Ultraviolet A1 phototherapy: One center's experience

Attili, Sasi Kiran; Dawe, Robert S.; Ibbotson, Sally H.

doi:10.4103/0378-6323.182805

Cited by 16 publications

(18 citation statements)

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“…These differences account for the healing action of UV-A1 wavelengths when contrasted with the noxious effects of the shorter UV wavelengths in patients with lupus. [3][4][5][6][7][8][9][10][11][12][13][14] The primary target of UV photons is the skin. The shortest terrestrial band of wavelengths, UV-B, penetrates to the superficial papillary dermis, deep enough to be absorbed by and do damage to epidermal DNA.…”

Section: Introductionmentioning

confidence: 99%

Ultraviolet-A1 irradiation therapy for systemic lupus erythematosus

McGrath

2017

Lupus

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Systemic lupus erythematosus (lupus, SLE) is a chronic autoimmune disease characterized by the production of autoantibodies, which bind to antigens and are deposited within tissues to fix complement, resulting in widespread systemic inflammation. The studies presented herein are consistent with hyperpolarized, adenosine triphosphate (ATP)-deficient mitochondria being central to the disease process. These hyperpolarized mitochondria resist the depolarization required for activation-induced apoptosis. The mitochondrial ATP deficits add to this resistance to apoptosis and also reduce the macrophage energy that is needed to clear apoptotic bodies. In both cases, necrosis, the alternative pathway of cell death, results. Intracellular constituents spill into the blood and tissues, eliciting inflammatory responses directed at their removal. What results is “autoimmunity.” Ultraviolet (UV)-A1 photons have the capacity to remediate this aberrancy. Exogenous exposure to low-dose, full-body, UV-A1 radiation generates singlet oxygen. Singlet oxygen has two major palliative actions in patients with lupus and the UV-A1 photons themselves have several more. Singlet oxygen depolarizes the hyperpolarized mitochondrion, triggering non-ATP-dependent apoptosis that deters necrosis. Next, singlet oxygen activates the gene encoding heme oxygenase (HO-1), a major governor of systemic homeostasis. HO-1 catalyzes the degradation of the oxidant heme into biliverdin (converted to bilirubin), Fe, and carbon monoxide (CO), the first three of these exerting powerful antioxidant effects, and in conjunction with a fourth, CO, protecting against injury to the coronary arteries, the central nervous system, and the lungs. The UV-A1 photons themselves directly attenuate disease in lupus by reducing B cell activity, preventing the suppression of cell-mediated immunity, slowing an epigenetic progression toward SLE, and ameliorating discoid and subacute cutaneous lupus. Finally, a combination of these mechanisms reduces levels of anticardiolipin antibodies and protects during lupus pregnancy. Capping all of this is that UV-A1 irradiation is an essentially innocuous, highly manageable, and comfortable therapeutic agency.

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Section: Introductionmentioning

confidence: 99%

Ultraviolet-A1 irradiation therapy for systemic lupus erythematosus

McGrath

2017

Lupus

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“…After title and abstract screening of 452 articles and full‐text review of 45 articles, 31 articles were ultimately included in our review (Figure 1). 10‐45 Two studies of which were conference abstracts and five not in the English language. Studies were published between 1988 and 2020 and included 31 case series (Table ).…”

Section: Resultsmentioning

confidence: 99%

Light‐ and laser‐based treatments for granuloma annulare: A systematic review

Mukovozov

Kashetsky

Richer

2021

Photoderm Photoimm Photomed

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Background: Granuloma annulare (GA) is challenging to treat, especially when generalized. A systematic review to support the use of light-and laser-based treatments for GA is lacking. Methods:We performed a systematic review by searching Cochrane, MEDLINE, and Embase. Title, abstract, full-text screening, and data extraction were done in duplicate. Quality appraisal was performed using the Joanna Briggs Institute critical appraisal tool for case series.Results: Thirty-one case series met the inclusion criteria, representing a total of 336 patients. Overall, psoralen ultraviolet light A (PUVA) showed the greatest frequency of cases with complete response (59%, n = 77/131), followed by photodynamic therapy (PDT) (52%, n = 13/25), ultraviolet light B (UVB)/narrowband UVB (nbUVB)/excimer laser (40%, n = 19/47), UVA1 (31%, n = 27/86), and lasers (29%, n = 8/28). Overall across treatment modalities, higher response rates were seen in localized GA compared to generalized GA. Conclusions:The body of evidence for light-and laser-based treatment of GA is sparse. Our results suggest that PUVA has a high clearance rate for GA but its use may be limited by concerns of carcinogenesis. Although PDT has the second highest clearance rate, adverse effects, small sample sizes, impractical treatment delivery (especially with generalized disease), and long-term concerns of carcinogenesis may limit its use. Although UVB/nbUVB/excimer laser appeared slightly less effective than other light therapies, we recommend UVB/nbUVB/excimer laser therapy as a first-line treatment for patients with generalized GA given wider availability and a favorable long-term safety profile.

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“…Положительный эффект наблюдался через месяц терапии, при этом около 64% пациентов достигли полного или частичного регресса высыпаний [54]. Имеются отдельные публикации об эффективности методов фототерапии при диссеминированной форме кольцевидной гранулемы [55][56][57][58]. В результате использования методов дальней длинноволновой ультрафиолетовой терапии, узкополосной (311 нм) фототерапии, ПУВА-терапии отмечалась положительная динамика в виде частичного или полного регресса высыпаний.…”

Section: Discussionunclassified

Combination treatment of disseminated granuloma annulare

Карамова

Эдурдовна²,

ZNAMENSKAYA

et al. 2020

Vestnik dermatologii i venerologii

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Purpose. To present the results of the treatment of disseminated form of granuloma annulare with remote long-wave ultraviolet therapy and low level laser therapy. Material and methods. Two female patients at the age of 50 and 53 years with complaints of generalised eruptions on the skin of the trunk, upper and lower limbs and a histologically confirmed diagnosis were treated using a combination of remote long-wave ultraviolet therapy and low level laser therapy of infrared spectrum. 16 sessions of remote long-wave ultraviolet therapy and 10 sessions of low level laser therapy were conducted directly on the lesions. Considering the multidirectionality of the mechanisms of action of phototherapy and laser therapy, the procedures were carried out on different days or with many hours long intervals. Results. Combined use of the remote long-wave ultraviolet therapy and laser therapy led to a significant improvement by the 21st day of the treatment. No side effects were noticed during the treatment, tolerance of the sessions was good. Conclusion. Combined use of the remote long-wave ultraviolet therapy and low level laser therapy of infrared spectrum is effective in treatment of disseminated form of granuloma annulare.

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Ultraviolet A1 phototherapy: One center's experience

Abstract: Our data suggest that ultraviolet A1 can be considered for the treatment of selected dermatoses. However, long-term malignancy risk is as yet unknown.

Cited by 16 publications

References 0 publications

Ultraviolet-A1 irradiation therapy for systemic lupus erythematosus

Ultraviolet-A1 irradiation therapy for systemic lupus erythematosus

Light‐ and laser‐based treatments for granuloma annulare: A systematic review

Combination treatment of disseminated granuloma annulare

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