UVA1 phototherapy is effective in darker skin: a review of 101 patients of Fitzpatrick skin types I-V

Abstract

Background Studies suggest ultraviolet (UV) A1 phototherapy is efficacious and safe in treating a variety of skin disorders. However, most reports evaluating the benefits of UVA1 phototherapy have been from Europe, focusing on a predominantly Caucasian population. Darker skin types have been evaluated only sparingly; none the less, it is widely held that these patients respond poorly to UVA1 phototherapy due to increased pigmentation. Objectives We aim to compare efficacy (clinical improvement scores) of UVA1 phototherapy among Fitzpatrick skin types. Methods A retrospective analysis of 101 patients receiving UVA1 treatment at the University of Texas Southwestern Medical Center in Dallas, TX was performed. Data on Fitzpatrick skin type and cumulative UVA1 doses were collected. Clinical improvement scores based on body surface area, erythema, induration, sclerosis, pigmentation, and symptoms of pain or pruritus were obtained. Results In the population studied, with morphoea and scleroderma being the most frequent diagnoses, improvement scores from UVA1 phototherapy and mean cumulative UVA1 doses were not significantly different among the Fitzpatrick skin types evaluated. Furthermore, little or no correlation was found between improvement score and skin type.Conclusions Data indicate skin pigmentation as graded by Fitzpatrick skin type does not significantly influence the efficacy of UVA1 phototherapy. Thus, UVA1 should be considered as a therapeutic option in more darkly pigmented patients.

Update on morphea

“…Forty-seven of the patients had morphea, and again, no difference in efficacy of therapy was noted across the five skin types. 42 This is in contrast to a 2008 molecular-based prospective trial carried out by Wang et al 43 Wang et al 43 made several interesting observations. First, skin type was predictive of the amount of decline of type 1 and type 3 collagen and the increase of matrix metalloproteinases after treatment with high dose UVA1 (ie, the lighter the skin type, the more dramatic the changes and the darker the skin type, the less dramatic the changes).…”

“…What is lacking is agreement on the correct dosing regimen or frequency, total exposure, and whether UVA1 is effective in patients with darker skin tones (ie, Fitzpatrick skin types $ IV). 42,43 Since 1995, 121 patients with morphea treated prospectively with UVA1 have been reported in the literature. 10,17,18,27,28,37,[44][45][46] These patients ranged in age from 3 to 73 years and had morphea based on clinical and histologic findings with a range of duration from 6 months to 20 years.…”

“…In 2008, Jacobe et al 42 published a retrospective review of 101 patients spanning Fitzpatrick skin types I through V who were treated with high dose UVA1. 42 Patient diagnoses spanned morphea, systemic sclerosis, graft versus host disease, atopic dermatitis, nephrogenic systemic fibrosis, granuloma annulare, pityriasis rubra pilaris, and urticaria pigmentosa. No difference in UVA1 therapy efficacy was noted across the five skin types when all disease subtypes were assessed.…”

Scleroderma: Nomenclature, etiology, pathogenesis, prognosis, and treatments: Facts and controversies

“…[57][58][59][60][61][62][63][64][65][66][67][68][69][70] Deep plaque morphea may require local phototherapy (nb-uvb, UVA, low-and medium-dose UVA1, or psoralen plus UVA [PUVA]) or systemic immunosuppression. 50 If systemic immunosuppression is required, treatment with methotrexate in combination with a prednisone taper is supported by the strongest data.…”

Phototherapy for sclerosing skin conditions

“…To compare the efficacy of UVA1 among patients with darker skin types, Jacobe et al conducted a retrospective review of 101 patients with Fitzpatrick skin types I-V treated with UVA1 phototherapy [32]. Most patients had morphea or scleroderma and had Fitzpatrick skin types I-V.…”