Efficacy of Ultraviolet A1 Phototherapy in Recalcitrant Skin Diseases

BACKGROUND: Ultraviolet (UV) radiation has been used for decades to treat a variety of skin diseases. UVA1 was used initially as an effective treatment for acute exacerbated atopic dermatitis. Since then, UVA1 has been attempted for recalcitrant skin diseases. OBJECTIVE: This study examined the efficacy of UVA1 phototherapy in three recalcitrant skin diseases. METHODS: This retrospective study reviewed the efficacy and follow-up of 26 patients with atopic dermatitis (AD), mycosis fungoides (MF) and localized scleroderma (LS). SUPUVASUN 3000 (Mutzhas Co., Munich, Germany) and SELLAMED 3000 (Sellas Medizinische Gerate GmbH, Gevelsberg, Germany) were the UVA1 equipment used. Irradiation was performed in accordance with the disease. Low-dose (20 J/cm2), medium-dose (65 J/cm2) and high-dose regimens (100 J/cm2) of UVA1 therapy were employed. The frequency of the therapy ranged from 3 to 5 times weekly. The therapeutic effectiveness was assessed according to the clinical examination before and after the last treatment. RESULTS: In patients with AD, complete and partial remission was achieved in four (80%) and one (20%) patient, respectively. In patients with MF, complete and partial remission was observed in thirteen (86.7%) and two (13.3%) patients, respectively. In patients with LS, complete and partial remission was observed in three (50%) and three (50%) patients, respectively. CONCLUSION: UVA1 phototherapy is an effective treatment modality for acute exacerbated AD, MF and LS.

Low-dose Ultraviolet A1 Phototherapy for Treating Pityriasis Rosea

BACKGROUND: UVA1 phototherapy has recently demonstrated high levels of efficacy and tolerability for treating a variety of inflammatory and neoplastic skin diseases. OBJECTIVE: The purpose of the present study was to assess the clinical efficacy of UVA1 (340~400 nm) phototherapy for treating pityriasis rosea and to assess the course of the disease after treatment. METHODS: Fifteen patients with extensive pityriasis rosea were treated with low-dose UVA1 phototherapy (starting at 10~20 J/cm2 and then it was increased to 30 J/cm2). The treatments were given 2~3 times a week until complete clearance of lesions was achieved or until there was partial improvement without further amelioration, in spite of 5 additional treatments. The rate of clearing was monitored by estimating the pityriasis rosea severity (PRSS) score and the pruritus score. RESULTS: The extent of disease (PRSS) in all 15 patients lessened during the study (30.1+/-3.6 vs. 2.0+/-1.6, respectively, p<0.05). The overall reduction of the PRSS showed a significant improvement after the second or third treatment. The pruritus of 12 of 15 patients lessened during the treatment period, and it was unchanged in the remaining 3 patients. The mean previous duration of disease was 11.2+/-4.9 days and this did not interfere with the successful outcome of UVA1 phototherapy. CONCLUSION: This study shows that UVA1 phototherapy is a useful, well-tolerated treatment option for patients suffering from pityriasis rosea with extensive eruptions and considerable pruritus.

High Dose UVA-1 Phototherapy for Morphea / 대한피부과학회지

Morphea is a rare, sclerotic connective tissue disorder and is thought to be caused by a decreased collagenase activity. Numerous treatment modalities have been tried, such as infiltration with glucocorticosteroid, D-penicillamine, antimalarial agents and cyclosporine. However, all have shown only limited success. We report a case of a 21 year- old female with localized scleroderma, who showed a marked improvement after localized therapy with high dose UVA-1.

A Case of Localized Scleroderma Treated with Low-dose UVA1 Phototherapy / 대한피부과학회지

Localized scleroderma is a form of connective tissue disease in which the normally soft-textured surface of the skin hardens due to deposition of collagen within the dermis. Recently, UVA1 phototherapy with shorter wavelength in the UVA2 region has been shown to have excellent effect in the treatment of scleroderma, including systemic sclerosis. Here, we report a case of a 57 year-old female with linear scleroderma and manifestation of Raynaud's phenomenon who showed marked improvement after 13 sessions of whole body therapy with low dose UVA1. Ultrasound scanning and skin elasticity measurement were taken to evaluate therapeutic effectiveness of UVA1 phototherapy.

Low-dose UVA1 Phototherapy for Localized Scleroderma / 대한피부과학회지

Localized scleroderma(LS) is sclerosis of the skin characterized by one or multiple circumscribed ivory-white, indurated, sometimes confluent plaques. It has been reported that LS might result from the unbalance between synthesis and degradation of collagen in the dermis. Recently, treatment of LS with long wave UVA1, which can induce mRNA of matrix metalloproteinase-1 from dermal fibroblast and can cause apoptosis of infiltrating T lymphocytes, showed promising results. In this case, a 14-year-old girl had a 6 month history of linear, brown colored, indurated plaque on her left thigh compatible with LS histopathologically. UVA1(2.4-10.8J/cm2) was irradiated to the skin lesion at each visit, a total of 68 times for 18 months with the cumulative dose of 533J/cm2 UVA1. Her fibrotic skin lesion was resolved during treatment, but became hardened with cessation of phototherapy. She remains disease free for 11 months. We report a case of LS with improvement with low-dose UVA1 phototherapy.

Study of the Minimal Erythema Dose and Minimal Melanogenic Dose of UVA - 1 and Minimal Phototoxic Dose of UVA - 1 and UVA - 2 in Young Adult Koreans / 대한피부과학회지

BACKGROUND: Minimal erythema dose(MED), minimal melanogenic dose (MMD) and minimal phototoxic dose(MPD) of UVA-1 in Koreans has not been determined, although MED and MMD of UVB and MPD of UVA-2 in Koreans have been reported. OBJECTIVE: This study was done to measure the MED and MMDs including minimal immediate tanning dose(MITD) and minimal delayed tanning dose(MDTD) of UVA-1 radiation and compare the MPD of UVA-1 with that of UVA-2. METHODS: In this study, a metal halide lamp (SUPUVASUN 3000) and a fluorescent blacklight lamp (Philips TL 20W/09N UVA lamp) were used as the UVA-1 and UVA-2 light sources, respectively. After the determining of Fitzpatrick's skin phototypes, the back skins of young adults were irradiated and the MED, MITD and MDTD of UVA-1 were assessed at 24 hours, 1 hour, and 7 days after irradiation, respectively. The minimal doses of phototoxic reaction, which was induced by oral 8-MOP plus UVA-1 or UVA-2, were assessed visually 72 hours after irradiation. RESULTS: MED,was 61.20+/-11.50J/cm(mean+S.D.). MITD and MDTD of UVA-1 were 48.00+/-8.57J/cm and 65.30+/-12.10J/cm respectively. MPDs of UVA-1 and UVA-2 were 14.88+/-3.88J/cm and 4.40+/-1.69J/cm, respectively. CONCLUSION: In this study, the MED and MMD of UVA-1 radiation and the MPD of UVA-1 and UVA-2 radiation were measured in young adult Koreans. The MITD was less than the MED, and the MDTD was almost the same as the MED. The MPD of UVA-1 was three times higher than that of UVA-2. There vere no significant correlations between the MEDs, MMDs or MPDs and the skin phototypes.

Study of the Minimal Erythema Dose and Minimal Melanogenic Dose of UVA - 1 and Minimal Phototoxic Dose of UVA - 1 and UVA - 2 in Young Adult Koreans / 대한피부과학회지

BACKGROUND: Minimal erythema dose(MED), minimal melanogenic dose (MMD) and minimal phototoxic dose(MPD) of UVA-1 in Koreans has not been determined, although MED and MMD of UVB and MPD of UVA-2 in Koreans have been reported. OBJECTIVE: This study was done to measure the MED and MMDs including minimal immediate tanning dose(MITD) and minimal delayed tanning dose(MDTD) of UVA-1 radiation and compare the MPD of UVA-1 with that of UVA-2. METHODS: In this study, a metal halide lamp (SUPUVASUN 3000) and a fluorescent blacklight lamp (Philips TL 20W/09N UVA lamp) were used as the UVA-1 and UVA-2 light sources, respectively. After the determining of Fitzpatrick's skin phototypes, the back skins of young adults were irradiated and the MED, MITD and MDTD of UVA-1 were assessed at 24 hours, 1 hour, and 7 days after irradiation, respectively. The minimal doses of phototoxic reaction, which was induced by oral 8-MOP plus UVA-1 or UVA-2, were assessed visually 72 hours after irradiation. RESULTS: MED,was 61.20+/-11.50J/cm(mean+S.D.). MITD and MDTD of UVA-1 were 48.00+/-8.57J/cm and 65.30+/-12.10J/cm respectively. MPDs of UVA-1 and UVA-2 were 14.88+/-3.88J/cm and 4.40+/-1.69J/cm, respectively. CONCLUSION: In this study, the MED and MMD of UVA-1 radiation and the MPD of UVA-1 and UVA-2 radiation were measured in young adult Koreans. The MITD was less than the MED, and the MDTD was almost the same as the MED. The MPD of UVA-1 was three times higher than that of UVA-2. There vere no significant correlations between the MEDs, MMDs or MPDs and the skin phototypes.

The Effect of High Dose UVA - 1 and UVA - 2 Irradiation on the Expression of Surface Markers of Epidermal Langerhans Cells and Induction of contact Hypersensitivity in Mice Skin / 대한피부과학회지

BACKGROUND: It is knovn that Langerhans cells are damaged fuctionally and morphologically by UV irradiation. Recently, high-dose UVA-1 therapy (340-400nm) was introduced as an effective treatment of severe exacerbated atopic dermatitis. However, the effect of UVA-1 therapy on surface markers and function of epidermal Langerhans cells are still unclear. OBJECTIVE: To determine whether a high dose UVA-1 irradiation affects cutaneous immune system, the effect of UVA-1 on the expression of ATPase and Ia antigen of mouse epidermal Langerhans cells and induction of contact hypersensitivity in mice skin were investigated and were compared to those of UVA-2. METHODS: Balb/c mice were irradiated with 150J/cm and 300J/cm of UVA-1 and UVA-2 in a single dose at one time or 3 fractionated doses for 3 days. The number of Langerhans cells was evaluated using ATPase and immunoperoxidase-stained epidermal sheets. Balb/c mice were irradiated with same manner after induction of contact hypersensiyity by applying 0.5% oxazolone solution and the influence of UV irradiation was evaluated by measuring the ear swelling of mice. RESULTS: 1. The expression of surface markers of Langerhans cells was not affected by 150J/cm and fractionated 300J/cm of UVA-1. However, single irradiation of 300J/cm of UVA-1 reduced signifi-cantly the expression of surface markers. The irradiation of UVA-2 induced more prominent reduction of the expression of surface markers compared to UVA-l. 2. Although the induction of contact hypersensitity was not inhibited in groups irradiated by single or fractionated 150J/cm of UVA-1, it was inhibited in groups irradiated with 300J/cm of UVA-1. The inhibition of contact hypersensitivity induction by UVA-2 irradiation was also more prominent than that by UVA-1. CONCLUSION: These results suggest that epidermal Langerhans cells could be damaged by high doses of UVA-1 and the damage of Langerhans cells by UVA-1 is weaker than that by UVA-2.