#41; and 11 women &#40;73&#46;3&#37;&#41;&#46; The mean age was 42&#46;4 years &#40;range 16&#8211;62&#41;&#46; All of them had decreased serum levels of 25-hydroxyvitamin-D3 &#40;&#60;25<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#41; in blood tests&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Sixty-six per cent of subjects were found to be ANA positive&#44; but only 3 of them had levels &#62;1&#58;160&#46; However&#44; none of them met the diagnostic criteria for lupus erythematous &#40;LE&#41; of the American College of Rheumatology&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The mean duration of PLE at presentation was 6&#46;13 years &#40;range&#44; 1&#8211;15 years&#41;&#46; There were no differences between the duration of the disease and the age and sex of the subjects &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Phototesting revealed that the minimal erythema dose for UVB was decreased in 64&#46;8&#37; of subjects tested while the remaining 35&#46;7&#37; fell within normal limits&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> The result of phototesting did not show differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; between age and sex of subjects&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Treatment courses</span><p id="par0090" class="elsevierStylePara elsevierViewall">Nine subjects were treated both in 2014 and in 2015 and 6 started phototherapy in 2015&#46; Therefore&#44; a total of 24 desensitization treatment courses were performed between 2014 and 2015&#46; All treatment courses were administered in spring&#58; 8&#46;3&#37; started in March&#44; 50&#37; in April&#44; 33&#46;3&#37; in May and 8&#46;3&#37; in June&#46; All subjects completed their desensitization courses&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Polymorphous light eruption &#40;PLE&#41; was provoked in 8 treatment courses &#40;33&#46;3&#37;&#41;&#46; All of the induced PLE were mild&#44; and only 3 of them &#40;12&#46;5&#37;&#41; required the administration of 20<span class="elsevierStyleHsp" style=""></span>mg of oral prednisone in decreasing doses during 10 days&#46; The induced flares resolved in all subjects&#44; and the interruption of the desensitization treatment course was not required in any case&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Response&#47;Follow up</span><p id="par0100" class="elsevierStylePara elsevierViewall">The evaluation of response was performed both after finishing the desensitization treatment and at the beginning of autumn&#46; The effect of hardening was sustained during the follow up after 21 desensitization treatment courses&#44; as subjects reported a complete remission of symptoms during all the sunny Spanish summer&#46; The remaining 3 desensitization treatment courses were ineffective and subjects continued having disease outbreaks&#46; The nine subjects&#44; who received 2 desensitization treatment courses&#44; were complete responders both in 2014 and 2015&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">There was no association between the maintained response to the desensitization treatment and demographic characteristics of the subjects&#46; No association was found either between response and serum levels of 25-hydroxyvitamin-D3&#44; positive antinuclear antibodies &#40;ANAs&#41; in laboratory tests or the result of previous subjects&#8217; phototest &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Female sex and low vitamin D levels were associated with a better response although this could not be considered statistically significant due to the high percentage of female subjects and the suboptimal vitamin D levels in all the cases&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">We found a statistically significant association &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; between the years of progression of the polymorphous light eruption &#40;PLE&#41; at presentation and the complete remission of symptoms after the desensitization treatment &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; The mean time from when the PLE began was 5&#46;9 years &#40;std&#46; deviation 4&#46;318&#41; in the 87&#46;5&#37; of subjects that presented a sustained response during the summer&#44; while the mean time was 8 years &#40;std&#46; deviation 6&#46;245&#41; in those who did not respond&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">With respect to the year&#39;s period of treatment&#44; there were no differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; between the sustained response to the desensitization and the month in which photo hardening was performed&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Nearly half of the cases &#40;45&#46;8&#37;&#41; spent the summer without need for any other treatment&#46; In 11 treatment courses &#40;45&#46;8&#37;&#41; subjects attempted to strengthen the response with oral beta-carotene&#44; and only in 2 cases &#40;8&#46;4&#37;&#41; antihistaminic drugs were taken&#46; However&#44; there were no differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; between the maintained response to photohardening and the use of extra treatments after the desensitization course&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">In accordance with what has been reported in the literature&#44; in our study PLE was predominantly affecting females&#46; The mean age of onset was 42&#46;4 years&#44; slightly higher than previously described&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;20&#44;21</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Consistent with what Gruber-Wackernagel et al&#46; defined&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> our PLE subjects had low 25&#40;OH&#41; vitamin D serum levels&#44; probably related to the avoidance of sun exposure&#46; It has been reported that 311<span class="elsevierStyleHsp" style=""></span>nm UVB phototherapy increases those levels&#44; and that boosting levels of vitamin D may be important in ameliorating PLE&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">22&#44;23</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">None of the ANA-positive subjects had or developed systemic lupus erythematous during follow-up&#46; Previous studies have shown elevated levels of antinuclear antibodies &#40;ANA&#41; in subjects with polymorphic light eruption&#59; however&#44; PLE is a benign disease without tendency to progress to LE&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">24&#44;25</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">In regard to phototest results in PLE subjects&#44; data are diverse in the literature&#46; Phototesting is useful to determine the responsible ultraviolet action spectrum and to exclude differential diagnoses like photosensitive eczema&#44; lupus erythematous or chronic actinic dermatitis&#46; It is reported that the majority of subjects with PLE have results that fell within normal limits when it refers to UVA and UVB MED determination&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;6&#44;18&#44;21&#44;23&#44;26&#8211;28</span></a> However&#44; in our series 64&#46;8&#37; of the subjects had decreased UVB MED&#44; a higher percentage compared to what has been previously described&#46; In accordance with our results&#44; phototest and photoprovocation showed no significant relationship with clinical disease severity and response in other series&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">When discussing a desensitization course in a PLE patient&#44; it is important to highlight that each patient will respond differently&#44; and treatment is almost always individualized&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> However&#44; we are of the opinion that a standard treatment course should be implemented&#44; in order to facilitate the management of PLE subjects&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Despite its widespread use&#44; treatment regimes vary greatly between health clinics&#44; and in most centres&#44; narrowband UVB has gradually replaced broadband UVB and PUVA and is now considered the treatment of choice&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In this paper we report our experience in PLE subjects being treated with our standard protocol&#44; based on narrowband UVB &#40;TL-01&#41; phototherapy&#44; starting with 0&#46;15<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span> followed by a 20&#37; incremental dosage&#44; until 0&#46;53<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span> achieving a total number of 8 sessions administered twice a week&#44; during four weeks&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The effect of hardening was sustained in the vast majority of our subjects&#44; obtaining a good benefit with no PLE episodes during all the summer&#46; With these results&#44; we demonstrate that this standard protocol is effective&#44; and produces a successful outcome for the majority of PLE subjects&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Moreover&#44; we found a direct association between the time from the onset of PLE and the response to the desensitization treatment&#44; being better responders those who had a short lasting disease&#46; Therefore&#44; it seems that treatment should be administrated as soon as the broad-spectrum topical sunscreens and the gradual increase in sunlight exposure fail to control the PLE symptoms in order to achieve better results&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Although PLE may be provoked during desensitization and subjects must be forewarned&#44; it should not prevent them from continuing treatment&#44; as acute flares can be treated with oral corticosteroids&#44; and it is not predictive for poor outcome&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Contrary to what was believed&#44;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18&#44;29&#44;30</span></a> we found no significant results regarding the maintained response to photohardening and the use of beta-carotene or oral antihistaminic after the desensitization course&#46; Nearly half of our subjects could spend the whole summer free of symptoms without any extra treatment&#44; which implies an increase in their quality of life&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">The protocol that we propose is shorter than those currently applied&#44; being favourable both for the patient and the physician&#46; Thereby&#44; treatment adherence will probably increase and the cost of the treatment might be reduced&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Treatment needs to be repeated yearly in early spring&#44; as the photoprotective effects of phototherapy are temporary&#46; There appears to be no loss of benefit with subsequent courses&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Limitations</span><p id="par0190" class="elsevierStylePara elsevierViewall">Important limitations of studies like this include the small numbers of subjects due to the low prevalence of the disease&#44; and a study design that is not double-blinded and placebo controlled&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflict of interest</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Ethical disclosures</span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Protection of human and animal subjects</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Confidentiality of data</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work centre on the publication of patient data&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Right to privacy and informed consent</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span></span>"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-11-21"
    "fechaAceptado" => "2017-04-14"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec888220"
          "palabras" => array:5 [
            0 => "Polymorphic light eruption"
            1 => "Narrow-band UVB"
            2 => "NBUVB"
            3 => "Desensitization"
            4 => "Hardening"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec888221"
          "palabras" => array:5 [
            0 => "Erupci&#243;n polimorfa lum&#237;nica"
            1 => "UVB de banda estrecha"
            2 => "NBUVB"
            3 => "Desensibilizaci&#243;n"
            4 => "Hardening"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Polymorphic light eruption &#40;PLE&#41; is a common idiopathic photodermatosis that typically presents with pruritic papular or papulovesicular lesions on sun-exposed skin between spring and autumn&#46; In many subjects PLE is mild&#44; and can usually be prevented by the use of broad-spectrum topical sunscreens and a gradual increase in sunlight exposure&#46; However&#44; in some individuals&#44; sunlight exposure results in florid PLE and they often benefit from prophylactic desensitization treatment using phototherapy in early spring&#44; an artificial method that induces a &#8220;hardening&#8221; phenomenon&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Objective</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">To describe and evaluate the efficacy of a short desensitization protocol&#44; based on a one-month-treatment&#44; administered twice a week with narrow band UVB in subjects with severe polymorphic light eruption &#40;PLE&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Methods</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A retrospective&#44; open planned and non-randomized study to assess the efficacy of UVB phototherapy in prevention of polymorphic light eruption&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Fifteen subjects diagnosed with severe PLE were treated with the standard protocol in our Photobiology Unit between 2014 and 2015&#46; The effect of hardening was sustained during follow up in 87&#46;5&#37; of desensitization treatments&#46; A statistically significant association &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; between the years of duration of the PLE and the response to treatment was found&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusions</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The effect of hardening was maintained in the vast majority of subjects&#44; obtaining a good benefit with no PLE episodes during all the summer&#46; We demonstrate that our standard protocol is effective&#44; and produces a successful outcome for the majority of PLE subjects&#46; Our protocol is shorter than those currently applied&#44; being favourable both for the patient and the physician&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Objective"
          ]
          2 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Methods"
          ]
          3 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Results"
          ]
          4 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introducci&#243;n</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La erupci&#243;n polimorfa lum&#237;nica &#40;EPL&#41; es una fotodermatosis idiop&#225;tica que se presenta t&#237;picamente en forma de lesiones papulares o p&#225;pulo-vesiculosas pruriginosas en &#225;reas fotoexpuestas&#44; t&#237;picamente entre primavera y oto&#241;o&#46; En la mayor&#237;a de pacientes la EPL es leve&#44; y se previene mediante el uso de fotoprotectores y una exposici&#243;n gradual a la luz solar&#46; En algunos casos la EPL es muy florida&#44; y requiere una desensibilizaci&#243;n profil&#225;ctica en primavera&#44; que induce fen&#243;meno de <span class="elsevierStyleItalic">hardening</span>&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Objetivo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Describir y evaluar la eficacia de un protocolo de desensibilizaci&#243;n que se basa en la administraci&#243;n de UVB de banda estrecha&#44; 2 veces a la semana&#44; durante un mes&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se trataron un total de 15 sujetos con el protocolo de desensibilizaci&#243;n entre los a&#241;os 2014 y 2015&#46; Se realizaron un total de 24 tratamientos&#46; El efecto <span class="elsevierStyleItalic">hardening</span> se mantuvo en el 87&#44;5&#37; de los casos tratados&#46; Se encontr&#243; una asociaci&#243;n estad&#237;sticamente significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; entre los a&#241;os de progresi&#243;n de la enfermedad y la respuesta al tratamiento&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Los efectos del <span class="elsevierStyleItalic">hardening</span> se mantuvieron en la mayor&#237;a de los sujetos&#44; los cuales presentaron un buen control de la EPL y ausencia de brotes durante el verano&#46; Se demuestra la efectividad del protocolo de desensibilizaci&#243;n en los sujetos con EPL&#44; el cual tiene una duraci&#243;n m&#225;s corta que los previamente descritos en la literatura&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Objetivo"
          ]
          2 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
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      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "mostrarDisplay" => false
        "detalles" => array:1 [
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            "identificador" => "at1"
            "detalle" => "Table "
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        "tabla" => array:1 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Session of treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dose NBUVB &#40;J&#47;cm<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Increase &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1527658.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Standard treatment protocol for NBUVB &#40;311<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>nm&#41;&#46; The starting dose was 0&#46;15<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span> followed by a 20&#37; incremental dosage&#46; The total number of courses of treatment was eight and the final dose was 0&#46;53<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#46; The treatment was administered twice a week&#44; during four weeks&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Pearson Chi square&#46; Fisher&#39;s exact test was performed when required&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Discrete variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Response</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Statistical significance &#40;<span class="elsevierStyleItalic">p</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Comments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Sex &#40;N 24&#41;</span></td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">The majority are female thus this result is clinically insignificant</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;62&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;8&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Vitamin D &#40;N 18&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sufficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Insufficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;87&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;12&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;405&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">ANAs &#40;N 18&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60; 1&#47;160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;55&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;16&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62; 1&#47;160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;27&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;410&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Phototest &#40;N 23&#41;</span></td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;34&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pathological&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;52&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Other treatments &#40;N 24&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>None&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">The antihistamines were taken after having a flare&#44; therefore result is clinically insignificant</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Beta-carotene&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;8&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Month of treatment &#40;N 24&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>March&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;8&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>April&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;41&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;842&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                          "autores" => array:3 [
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                            0 => "A&#46;L&#46; Naleway"
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                          "etal" => false
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                      "doi" => "10.1016/S0190-9622(00)90126-9"
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                      "titulo" => "Polymorphous light eruption-like skin lesions in welders caused by ultraviolet C light"
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                            0 => "I&#46;M&#46; Majoie"
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                            2 => "I&#46;M&#46; Sybesma"
                            3 => "P&#46;J&#46; Coenraads"
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                      "titulo" => "Polychromatic phototest as a prognostic tool for polymorphic light eruption"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46; Leroy"
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                            3 => "M&#46; Michel"
                            4 => "L&#46; Verneuil"
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                      "titulo" => "A comparison of narrow band phototherapy &#40;TL-01&#41; and photochemotherapy &#40;PUVA&#41; in the management of polymorphic light eruption"
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                        0 => array:2 [
                          "etal" => false
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                            2 => "N&#46;K&#46; Gibbs"
                            3 => "T&#46; Aitchison"
                            4 => "B&#46;E&#46; Johnson"
                            5 => "J&#46; Ferguson"
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                    0 => array:1 [
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                        "tituloSerie" => "Br J Dermatol"
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                0 => array:3 [
                  "comentario" => "pp25187f"
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                      "titulo" => "Phototherapeutic hardening modulates systemic cytokine levels in patients with polymorphic light eruption"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Wolf"
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Original Article
Successful short desensitization treatment protocol with narrowband UVB phototherapy (TL-01) in polymorphic light eruption
Protocolo de desensibilización corto y eficaz con NB-UVB (TL-01) en la Erupción Polimorfo Lumínica”
A. Combalia
Autor para correspondencia
andreacombalia@gmail.com

Corresponding author.
, C. Fernández-Sartorio, X. Fustà, D. Morgado-Carrasco, S. Podlipnik, P. Aguilera
Dermatology Department, Hospital Clínic de Barcelona, Barcelona, Spain
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    "titulo" => "Successful short desensitization treatment protocol with narrowband UVB phototherapy &#40;TL-01&#41; in polymorphic light eruption"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Polymorphic light eruption &#40;PLE&#41; is a common idiopathic photodermatosis that typically presents with pruritic papular or papulovesicular lesions on sun-exposed skin between spring and autumn&#46; The prevalence is higher in females &#40;ratio 2&#58;1&#41; and usually onsets in the first 3 decades of life&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#8211;4</span></a> The cause of PLE is not yet well understood&#46; It is thought to be due to an imbalance between the immunosuppressive and stimulative effects of UV radiation in favour of the latter&#44; that could give rise to delayed-type hypersensitivity reaction to photoinduced endogenous neoallergens&#46; Some cases of PLE caused by UVC have been recently described&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> Diagnosis of PLE is based on patient history&#44; morphology of the lesions and results of phototesting&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In many subjects PLE is mild&#44; and can usually be prevented by the use of broad-spectrum topical sunscreens and a gradual increase in sunlight exposure&#46; However&#44; in some individuals&#44; sunlight exposure results in florid PLE and they often benefit from prophylactic desensitization treatment using phototherapy in early spring&#44; an artificial method that induces a &#8220;hardening&#8221; phenomenon&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;7&#44;8</span></a> The mechanism of action of phototherapy in the desensitization process is not fully understood but it seems to be the result of hyperpigmentation&#44; epidermal hyperplasia&#44; thickening of stratum corneum&#44; immunosuppression&#44; an increase in the number of regulatory T cells&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> and a gradual exposure to the main trigger of PLE&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#8211;12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Previous studies have demonstrated that the use of narrow band ultraviolet B phototherapy &#40;NB-UVB&#44; TL-01&#44; 311<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>nm bandwidth&#41; is as effective as psoralen plus ultraviolet &#40;UV&#41; A &#40;PUVA&#41; photochemotherapy in the induction of skin tolerance to sunlight in PLE subjects&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;13&#8211;15</span></a> In some centres desensitization with narrowband UVB &#40;NB-UVB&#41; has gradually replaced PUVA&#44; becoming the treatment of choice&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;10&#44;15</span></a> Advantages of UVB include absence of psoralen and its associated gastrointestinal upset&#44; avoidance of wearing photoprotective glasses in the post-treatment period&#44; the ability to be used in children and pregnancy&#44; and the supposed lower carcinogenic potential of UVB irradiation&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;15&#44;16</span></a> Nevertheless treatment regimens vary greatly between centres&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> and a standardized therapy has still not been implemented&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In this study we describe a short desensitization protocol based on a four-week treatment with narrow band UVB &#40;NB-UVB&#44; TL-01&#44; 311<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>nm bandwidth&#41; that may guide other physicians intending to use these forms of therapy&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Subjects</span><p id="par0025" class="elsevierStylePara elsevierViewall">Inclusion criteria were consecutive subjects 18 years or older diagnosed of PLE between 2014 and 2015 which reported benefit with natural hardening and who accepted the 2 days per week regime during one month period&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The diagnosis of PLE had been previously established by clinical history&#44; phototesting and laboratory tests &#40;including antinuclear antibodies &#40;ANAs&#41; and porphyrins to rule out lupus erythematous &#40;LE&#41;&#44; erythropoietic protoporphyria &#40;EPP&#41; and other sun induced skin diseases&#41;&#46; None of the subjects were taking photosensitizing drugs at the time of diagnosis&#46; All subjects presented frequent episodes of PLE and had not benefited from the use of broad-spectrum sunscreens&#44; oral beta-carotene or antihistaminic drugs&#46; Sex&#44; age&#44; clinical presentation&#44; time since the onset of the disease&#44; serum antinuclear antibodies and vitamin D levels&#44; and the result of phototest were registered in our database&#46; The result of the phototest was classified between normal or pathologic&#44; defined as a decreased Minimal Erythema Dose &#40;MED&#41; to UVB or an abnormal UVA reaction&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Study design</span><p id="par0035" class="elsevierStylePara elsevierViewall">This is a retrospective&#44; open planned and non-randomized study to assess the efficacy of UVB phototherapy in prevention of polymorphic light eruption&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Phototest</span><p id="par0040" class="elsevierStylePara elsevierViewall">Phototesting was performed using a template on uninvolved skin on the patient&#39;s back&#44; and subsequent exposure to different doses of UVA and UVB &#40;Waldmann<span class="elsevierStyleSup">&#174;</span> UVA 700L and UV 801 BL&#41;&#46; Each patient was evaluated 24<span class="elsevierStyleHsp" style=""></span>h later for the development of erythema&#46; The minimal erythema dose &#40;MED&#41; was defined as the lowest dose of UVB&#44; or UVA&#44; that produced perceptible erythema&#44; covering the entire irradiated area&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> Photoprovocation was not performed&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Desensitization treatment</span><p id="par0045" class="elsevierStylePara elsevierViewall">Desensitization treatment courses were offered to each subject once a year in spring in 2014 and in 2015&#46; All subjects were whole body irradiated with Waldmann<span class="elsevierStyleSup">&#174;</span> UV 7001K light stand calibrated annually&#46; The standard treatment protocol for narrowband UVB &#40;TL-01&#41; is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The starting dose was 0&#46;15<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#46; This was followed by a 20&#37; incremental dosage&#44; twice a week&#44; during four weeks&#46; The total number of sessions was eight and the final dose achieved was 0&#46;53<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#46; Each course of treatment was carefully documented including the total number of treatment sessions administered and the frequency of PLE flares&#46; If PLE was provoked&#44; oral corticosteroids were administered without discontinuation of the treatment&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Subjects were told to keep exposing themselves to sunlight through over the summer after the desensitization protocol&#46; As the photo-protective effects of desensitization treatments are temporary with a complete loss of the hardening phenomenon once subjects are no longer exposed to sunlight or the intensity of sunlight decreases &#40;e&#46;g&#46; winter&#41;&#59; we considered each treatment course as an independent one&#44; and did not perform a separate analysis of first and second course&#46; Treatment courses in different years were considered not cumulative and were analyzed separately&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Follow up</span><p id="par0055" class="elsevierStylePara elsevierViewall">Subjects were followed up both after the end of the desensitization treatment and at the beginning of autumn&#46; Each subject&#39;s response to treatment during the subsequent months was tabulated and analyzed&#46; Subjects were asked whether they have had flares during the summer&#44; considering complete responders those who reported from 0 to 1 flare and partial responders those who reported 2 flares&#46; Subjects who had more than 2 flares were considered non-responders&#46; Taking extra treatment during the summer such as oral beta-carotene or antihistaminic drugs was also registered&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Statistical analyses</span><p id="par0060" class="elsevierStylePara elsevierViewall">Statistical analyses were performed with SPSS &#40;version 20&#46;0&#59; SPSS Inc&#46;&#44; Chicago&#44; IL&#41;&#46; Descriptive analysis of the sample was performed&#44; including percentages for categorical variables&#44; and mean&#44; minimum&#44; maximum and standard deviation values for continuous variables&#46; Comparisons of continuous variable means were performed using Student&#39;s exact <span class="elsevierStyleItalic">t</span>-test when variables followed a normal distribution&#46; Comparisons of discrete variable means were performed using the Mann&#8211;Whitney non-parametric test&#46; Comparisons between category variables were performed with tests and Fisher corrections were performed when required&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Subjects</span><p id="par0065" class="elsevierStylePara elsevierViewall">Between 2014 and 2015&#44; 16 subjects with the diagnosis of polymorphic light eruption &#40;PLE&#41; were seen at our Photobiology Unit fulfilled the inclusion criteria for desensitization and agreed to complete the treatment protocol&#46; Desensitization treatment with narrow band UVB &#40;NBUVB&#41; was offered to 15 subjects&#46; The remaining one was not finally included because of personal history of melanoma&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Regarding sex distribution&#44; there were 4 men &#40;26&#46;7&#37;&#41; and 11 women &#40;73&#46;3&#37;&#41;&#46; The mean age was 42&#46;4 years &#40;range 16&#8211;62&#41;&#46; All of them had decreased serum levels of 25-hydroxyvitamin-D3 &#40;&#60;25<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#41; in blood tests&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Sixty-six per cent of subjects were found to be ANA positive&#44; but only 3 of them had levels &#62;1&#58;160&#46; However&#44; none of them met the diagnostic criteria for lupus erythematous &#40;LE&#41; of the American College of Rheumatology&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The mean duration of PLE at presentation was 6&#46;13 years &#40;range&#44; 1&#8211;15 years&#41;&#46; There were no differences between the duration of the disease and the age and sex of the subjects &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Phototesting revealed that the minimal erythema dose for UVB was decreased in 64&#46;8&#37; of subjects tested while the remaining 35&#46;7&#37; fell within normal limits&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> The result of phototesting did not show differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; between age and sex of subjects&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Treatment courses</span><p id="par0090" class="elsevierStylePara elsevierViewall">Nine subjects were treated both in 2014 and in 2015 and 6 started phototherapy in 2015&#46; Therefore&#44; a total of 24 desensitization treatment courses were performed between 2014 and 2015&#46; All treatment courses were administered in spring&#58; 8&#46;3&#37; started in March&#44; 50&#37; in April&#44; 33&#46;3&#37; in May and 8&#46;3&#37; in June&#46; All subjects completed their desensitization courses&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Polymorphous light eruption &#40;PLE&#41; was provoked in 8 treatment courses &#40;33&#46;3&#37;&#41;&#46; All of the induced PLE were mild&#44; and only 3 of them &#40;12&#46;5&#37;&#41; required the administration of 20<span class="elsevierStyleHsp" style=""></span>mg of oral prednisone in decreasing doses during 10 days&#46; The induced flares resolved in all subjects&#44; and the interruption of the desensitization treatment course was not required in any case&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Response&#47;Follow up</span><p id="par0100" class="elsevierStylePara elsevierViewall">The evaluation of response was performed both after finishing the desensitization treatment and at the beginning of autumn&#46; The effect of hardening was sustained during the follow up after 21 desensitization treatment courses&#44; as subjects reported a complete remission of symptoms during all the sunny Spanish summer&#46; The remaining 3 desensitization treatment courses were ineffective and subjects continued having disease outbreaks&#46; The nine subjects&#44; who received 2 desensitization treatment courses&#44; were complete responders both in 2014 and 2015&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">There was no association between the maintained response to the desensitization treatment and demographic characteristics of the subjects&#46; No association was found either between response and serum levels of 25-hydroxyvitamin-D3&#44; positive antinuclear antibodies &#40;ANAs&#41; in laboratory tests or the result of previous subjects&#8217; phototest &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Female sex and low vitamin D levels were associated with a better response although this could not be considered statistically significant due to the high percentage of female subjects and the suboptimal vitamin D levels in all the cases&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">We found a statistically significant association &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; between the years of progression of the polymorphous light eruption &#40;PLE&#41; at presentation and the complete remission of symptoms after the desensitization treatment &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; The mean time from when the PLE began was 5&#46;9 years &#40;std&#46; deviation 4&#46;318&#41; in the 87&#46;5&#37; of subjects that presented a sustained response during the summer&#44; while the mean time was 8 years &#40;std&#46; deviation 6&#46;245&#41; in those who did not respond&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">With respect to the year&#39;s period of treatment&#44; there were no differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; between the sustained response to the desensitization and the month in which photo hardening was performed&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Nearly half of the cases &#40;45&#46;8&#37;&#41; spent the summer without need for any other treatment&#46; In 11 treatment courses &#40;45&#46;8&#37;&#41; subjects attempted to strengthen the response with oral beta-carotene&#44; and only in 2 cases &#40;8&#46;4&#37;&#41; antihistaminic drugs were taken&#46; However&#44; there were no differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; between the maintained response to photohardening and the use of extra treatments after the desensitization course&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">In accordance with what has been reported in the literature&#44; in our study PLE was predominantly affecting females&#46; The mean age of onset was 42&#46;4 years&#44; slightly higher than previously described&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;20&#44;21</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Consistent with what Gruber-Wackernagel et al&#46; defined&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> our PLE subjects had low 25&#40;OH&#41; vitamin D serum levels&#44; probably related to the avoidance of sun exposure&#46; It has been reported that 311<span class="elsevierStyleHsp" style=""></span>nm UVB phototherapy increases those levels&#44; and that boosting levels of vitamin D may be important in ameliorating PLE&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">22&#44;23</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">None of the ANA-positive subjects had or developed systemic lupus erythematous during follow-up&#46; Previous studies have shown elevated levels of antinuclear antibodies &#40;ANA&#41; in subjects with polymorphic light eruption&#59; however&#44; PLE is a benign disease without tendency to progress to LE&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">24&#44;25</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">In regard to phototest results in PLE subjects&#44; data are diverse in the literature&#46; Phototesting is useful to determine the responsible ultraviolet action spectrum and to exclude differential diagnoses like photosensitive eczema&#44; lupus erythematous or chronic actinic dermatitis&#46; It is reported that the majority of subjects with PLE have results that fell within normal limits when it refers to UVA and UVB MED determination&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;6&#44;18&#44;21&#44;23&#44;26&#8211;28</span></a> However&#44; in our series 64&#46;8&#37; of the subjects had decreased UVB MED&#44; a higher percentage compared to what has been previously described&#46; In accordance with our results&#44; phototest and photoprovocation showed no significant relationship with clinical disease severity and response in other series&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">When discussing a desensitization course in a PLE patient&#44; it is important to highlight that each patient will respond differently&#44; and treatment is almost always individualized&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> However&#44; we are of the opinion that a standard treatment course should be implemented&#44; in order to facilitate the management of PLE subjects&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Despite its widespread use&#44; treatment regimes vary greatly between health clinics&#44; and in most centres&#44; narrowband UVB has gradually replaced broadband UVB and PUVA and is now considered the treatment of choice&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In this paper we report our experience in PLE subjects being treated with our standard protocol&#44; based on narrowband UVB &#40;TL-01&#41; phototherapy&#44; starting with 0&#46;15<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span> followed by a 20&#37; incremental dosage&#44; until 0&#46;53<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span> achieving a total number of 8 sessions administered twice a week&#44; during four weeks&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The effect of hardening was sustained in the vast majority of our subjects&#44; obtaining a good benefit with no PLE episodes during all the summer&#46; With these results&#44; we demonstrate that this standard protocol is effective&#44; and produces a successful outcome for the majority of PLE subjects&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Moreover&#44; we found a direct association between the time from the onset of PLE and the response to the desensitization treatment&#44; being better responders those who had a short lasting disease&#46; Therefore&#44; it seems that treatment should be administrated as soon as the broad-spectrum topical sunscreens and the gradual increase in sunlight exposure fail to control the PLE symptoms in order to achieve better results&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Although PLE may be provoked during desensitization and subjects must be forewarned&#44; it should not prevent them from continuing treatment&#44; as acute flares can be treated with oral corticosteroids&#44; and it is not predictive for poor outcome&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Contrary to what was believed&#44;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">18&#44;29&#44;30</span></a> we found no significant results regarding the maintained response to photohardening and the use of beta-carotene or oral antihistaminic after the desensitization course&#46; Nearly half of our subjects could spend the whole summer free of symptoms without any extra treatment&#44; which implies an increase in their quality of life&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">The protocol that we propose is shorter than those currently applied&#44; being favourable both for the patient and the physician&#46; Thereby&#44; treatment adherence will probably increase and the cost of the treatment might be reduced&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Treatment needs to be repeated yearly in early spring&#44; as the photoprotective effects of phototherapy are temporary&#46; There appears to be no loss of benefit with subsequent courses&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Limitations</span><p id="par0190" class="elsevierStylePara elsevierViewall">Important limitations of studies like this include the small numbers of subjects due to the low prevalence of the disease&#44; and a study design that is not double-blinded and placebo controlled&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflict of interest</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Ethical disclosures</span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Protection of human and animal subjects</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Confidentiality of data</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work centre on the publication of patient data&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Right to privacy and informed consent</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span></span>"
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    "fechaRecibido" => "2016-11-21"
    "fechaAceptado" => "2017-04-14"
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            0 => "Polymorphic light eruption"
            1 => "Narrow-band UVB"
            2 => "NBUVB"
            3 => "Desensitization"
            4 => "Hardening"
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          "palabras" => array:5 [
            0 => "Erupci&#243;n polimorfa lum&#237;nica"
            1 => "UVB de banda estrecha"
            2 => "NBUVB"
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            4 => "Hardening"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Polymorphic light eruption &#40;PLE&#41; is a common idiopathic photodermatosis that typically presents with pruritic papular or papulovesicular lesions on sun-exposed skin between spring and autumn&#46; In many subjects PLE is mild&#44; and can usually be prevented by the use of broad-spectrum topical sunscreens and a gradual increase in sunlight exposure&#46; However&#44; in some individuals&#44; sunlight exposure results in florid PLE and they often benefit from prophylactic desensitization treatment using phototherapy in early spring&#44; an artificial method that induces a &#8220;hardening&#8221; phenomenon&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Objective</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">To describe and evaluate the efficacy of a short desensitization protocol&#44; based on a one-month-treatment&#44; administered twice a week with narrow band UVB in subjects with severe polymorphic light eruption &#40;PLE&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Methods</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A retrospective&#44; open planned and non-randomized study to assess the efficacy of UVB phototherapy in prevention of polymorphic light eruption&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Fifteen subjects diagnosed with severe PLE were treated with the standard protocol in our Photobiology Unit between 2014 and 2015&#46; The effect of hardening was sustained during follow up in 87&#46;5&#37; of desensitization treatments&#46; A statistically significant association &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; between the years of duration of the PLE and the response to treatment was found&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusions</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The effect of hardening was maintained in the vast majority of subjects&#44; obtaining a good benefit with no PLE episodes during all the summer&#46; We demonstrate that our standard protocol is effective&#44; and produces a successful outcome for the majority of PLE subjects&#46; Our protocol is shorter than those currently applied&#44; being favourable both for the patient and the physician&#46;</p></span>"
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        "resumen" => "<span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introducci&#243;n</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La erupci&#243;n polimorfa lum&#237;nica &#40;EPL&#41; es una fotodermatosis idiop&#225;tica que se presenta t&#237;picamente en forma de lesiones papulares o p&#225;pulo-vesiculosas pruriginosas en &#225;reas fotoexpuestas&#44; t&#237;picamente entre primavera y oto&#241;o&#46; En la mayor&#237;a de pacientes la EPL es leve&#44; y se previene mediante el uso de fotoprotectores y una exposici&#243;n gradual a la luz solar&#46; En algunos casos la EPL es muy florida&#44; y requiere una desensibilizaci&#243;n profil&#225;ctica en primavera&#44; que induce fen&#243;meno de <span class="elsevierStyleItalic">hardening</span>&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Objetivo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Describir y evaluar la eficacia de un protocolo de desensibilizaci&#243;n que se basa en la administraci&#243;n de UVB de banda estrecha&#44; 2 veces a la semana&#44; durante un mes&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se trataron un total de 15 sujetos con el protocolo de desensibilizaci&#243;n entre los a&#241;os 2014 y 2015&#46; Se realizaron un total de 24 tratamientos&#46; El efecto <span class="elsevierStyleItalic">hardening</span> se mantuvo en el 87&#44;5&#37; de los casos tratados&#46; Se encontr&#243; una asociaci&#243;n estad&#237;sticamente significativa &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; entre los a&#241;os de progresi&#243;n de la enfermedad y la respuesta al tratamiento&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Los efectos del <span class="elsevierStyleItalic">hardening</span> se mantuvieron en la mayor&#237;a de los sujetos&#44; los cuales presentaron un buen control de la EPL y ausencia de brotes durante el verano&#46; Se demuestra la efectividad del protocolo de desensibilizaci&#243;n en los sujetos con EPL&#44; el cual tiene una duraci&#243;n m&#225;s corta que los previamente descritos en la literatura&#46;</p></span>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Session of treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dose NBUVB &#40;J&#47;cm<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Standard treatment protocol for NBUVB &#40;311<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>nm&#41;&#46; The starting dose was 0&#46;15<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span> followed by a 20&#37; incremental dosage&#46; The total number of courses of treatment was eight and the final dose was 0&#46;53<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#46; The treatment was administered twice a week&#44; during four weeks&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Discrete variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Response</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Statistical significance &#40;<span class="elsevierStyleItalic">p</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Comments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Sex &#40;N 24&#41;</span></td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">The majority are female thus this result is clinically insignificant</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;62&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;8&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Vitamin D &#40;N 18&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sufficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Insufficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;87&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;12&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;405&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">ANAs &#40;N 18&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60; 1&#47;160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;55&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;16&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62; 1&#47;160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;27&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;410&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Phototest &#40;N 23&#41;</span></td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;34&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pathological&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;52&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;8&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Other treatments &#40;N 24&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;45&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">The antihistamines were taken after having a flare&#44; therefore result is clinically insignificant</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Beta-carotene&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;45&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Antihistaminic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;8&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Month of treatment &#40;N 24&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>March&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;8&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>April&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;41&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;8&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;842&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>May&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;29&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;4&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>June&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;8&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Response to treatment regarding discrete variables&#58; sex&#44; levels of vitamin D&#44; ANAs&#44; result of phototest&#44; month of treatment and medication taken after desensitization treatment&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Time of evolution &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;9 std&#46; deviation 4&#46;318&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;0 std&#46; deviation 6&#46;245&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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    "bibliografia" => array:2 [
      "titulo" => "References"
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          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:30 [
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              "identificador" => "bib0155"
              "etiqueta" => "1"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Artificial hardening for polymorphic light eruption&#58; practical points from ten years&#8217; experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "I&#46; Man"
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                            2 => "J&#46; Ferguson"
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                        "tituloSerie" => "Photodermatol Photoimmunol Photomed"
                        "fecha" => "1999"
                        "volumen" => "15"
                        "paginaInicial" => "96"
                        "paginaFinal" => "99"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10404717"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characteristics of diagnosed polymorphous light eruption"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;L&#46; Naleway"
                            1 => "R&#46;T&#46; Greenlee"
                            2 => "J&#46;W&#46; Melski"
                          ]
                        ]
                      ]
                    ]
                  ]
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ISSN: 15782190
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