The World of UV Phototherapy by Chris Cane » UVA1

Combined treatment with calcipotriol ointment and low-dose ultraviolet A1 phototherapy in childhood morphea.

Chris Cane — Mon, 26 Apr 2010 18:46:31 +0000

Combined treatment with calcipotriol ointment and low-dose ultraviolet A1 phototherapy in childhood morphea.

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

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Morphea – Some Background Information

Chris Cane — Fri, 26 Feb 2010 18:56:34 +0000

Author: Jennifer V Nguyen, MD, Resident Physician, Department of Dermatology, Hospital of the University of Pennsylvania

Coauthor(s): Victoria P Werth, MD, Professor of Dermatology and Medicine, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, Philadelphia Veterans Affairs Medical Center; Nicole Fett, MD, Clinical Educator, Department of Dermatology, University of Pennsylvania School of Medicine

Introduction:

Morphea, also known as localized scleroderma, is a disorder characterized by excessive collagen deposition leading to thickening of the dermis, subcutaneous tissues, or both. Morphea is classified into plaque, generalized, linear, and deep subtypes according to the clinical presentation and depth of tissue involvement. Unlike systemic sclerosis, morphea lacks features such as sclerodactyly, Raynaud phenomenon, nailfold capillary changes, telangiectasias, or progressive internal organ involvement. Morphea can present with extracutaneous manifestations, including fever, lymphadenopathy, arthralgias, and central nervous system involvement, and laboratory abnormalities, including eosinophilia, polyclonal hypergammaglobulinemia, and positive antinuclear antibodies.1,2,3

Although rare, epidemiologic studies suggest 0.9-5.7% of patients with morphea progress to systemic scleroderma.2 The transition may be marked by the development of Raynaud phenomenon and nailfold capillary changes.

It would be silly and foolhardy of me to copy the entire article from the eMedicine website.

The article in its entirety can be found at http://emedicine.medscape.com/article/1065782-overview

This article links to http://emedicine.medscape.com/article/1065782-treatment

Amongst other treatments the article discusses:

UVA and UVA-1 Broadband UVA (320-400 nm, low-dose), long-wavelength UVA (UVA1; 340-400 nm, low- or medium-dose), and psoralen plus UVA (oral or bath) photochemotherapy have produced marked clinical improvement of morphea lesions in multiple case series and a randomized controlled trial. Because UVA1 wavelengths penetrate deeper into the dermis, this modality is particularly effective in the treatment of morphea. Low-, medium-, and high-dose UVA are all effective. Medium-dose UVA1 provides for better long-term results than low-dose UVA1 in morphea as shown by ultrasound assessment.26 Unfortunately, the availability of UVA1 is currently limited. Narrowband UVB therapy, although less potent owing to its limited dermal penetration, can also be beneficial. Regimens combining UV therapy with topical corticosteroids or calcipotriene may be superior to either method alone.42,43

To see the entire article on treatment at the eMedicine site, See http://emedicine.medscape.com/article/1065782-treatment

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UVA1 Phototherapy – Is it effective?

Chris Cane — Tue, 26 Jan 2010 05:01:16 +0000

The article concludes “Besides topical and systemic therapy, UVA1 radiation is a good option of treatment in various skin diseases. It is one of the first-line treatments for several sclerotic diseases and it often improves pruritus considerably.”

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

“Good therapeutic effects of UVA1 therapy were shown in patients with atopic eczema, scleroderma, lichen sclerosus et atrophicus, keratosis lichenoides chronica, prurigo nodularis and with cutaneous T-cell lymphoma. Positive effects in some patients were seen in the urticaria pigmentosa and granuloma annulare group, no change to slight improvement was seen in most of the patients with rare, sclerosing skin diseases and no effect was seen in the chronic urticaria group.”

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 >>

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