Transcript Efficacy of UVA1 phototherapy in 230 patients with various skin

Efficacy of UVA1 phototherapy in 230
patients with various skin
diseases.Rombold S., Lobisch K, Katzer
K, Grazziotin TC, Ring J, Eberlein B.
Department of Dermatology and Allergy
Biederstein, Technical University of
Munich, Munich, Germany.
[email protected]
Photodermatol Photoimmunol Photomed.
2008 Feb;24(1):19-23.
Introduction
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-In the past patients were treated with
broadband UVB (280-320nm), broadband UVA
(320-400nm), or combination of both.
-Broadband UV phototherapy is more and more
replaced by irradiation devices that allow
treatment with selected emission spectra:
-UVB phototherapy which uses long wave
UVB radiation above 300nm
-UVA1 phototherapy which uses long wave
UVA radiation above 340nm
UVA1 phototherapy
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-available since 1981
-dosimetry: high doses (up to 130J/cm2), medium
doses (40-70J/cm2), low doses (10-30J/cm2) for a single treatment.
-safe in exacerbated atopic eczema, localized
scleroderma and granuloma annulare.
-Effects:
-may contribute to suppression and
prevention of eczema flares by inducing T-lymphocyte apoptosis and
reducing Langerhans Cells and mastocytes in the dermis.
-may contribute to improvement of
morphea by increasing collagenase expression.
-may contribute to reduction of pruritus
by inhibiting histamine release from basophile and mast cells.
-Well tolerated: side effects are erythema,
hypopigmentation, polymorphic light eruption, pruritus due to
druness of the skin and chronically photoaging and skin cancer
Study design and methods
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-data collection in the Department of Dermatology and Allergy from August 1999 to
June 2005 (6 years).
-230 patients analysed:
-86 with atopic dermatitis (39males, 27 females; age 40.22 +/- 16.6 years)
-54 with scleroderma (14 males, 40 females; age 46.17 +/- 19.12 years)
-20 with granuloma annulare (3 males, 17 females; age 57.90 +/- 10.13 years)
-19 with urticaria pigmentosa (3 males, 16 females; age 41.37 +/- 12.1 years)
-17 with prurigo nodularis (7 males, 10 females; age 59.65 years +/- 16.89
years)
-10 with lichen sclerosus et atrophicus (1male, 9 females; age 64.4 +/- 7.49
years)
-7 with T-cell lymphoma (4 males, 3 females; age 67 +/- 19 years)
-5 with keratosis lichenoides chronica (1 male, 4 females; age 50.80 +/- 15.25
years)
-4 patients with chronic urticaria (1 male, 3 females; age 46.75 +/- 11.98 years)
-3 males with scleredema adultorum Buschke (51, 59 and 60 years old)
-2 patients with GVHD (1male, 1 female; 58 and 5 years old)
-1 patient (male) with nephrogenic fibrosing nephropathy
-1 female with Werner’s sndrome and eosinophilic fasceitis.
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-Patients receiving less than 6 treatments without worsening of the
skin condition were excluded from the study.
-Patients receiving less than 6 treatments WITH worsening of the
skin condition were included in the study.
-Clinical evaluation: by physician: level of pruritus, efficacy evaluated
by following scale:
-2=withdrawal after 6 irradiations (worsened skin
condition only)
-1=aggravation
0=status quo
1=slight improvement
2=moderate improvement
3=marked improvement
4=complete remission
--UVA1 light=dermalight ultraA1 (Dr Hoenle GmbH, Kaufering,
Germany): spectrum 340-440nm, intensity 80mW/cm2 at 50cm
distance.
Results
Discussion
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In earlier studies with UVA1 , patients were treated with higher
doses comparing with earlier studies. This is why the mean single
doses vary accordingly to groups which include patients treated
earlier.
Atopic eczema
 Medium-dose UVA1 therapy in patients with atopic eczema led to a
moderate to marked improvement in most patients as already noted
in earlier studies. UVA1 has already been shown to be superiorly
effective than UVA/UVB or PUVA therapy.
 High-dose UVA1 therapy has been shown to significantly improve
clinically patients with severe atopic eczema. High-doses and
Medium-dose UVA1 therapy have been shown to have a
comparable effect. In contrast Low-dose UVA1 therapy does not
lead to significant reduction in severity of atopic eczema.
 Although High-dose and medium-dose UVA1 therapy are effective,
relapses typically 4-12 weeks after the last treatment.
Scleroderma
 Improved in the study.
 High dose decreases skin thickness ans stiffness.
 In other studies, low-dose and medium dose UVA1 are effective.
 It has also been shown that medium-dose UVA1 therapy in localized
scleroderma is significantly more effective than narrow-band UVB
treatment.
Lichen sclerosus et atrophicus and keratosis lichenoides chronica
 Medium-dose UVA1 has been shown to be effective in most cases
of these lesions.
 Even with low-dose UVA1, clinical score, skin thickness and
increase in dermal density have been demonstrated in lichen
sclerosus et atrophicus.
 PUVA is also effective.
 In keratosis lichenoides chronica, clearance of 98%, 88%, 82% and
41% has been shown in 4 patients treated with medium-dose UVA1
therapy.
Granuloma annulare:
 Only half of patients with medium- to high-dose UVA1 therapy
improved.
 At a high dosage, results are controversial with some advocating
that high-dose UVA1 leads to complete clearance or considerable
improvement in all patients wheras others have shown that
substantial improvement or healing occurs in 50% of patients.
 Relapses occur typically 3 months after last treatment.
 PUVA has been shown in more studies to be effective.
Urticaria pigmentosa
 Only half improved which is underestimated when compared with a
study where medium-dose UVA1 cleared all of patients (itch relief,
decrease of histamine and serotonine release)
 Others showed that there was no difference between medium- and
high-dose. Pruritus and quality of life improved condiderably, even
though the number of lesions was not reduced.
 UVA1 therapy is thus worth trying in patients with urticaria
pigmentosa, but also bath PUVA therapy is effective.
Prurigo Nodularis
 Quite effective
 No studies published on UVA1 therapy and
prurigo nodularis.
 Improvement has been shown in patients
treated with NBUVB combined with thalidomide.
Chronic urticaria
 No effect
 Little data in the literature in UV light treatment.
 Only solar urticaria can be successfully treated
with UV hardening.
GVHD
 One study shows that UVA1 therapy with lowdose regimen and a high number of irradiations
shows a moderate improvement whereas a
medium-dose regimen with a less number of
irradiations shows no effect.
Nephrogenic fibrosing nephropathy
 One study shows that medium-dose UVA1 leads
to slight improvement similar to another study.
Conclusion
Good effects of UVA1 therapy in atopic
eczema, scleroderma, lichen sclerosus et
atrophicus, keratosis lichenoides chronica,
prurigo nodularis, CTCL.
 Positive effects in urticaria pigmentosa,
granuloma annulare and rare sclerosing
skin disease group.
 No effect in chronic urticaria group.
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