Utilizing UVA-1 Phototherapy

Prasad, Smriti; Coias, Jennifer; Chen, Henry W.; Jacobe, Heidi

doi:10.1016/j.det.2019.08.011

Cited by 17 publications

(20 citation statements)

References 82 publications

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“…Phototherapy is thought to modulate cutaneous sensory nerve fibers directly or by inducing mediator release from skin cells, reducing pruritus [22]. We suppose that UVA1 phototherapy led to better treatment outcomes in our patients than UVBnb phototherapy as longer wavelength light (UVA1) can penetrate deeper into the skin, which is frequently thickened and shows significant acanthosis and hyperkeratosis, especially in LA [23].…”

Section: Discussionmentioning

confidence: 99%

Primary Localized Cutaneous Amyloidosis: A Retrospective Study of an Uncommon Skin Disease in the Largest Tertiary Care Center in Switzerland

et al. 2021

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Background: Primary localized cutaneous amyloidosis (PLCA) is defined by the deposition of amyloid protein in the skin without systemic involvement. There are four subtypes of PLCA: lichen amyloidosis (LA), macular amyloidosis (MA), biphasic amyloidosis (BA), and nodular amyloidosis (NA). PLCA occurs most frequently in Latin Americans and Asians. Treatment is not standardized. Objectives: To identify subtypes, demographic and clinical features and treatment efficacy in patients with histopathologically confirmed PLCA. Materials and Methods: Data of PLCA patients were extracted from the electronic hospital database and included if diagnosis of PLCA was histopathologically confirmed and if sufficient information regarding treatment and follow-up was available. The evaluation of the treatment efficacy was based on a novel score to assess the reduction of itch and skin lesions. Results: In this retrospective, monocentric study, 37 cases of PLCA diagnosed between 2000 and 2020 were included (21 females) with a mean age of 52 years. LA was the most frequent subtype found in 21 patients (56.8%), followed by MA in 10 patients (28%) and BA in 6 patients (16.2%). No cases of NA were included. 22 patients (59.4%) had skin phototype II or III. Regarding treatment, a combination of UVA1 phototherapy with high-potency topical corticosteroids seemed to show the highest efficacy with complete clearance of symptoms in 4 patients (10.8%). A substantial improvement of symptoms was found in 5 patients (12.7%) treated with high-potency topical corticosteroids alone or in combination either with UVA1 or bath PUVA or monotherapy with UVA1 phototherapy or capsaicin (0.075%) cream. Low-/medium-potency topical corticosteroids alone or in combination with UVBnb (311 nm) phototherapy showed a lower efficacy. Conclusion: Our data show that PCLA is a rare disease in central Europe but can also be expected in a predominantly Caucasian population. The best treatment response was achieved with a combination of UVA1 phototherapy and high-potency topical corticosteroids.

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Section: Discussionmentioning

confidence: 99%

Primary Localized Cutaneous Amyloidosis: A Retrospective Study of an Uncommon Skin Disease in the Largest Tertiary Care Center in Switzerland

et al. 2021

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“…PUVA therapy increases IL-2 and INF-g, key Th1 cytokines, and UVA therapy modulates collagen metabolism, due to the deep penetration [11,13]. UVA 1 phototherapy, according to data, induces better response to treatment in the patients with active and inflammatory morphea than in patients with sclerotic or atrophic plaques [14,15].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of PUVA vs. UVA1 phototherapy in the treatment of morphea patients

Malewska-Woźniak¹,

Osmola‐Mańkowska²,

Adamski³

2022

pdia

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Introduction: Morphea (localized scleroderma) is an inflammatory connective tissue disease, characterized by immune system dysfunction, vasculopathy and skin fibrosing. Phototherapy has been found to be effective in treating localized scleroderma. Psoralen + ultraviolet A (PUVA) and ultraviolet A1 (UVA1) phototherapy significantly enriched therapeutic possibilities. Aim: To compare the clinical effect of PUVA photochemotherapy and UVA1 phototherapy and to evaluate the treatment response rates. Material and methods: It was a retrospective one-centre research and observational study of all morphea patients treated with PUVA and UVA phototherapy. We reviewed phototherapy notes along with electronic and paper case records for all patients with morphea treated with PUVA and UVA1 phototherapy from January 2010 to December 2019. Results:The study shows that patients in both groups experienced improvement based on clinical measures, resulting in a reduction in the clinical score in all groups. There is positive short-and long-term efficacy of UVA1 and PUVA phototherapy in patients with morphea. There were no statistical differences between the treatment response rates. Limitations: We had a relatively small study sample and it was a retrospective, observational study. Conclusions: Our data suggest that ultraviolet PUVA and UVA1 should be considered for the treatment of morphea with disseminated lesions or not responding to topical treatment. UVA1 is free of side effects linked to oral psoralens such as nausea, vomiting, photokeratosis, but we showed that there was no statistical advantage in the effectiveness of both. UVA1 phototherapy is, however, a less accessible form of treatment, available in the centres of higher quality.

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“…Another treatment for morphea is ultraviolet (UV) phototherapy, used for a variety of sclerosing and inflammatory conditions of the skin (54). Phototherapy options include Ultraviolet A1 (UVA1) and narrowband UVB (NBUVB).…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

“…Phototherapy options include Ultraviolet A1 (UVA1) and narrowband UVB (NBUVB). While both can be used for treatment of morphea, UVA1 is preferred when available as there is more evidence supporting its efficacy in morphea (54). Patients with extensive dermal morphea are good candidates for this treatment, as they have a large amount of body surface area involved, making topical therapy alone impractical.…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

“…The relatively favorable side effect profile of phototherapy gives it an advantage over systemic immunosuppressants and thus is the preferred agent in these patients (54). Other procedures that have been reported to be effective in the treatment of some morphea patients include photodynamic therapy and pulsed dye laser therapy for sclerotic lesions, intralesional hyaluronidase injections for morphea-induced microstomia, and extracorporeal photochemotherapy for severe, generalized disease (31,(54)(55)(56)(57)(58)(59)(60). Further research into these agents and procedures is warranted in order to more clearly define efficacy and indications for use before they should be used as first line agents.…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

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Morphea: progress to date and the road ahead

et al. 2021

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Morphea is a rare autoimmune condition causing inflammation and sclerosis of the skin and underlying soft tissue. It is characterized by periods of activity (inflammation admixed with fibrosis), ultimately resulting in permanent damage (pigment change and tissue loss). Damage resulting from unchecked activity can lead to devastating, permanent cosmetic and functional sequelae including hair loss; cutaneous, soft tissue and bony atrophy; joint contractures; and growth restriction of the affected body site in children. This makes the early identification of activity and initiation of appropriate treatment crucial to limiting damage in morphea. To this end, recent investigative work has focused on validation of clinical, biomarker, imaging, and histologic outcomes aimed at accurately quantifying activity and damage.Despite promising results, further work is needed to better validate these measures before they can be used in the clinic and research settings. Although there has been recent approval of less toxic, targeted therapies for many inflammatory skin conditions, none have been systematically investigated in morphea.The mainstays of treatment for active morphea are corticosteroids and methotrexate. These are often limited by substantial toxicity. The paucity of new treatments for morphea is the result of a lack of studies examining its pathogenesis, with many reviews extrapolating from research in systemic sclerosis. Recent studies have demonstrated the role of dysregulated immune and fibrotic pathways in the pathogenesis of morphea, particularly interferon (IFN) gamma related pathways. Active morphea lesions have been foundto display an inflammatory morphea signature with CXCR3 receptor ligands, as well as a distinct fibrotic signature reflecting fibroblast activation and collagen production. CXCL9 and 10 have been associated with increased measures of disease activity. While immune dysfunction is thought to play the primary role in morphea pathogenesis, there are other factors that may also contribute, including genetic predisposition, environmental factors, and vascular dysregulation. There remains an essential need for further research to elucidate the pathogenesis of morphea and the mode of action of dysregulated upstream and downstream immune and fibrotic pathways. These studies will allow for the discovery of novel biomarkers and targets for therapeutic development.

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Utilizing UVA-1 Phototherapy

Cited by 17 publications

References 82 publications

Primary Localized Cutaneous Amyloidosis: A Retrospective Study of an Uncommon Skin Disease in the Largest Tertiary Care Center in Switzerland

Primary Localized Cutaneous Amyloidosis: A Retrospective Study of an Uncommon Skin Disease in the Largest Tertiary Care Center in Switzerland

Effectiveness of PUVA vs. UVA1 phototherapy in the treatment of morphea patients

Morphea: progress to date and the road ahead

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