Background Studies support efficacy of ultraviolet A1 (UVA1) phototherapy, but little is known about recurrence after successful UVA1 treatment. Objective Determine the frequency of recurrent activity after UVA1 phototherapy and variables associated with recurrence. Methods Case series and prospective cohort study of patients treated with UVA1 phototherapy with minimum 6 months follow-up. Demographics, clinical features, and cumulative UVA1 dose were analyzed for association with recurrence. Results Of 37 patients, 46% (n=17) had recurrence of active morphea lesions after successful UVA1 phototherapy. Two-year and three-year (after the last UVA1 phototherapy treatment) recurrence rates were 44.5% (95% CI: 30.1% – 62.2%) and 48.4% (95% CI: 33.2% – 66.1%). The only variable associated with recurrence was duration of morphea prior to UVA1 (p-value=0.02, HR=1.15, 95% CI=(1.06–1.27)). Limitations Sample size limits conclusions. Conclusion With the exception of increased duration of morphea, risk of recurrence is no different in adults and children, between morphea subtypes, skin type, and medium to high dose regimens. This indicates treatment doses in the medium-high UVA1 range are adequate with respect to frequency of recurrence.

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adulterants, (3) bacterial superinfections of the damaged nasal mucosa, and (4) autoimmunity activation. [2][3][4] High-resolution computed tomography and magnetic resonance imaging are investigative and complementary techniques used to accurately delineate the extent of the disease. However, imaging features of CIMDL are nonspecific. Body erosion and destruction initially involve the nasal septum and paranasal sinuses. In advanced phases, such destruction may spread to the hard palate, pterygopalatine fossa, infratemporal fossa, orbit, and anterior cranial fossa.We believe eustachian tube erosion seen in this patient represents a further nonspecific but uncommon extensive destruction change. Urine or blood toxicology testing at the initial presentation of CIMDL is helpful in preventing a misdiagnosis. Abstinence from cocaine remains the mainstay treatment.