Phototherapy in sclerotic skin diseases
DOI:
https://doi.org/10.12775/JEHS.2023.49.01.005Keywords
Scleroderma, Systemic, Scleroderma, Localized, Ultraviolet Therapy, PUVA TherapyAbstract
Introduction:
UVA therapy is used in treatment of wide range of skin diseases, which proceed with hardening of the skin or inflammation. First use of ultraviolet radiation can be tracked down to 1896. Wavelength vary among diseases against which it is used. In literature as results of therapy are mentioned improvement of skin elasticity, reduction of inflammation, and protection from relapse. In terms of sclerotic skin diseases most promising effect is seen in reducing skin hardness in the mechanism of stimulating collagen breakdown. The therapy itself has a good safety profile, but is time-consuming due to the high frequency of irradiation. Effectiveness of treatment are determined by factors such as advancement of skin lesions, pigmentation and the intensity of the therapy itself.
Aim of study:
The aim of the study is to summarize the available knowledge about the UVA therapy in skin diseases. The way of work, effectiveness of treatment, side effects and potential new methods of use were summarized and described.
Materials and methods:
The literature available in PubMed database was reviewed using following keywords:
“UVA therapy”, “UVA”, “Scleroderma”, “Buschke’s Scleredema”, “Systemic sclerosis”, “Morphea”
Conclusion:
UVA1 therapy is one of the most effective therapeutic options in subtypes of morphea which affect only superficial tissues. Phototherapy accelerate healing of ulcerations on fingertips in patients with Systemic sclerosis. Patient suffering from Buschke Sclerederma had good response to therapy. Observed side effects consist of hyperpigmentation, erythema, xerosis and pruritus in range from mild to severe. Carcinogenic effect has not yet been proven.
References
Finsen N, Forchhammer H. Resultate der Lichtbehandlung beiunseren ersten 800 Fällen von Lupus vulgaris. [Results of light therapy in our first 800 cases of lupus vulgaris] Mitt Fins Med Lichtinst. 1904;5(6):1-48.
https://doi.org/10.1039/c2pp25120e
Hönigsmann H. History of phototherapy indermatology. Photochem Photobiol Sci. 2012;12:16-21
https://doi.org/10.1039/c2pp25120e
Parrish JA, Fitzpatrick TB, Tanenbaum L, et al. Photochemotherapy of psoriasis with oral methoxsalen and longwave ultraviolet light. N Engl J Med 1974. 291(23):1207–11.
https://doi.org/10.1056/NEJM197412052912301
Plewig G, Hofmann C, Braun-Falco O, et al. A new apparatus for the delivery of high intensity UVA and UVA1UVB irradiation, and some dermatological applications. Br J Dermatol 1978;98(1):15–24.
https://doi.org/10.1111/j.1365-2133.1978.tb07328.x
Kroft, E. B. M., Berkhof, N. J. G., van de Kerkhof, P. C. M., Gerritsen, R. M. J. P., & de Jong, E. M. G. J. (2008). Ultraviolet A phototherapy for sclerotic skin diseases: A systematic review. In Journal of the American Academy of Dermatology (Vol. 59, Issue 6, pp. 1017–1030).
https://doi.org/10.1016/j.jaad.2008.07.042
Godar DE. UVA1 radiation triggers two different final apoptotic pathways. J Invest Dermatol 1999;112(1): 3–12.
https://doi.org/10.1046/j.1523-1747.1999.00474.x
Krutmann J, Honigsmann H, Elments CA, et al. Dermatological phototherapy and photodiagnostic methods. New York: Springer; 2001.
https://doi.org/10.1007/978-3-662-04511-4_19
Peterson L, Nelson A, Su W, et al. The epidemiology of morphea (localized scleroderma) in Olmsted County 1960-1993. J Rheumatol. 1997; 24:73-80.
PMID: 9002014.
Zulian F, Athreya BH, Laxer RM, Nelson AM, Feitosa-De Oliveira SK, Punaro MG, et al. Juvenile localized scleroderma: clinical and epidemiological features in 750 children. An international study. Rheumatology (Oxford). 2006;45:614-620.
https://doi.org/10.1093/rheumatology/kei251
Peterson LS, Nelson AM, Su WP. Classification of Morphea (Localized Scleroderma). Mayo Clin Proc. 1995;70:1068-76.
https://doi.org/10.4065/70.11.1068
Marzano AV, Menni S, Parodi A, Borghi A, Fuligni A, Fabbri P, et al. Localized scleroderma in adults and children. Clinical and laboratory investigations on 239 cases. Eur J Dermatol. 2003;13:171-6.
PMID: 12695134.
Krasowska D., Rudnicka L., Dańczak-Pazdrowska A., Chodorowska G., Woźniacka A., Lis-Święty A., Czuwara J., Maj J., Majewski S., Sysa-Jędrzejowska A., Wojas-Pelc A. Localized scleroderma (morphea). Diagnostic and therapeutic recommendations of the Polish Dermatological Society Dermatol Rev 2019, 106, 333–353
Daoud MS, Su WP, Leiferman KM, Perniciaro C. Bullous morphea: clinical pathologic and immunopathologic evaluation of 13 cases. J Am Acad Dermatol. 1994;30:937-43.
https://doi.org/10.1016/s0190-9622(94)70113-x
Florez-Pollack S., Kunzler E., Jacobe H.T.: Morphea: current concepts. Clin Dermatol 2018, 36, 475-486.
https://doi.org/10.1016/j.clindermatol.2018.04.005
Su WP, Greene SL. Bullous morphea profunda. Am J Dermatopathol 1986; 8:144-147
https://doi.org/10.1097/00000372-198604000-00009
Leitenberger JJ, Cayce RL, Haley RW, Adams-Huet B, Bergstresser PR, Jacobe HT. Distinct autoimune syndromes in morphea: a review of 245 adult and pediatric cases. Arch Dermatol. 2009;145:545-50.
https://doi.org/10.1001/archdermatol.2009.79
Christen-Zaech S, Hakim MD, Afsar FS, Paller AS. Pediatric morphea (localized scleroderma): review of 136 patients. J Am Acad Dermatol. 2008;59:385-96.
https://doi.org/10.1016/j.jaad.2008.05.005
Addison CH. Medico-chirurgical transactions of 1854 quoted by Fox TC: note on the history of scleroderma in England. Br J Dermatol. 1892;4:101.
https://doi.org/10.1590/abd1806-4841.20152890
Tollefson MM, Witman PM. En coup de sabre morphea and Parry-Romberg syndrome: a retrospective review of 54 patients. J Am Acad Dermatol. 2007;56:257-63.
https://doi.org/10.1016/j.jaad.2006.10.959
Azad J, Dawn G, Shaffrali FC, Holmes SC, Barnetson RJ, Forsyth A. Does solitary morphea profunda progress? Clin Exp Dermatol. 2004;29:25-7
https://doi.org/10.1111/j.1365-2230.2004.01422.x
Torrelo A, Suárez J, Colmenero I, Azorín D, Perera A, Zambrano A. Deep morphea after vaccination in two young children. Pediatr Dermatol. 2006;23:484-7.
https://doi.org/10.1111/j.1525-1470.2006.00289.x.
Morell A, Betlloch I, Sevila A, Bañuls J, Botella R. Morphea-like reaction from vitamin K1. Int J Dermatol. 1995;34:201-2
https://doi.org/10.1111/j.1365-4362.1995.tb01569.x
Alfaro-Cordero K. Morfea: el desequilibrio entre la producción y la destrucción del colágeno. Rev Med Cos. 2016;73:351-354.
García-Romero M, Laxer RM, Pope E. Localized scleroderma: symptoms, diagnosis and treatment. En: De Winter R, editor. Scleroderma symptoms, diagnosis and treatment. EE. UU.: Nova Science Publishers; 2013.
https://doi.org/10.24875/GMM.M20000336
Kerscher M, Dirschka T, Volkenandt M. Treatment of localized scleroderma by UVA1 phototherapy. Lancet 1995;346:1166.
https://doi.org/10.1016/s0140-6736(95)91843-4
Gambichler T, Schmitz L. Ultraviolet A1 phototherapy for fibrosing conditions. Front Med (Lausanne) 2018;5:237.
https://doi.org/10.3389/fmed.2018.00237
Vasquez R, Jabbar A, Khan F, et al. Recurrence of morphea after successful ultraviolet A1 phototherapy: A cohort study. J Am Acad Dermatol 2014; 70(3):481–8.
https://doi.org/10.1016/j.jaad.2013.10.018
Stege H, Berneburg M, Humke S, et al. High-dose UVA1 radiation therapy for localized scleroderma. J Am Acad Dermatol 1997; 36: 938–944.
https://doi.org/10.1016/s0190-9622(97)80277-0
Kreuter A, Hyun J, Stucker M, et al. A randomized controlled study of low-dose UVA1, medium-dose UVA1, and narrowband UVB phototherapy in the treatment of localized scleroderma. J Am Acad Dermatol 2006; 54: 440–447.
https://doi.org/10.1016/j.jaad.2005.11.1063
Buense R., Duarte I.A.G., Bouer M.: Localized scleroderma: assessment of the therapeutic response to phototherapy. An Bras Dermatol 2012, 87, 63-69.
https://doi.org/10.1590/s0365-05962012000100007
Rudnicka L., Olszewska M., Sar-Pomian M., Rakowska A., Współczesna Dermatologia ISBN 978-83-01-22603-9, Wydawnictwo Naukowe PWN S.A. Warszawa 2022 312-318.
von Kobyletzki G, Uhle A, Pieck C, et al. Acrosclerosis in patients with systemic sclerosis responds to low-dose UV-A1 phototherapy. Arch Dermatol 2000;136(2):275–6.
https://doi.org/10.1001/archderm.136.2.275
Kreuter A, Breuckmann F, Uhle A, et al. Low-dose UVA1 phototherapy in systemic sclerosis: effects on acrosclerosis. J Am Acad Dermatol 2004;50(5): 740–7.
https://doi.org/10.1016/j.jaad.2003.08.026
Knobler R, Moinzadeh P, Hunzelmann N, Kreuter A, Cozzio A, Mouthon L, et al. European dermatology forum S1-guideline on the diagnosis and treatment of sclerosing diseases of the skin, Part 2: Scleromyxedema, scleredema and nephrogenic systemic fibrosis. J Eur Acad Dermatol Venereol. 2017;31:1581-94
https://doi.org/10.1111/jdv.14458
L Linares-González , T Ródenas-Herranz , J L Espelt-Otero , R Ruiz-Villaverde. Buschke Sclerederma Refractory to Conventional Treatment: Response to UVA1 Phototherapy. Actas Dermosifiliogr (Engl Ed) 2021 May;112(5):466-468.
https://doi.org/10.1016/j.ad.2019.10.011
Kennemer C, Pavlidakey P, Sami N. Successful treatment with IVIg therapy of diabetes-associated scleredema severe progressive case and review of the literature. Dermatol Ther. 2017;30.
https://doi.org/10.1111/dth.12504
Janiga JJ, Ward DH, Lim HW. UVA-1 as a treatment for scleredema. Photodermatol Photoimmunol Photomed. 2004;20:210-1.
https://doi.org/10.1111/j.1600-0781.2004.00106.x
McGrath H Jr. Ultraviolet A1 (340-400 nm) irradiation and systemic lupus erythematosus. J Investig Dermatol Symp Proc 1999; 4: 79–84.
https://doi.org/10.1038/sj.jidsp.5640187
Wallenfang K, Stadler R. Association between UVA1 and PUVA bath therapy and development of malignant melanoma. Hautarzt 2001; 52: 705–707.
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Copyright (c) 2023 Bartłomiej Żmuda, Daniel Ślusarczyk, Piotr Pisera, Aleksandra Kiełkowicz, Zuzanna Popińska, Filip Pactwa, Wiktoria Jakubowska, Michał Żuberek
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