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Low-dose UVA1 phototherapy in systemic sclerosis: effects on acrosclerosis

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Abstract

Background

Increased collagen synthesis, vascular damage, and T-lymphocytic infiltration contribute to the development of systemic sclerosis. Preliminary studies revealed the effectiveness of low-dose UVA1 phototherapy in acrosclerosis.

Objective

We sought to confirm data of a pilot study revealing the efficacy of low-dose UVA1 irradiation in acrosclerosis in a larger number of patients.

Methods

Symptoms of 18 patients receiving low-dose UVA1 phototherapy were evaluated clinically and biometrically in an open, nonrandomized study. A number of pretherapeutic and posttherapeutic biopsy specimens were tested immunohistochemically for matrix-metalloproteinase-1.

Results

UVA1 irradiation led to softening of former stiffness reflected by a significant decrease of the hand score, increase of total skin distension, and reduction of skin thickness. Posttherapeutically, matrix-metalloproteinase-1 immunolabeling revealed a significant dermal elevation of collagenase.

Conclusion

Low-dose UVA1 phototherapy is a capable treatment option for acrosclerosis. Its beneficial effect may be mediated by the induction of collagenases and a reduction of collagen deposition and cellular infiltration.

Section snippets

Patients

This open, nonrandomized study included 18 patients (1 man and 17 women), aged 39 to 81 years (median age: 58.5 years). Data of 8 patients have previously been reported in part.20 All patients (n = 18) had systemic sclerosis associated with diffuse cutaneous sclerosis, pronounced acral edema and sclerosis, and–in 4 patients–even piecemeal necrosis (average duration of disease: 6 years). In all, 15 patients were classified as limited, and 3 patients were characterized by the diffuse

Results

All 18 patients accepted and completed the applied low-dose UVA1 phototherapy. Except for a mild tanning, no acute side effects were observed. Posttherapeutic clinical benefit was reflected by a clear reduction of sclerosis. In 16 patients, palpation and inspection showed a marked softening of the formerly affected skin, an improvement of finger mobility, and—in 4 cases—an almost complete healing of the piecemeal necrosis (Fig 1, Fig 2). Only 2 patients showed no or just a slight improvement

Discussion

Scleroderma represents a rare chronic disorder of the connective tissue of unknown origin affecting various organs (eg, musculoskeletal, gastrointestinal, renal, cardiac, and pulmonary involvement) including the skin.23, 24, 25, 26 No causal therapy, either in limited or in diffuse sclerosis, has so far been achieved.27

High- and medium-dose UVA1 phototherapy have been used in the treatment of various T cell–derived skin diseases.28, 29, 30, 31 Low-dose UVA1 phototherapy has been shown to be

Acknowledgements

This work is part of the doctoral thesis of Andrea Uhle.

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    Funding sources: None.

    Conflicts of interest: None identified.

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