Low-dose UVA1 phototherapy for treatment of localized scleroderma,☆☆,

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Abstract

Background: For treatment of localized scleroderma numerous treatments, including ones with potentially hazardous side effects, are currently used with only limited success. Objective: We attempted to determine the efficacy of low-dose UVA1 irradiation in patients with severe localized scleroderma. Methods: Patients were irradiated with 20 J/cm 2 UVA1 for 12 weeks (total number of treatments: 30; cumulative UVA1 dose: 600 J/cm2). Results: Low-dose UVA1 irradiation induced significant clinical improvement (clearance of>80% of lesions) in 18 of 20 patients. Clearance was documented by clinical score as well as by 20 MHz ultrasound and histopathologic analysis. Conclusion: Low-dose UVA1phototherapy can be highly effective for sclerotic plaques, even in patients with advanced localized scleroderma and with lesions rapidly evolving despite conventional therapy. (J Am Acad Dermatol 1998;38:21-6.)

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Patients

Twenty patients with severe LS were included in the study after informed consent was obtained. In all patients (11 female and 9 male; age 10 to 73 years) the diagnosis of LS was established according to clinical and histopathologic criteria. Patients were classified into three subgroups: (1) those with circumscribed plaques (n = 10), (2) those with linear morphea (n = 8), and (3) those with subcutaneous morphea (n = 2) (Fig. 1, A and B, Table I).

. A, A 61-year-old woman with long-standing

Equipment

The UVA1 irradiation equipment consisted of a high-intensity UVA1 cabin (Sellamed, Dr. Sellmeier, Ennepetal, Germany) emitting exclusively wavelengths in the 340 to 400 nm range. The irradiance at body distance was approximately 70 mW/cm2 for UVA.

Treatment

In all patients total body UVA1 phototherapy (340 to 400 nm) was administered four times a week for 6 weeks and once a week for another 6 weeks resulting in a total of 30 treatment sessions. Each treatment session consisted of an exposure of 20 J/cm2

RESULTS

The therapy was well accepted and completed by all patients. All patients had 30 treatments with doses of 20 J/cm2 at each treatment session resulting in a cumulative UVA1 dose of 600 J/cm2. During and after phototherapy, no side effects such as erythema, blistering, or pruritus were observed.

According to clinical and ultrasound criteria, more than 80% of the sclerotic lesions disappeared or markedly improved during UVA1irradiation in 18 of the 20 patients within less than 3 months (Table I).

DISCUSSION

Our results demonstrate that long-standing and severe LS can be markedly improved or cleared by low-dose UVA1 phototherapy. Different types of photochemotherapy have been suggested for sclerosing skin diseases, such as photopheresis, PUVA bath photochemotherapy, and oral PUVA therapy.8, 11, 13 Photopheresis has mainly been studied in patients with systemic sclerosis and has led to different results.11, 14 PUVA bath photochemotherapy, in which patients are immersed in an 8-MOP dilute bath water

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From the Departments of Dermatology, Ruhr-University Bochum, a Ludwig-Maximilians University Munich,b and Heinrich-Heine University Düsseldorf.c

☆☆

Reprint requests: Martina Kerscher, MD, Department of Dermatology, Ruhr-University Bochum, Gudrunstrasse 56, D-44791 Bochum, Germany.

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