Kreuter A, Gambichler T, Avermaete A, Jansen T, Hoffmann M, Hoffmann K, Altmeyer P, von Kobyletzki G, Bacharach-Buhles M.

Department of Dermatology, Ruhr-University Bochum, Bochum, Germany. a.kreuter@derma.de

Abstract

Various therapies for morphea have been used with limited success, including ones with potentially hazardous side effects. When morphea occurs in childhood it may lead to progressive and long-lasting induration of the skin and subcutaneous tissue, growth retardation, and muscle atrophy.

We report an open prospective study in which the efficacy of a combined treatment with calcipotriol ointment and low-dose ultraviolet A1 (UVA1) phototherapy in childhood morphea was investigated. Nineteen children (mean age 8.5 years, range 3-13 years) with morphea were exposed to UVA1 (340-400 nm) phototherapy at a dose of 20 J/cm(2) four times a week for 10 weeks. Forty phototherapy sessions resulted in a cumulative dose of 800 J/cm(2) UVA1.

In addition, calcipotriol ointment (0.005%) was applied twice a day. After 10 weeks, palpation and inspection showed a remarkable softening and repigmentation of formerly affected skin resulting in a highly significant (p < 0.001) decrease of the mean clinical score from 7.3 +/- 0.9 at the beginning to 2.4 +/- 0.9 (relative reduction 67.1%) at the end of combined therapy.

Our results indicate that a combined therapy with calcipotriol ointment and low-dose UVA1 phototherapy is highly effective in childhood morphea. Further controlled studies are necessary to investigate whether this combined therapy is superior to UVA1 phototherapy alone.

PUB MED Link: http://www.ncbi.nlm.nih.gov/pubmed/11438008

I came across this study during an internet search when a customer called me about the use of UVA1. I have to admit I was surprise by the fact that the use of UVA1 has shown some good results with atopic eczema, scleroderma and other challenges.

The authors say

The study is titled “Efficacy of UVA1 phototherapy in 230 patients with various skin diseases” and is written by S. Rombold, K. Lobisch, K. Katzer, T. C. Grazziotin, J. Ring & B. Eberlein of the Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany.

To see the entire article << CLICK HERE FOR PDF >>

UVA1 id long wavelength UV in the 340 nm to 400 nm range. UVA1 therapy has been available since the early eighties in Europe and we’re slowly catching up here in the USA. UVA1 phototherapy can be effective in the treatment of inflammatory skin diseases such as exacerbated atopic eczema, localized scleroderma and granuloma annulare.

To see the entire article << CLICK HERE FOR PDF >>

• See http://www.uvbnarrowband.com/index.php/2009/11/uvbnb-and-uva-1-treats-scleroderma/
• See http://www.uvbnarrowband.com/index.php/2009/11/ultraviolet-uva-1-phototherapy-uk-study/

Department of Dermatology and Allergology, Ruhr-University Bochum, Bochum, Germany.

BACKGROUND: In previous trials, UV therapy has been demonstrated to be effective in the treatment of localized scleroderma (LS). To date, a randomized comparison study to evaluate the efficacy and safety of different, commonly used phototherapeutic modalities in LS is still outstanding.

OBJECTIVE: The aim of this study was to compare the safety and efficacy of

• low-dose (LD) UVA1,
• medium-dose (MD) UVA1, and
• narrowband (NB) UVB phototherapy in the treatment of LS.

METHODS: Sixty four patients with LS were consecutively included in a prospective, open, randomized controlled 3-arm study. Severity of LS was determined by means of a clinical score, and clinical improvement was also monitored by histopathologic analysis and 20-MHz ultrasound.

RESULTS: A total of 27 patients were treated with LD UVA1 (20 J/cm2), 18 patients received MD UVA1 (50 J/cm2), and 19 patients were treated with NB UVB dependent on their skin type. Phototherapy was performed 5 times weekly for 8 weeks. Two of the 64 patients included in this trial discontinued therapy. Skin status significantly improved in all patients who finished the treatment protocol, resulting in a reduction of the clinical score in all groups (LD UVA1, 7.6-5.0 [P < .001, 95% confidence interval 1.6-3.4]; MD UVA1, 11.1-6.6 [P < .001, 95% confidence interval 2.5-6.2]; NB UVB, 7.3-4.9 [P < .001, 95% confidence interval 1.6-3.2]). The reduction of the score was accompanied by an improvement of the visual analog scale for itching and tightness, histologic score, and 20-MHz ultrasound. MD UVA1 was significantly more effective than NB UVB (P < .05). There were no significant differences between LD UVA1 and NB UVB and the former and MD UVA1 (P > .05).

LIMITATIONS: We had a relatively small study sample and nonblinded assessment of primary outcome.

CONCLUSION: Phototherapy, as previously reported in several noncontrolled trials, is an effective therapeutic option in LS, with a favorable risk/benefit ratio. UVA1 phototherapy should be considered among the first approaches in the management of LS.

Link to PubMed Article:  << Click Here >>

NOTE: Amjo does offer UVA-1 Products at www.HomePhotoTherapy.com

The original work was completed by Dawe RS. at the: Photobiology Unit, Department of Dermatology, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. r.s.dawe@dundee.ac.uk

Long-wavelength ultraviolet A (340-400 nm; UVA1) therapy is currently available in only a few dermatology departments. Equipment capable of delivering this waveband has been available since 1981, but it is only over the past decade that increasing numbers of studies assessing the potential of this as a therapy have been published. High-dose UVA1, which requires expensive and space-occupying apparatus, is effective as a monotherapy for acute flares of atopic dermatitis, but it has not yet been formally assessed as an adjunct, rather than as an alternative to conventional therapies including potent and very potent topical corticosteroids. Low-dose (which can be administered using a standard phototherapy cubicle fitted with appropriate lamps) and medium-dose UVA1 may be less effective for this indication. Another condition for which UVA1 is effective, and is particularly promising because we have no reliably effective treatment already, is localized scleroderma. It also appears to be effective in systemic lupus erythematosus (although it is not yet clear when it is indicated, and its safety needs to be assessed in more patients) and in polymorphic light eruption (although there have been no studies suggesting that UVA1 will have any advantages over standard prophylactic phototherapies). Open studies and case series suggest that UVA1 may prove beneficial for various other diseases, including cutaneous T-cell lymphoma, lichen sclerosus, keloids, systemic sclerosis and hand dermatitis. In the centres where it is available, UVA1 has already proved a useful addition to the range of phototherapies previously available. However, much more research is needed to confirm its efficacy for many of its potential indications, and to determine when and how it should be used.

Original Article << Click Here >>