Recurrence of morphea after successful ultraviolet A1 phototherapy: A cohort study

Abstract

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.

European Dermatology Forum S1‐guideline on the diagnosis and treatment of sclerosing diseases of the skin, Part 1: localized scleroderma, systemic sclerosis and overlap syndromes

“…Whether patients with darker skin respond less to UVA1 phototherapy is still a matter of debate . Moreover, it has been shown that within 3 years after therapy, about 50% of patients treated with UVA1 experience recurrences . In these cases, a second cycle of UVA1 phototherapy should be considered.…”

Current Approach to Phototherapy Applications in Dermatology Practice: Part 2. Phototherapy in Vitiligo, Mycosis Fungoides, Atopic Dermatitis, Sclerosing Diseases and Psoriasis

“…MF ve AD'de olduğu gibi, lokalize sklerodermada da UVA1 ile başarılı tedavi sonrası nüks olabilmektedir. UVA1 tedasivine yanıt veren 37 hastanın %46'sında, tedavi bitiminden ortanca 10,8 ay sonra nüks olduğu gözlenmiştir (75). UVA1'in, ekstragenital liken skleroz, sistemik skleroz, sklerodermoid Graft Versus Host hastalığı ve nefrojenik sistemik fibroziste de etkili olduğuna dair çeşitli yayınlar bulunmaktadır (76,77).…”

Phototherapy in Scleroderma

“…In a cohort study of 37 patients with morphea with positive clinical benefits from UVA1 treatment 44.5% recurred at 2 years, and 48.4% recurred at 3 years [52]. There was no difference between medium- (60–90 J/cm 2 ) and high-dose (>90 J/cm 2 ) UVA1 phototherapy with respect to recurrence.…”

“…There was no difference between medium- (60–90 J/cm 2 ) and high-dose (>90 J/cm 2 ) UVA1 phototherapy with respect to recurrence. There was a 1.15-times higher chance of disease recurrence for an increment of 1 year in duration of morphea prior to UVA1 treatment [52]. …”