Low-dose UVA1 phototherapy for treatment of localized scleroderma

Kerscher, Martina; Volkenandt, Matthias; Gruss, Claus; Reuther, T.; Kobyletzki, Gregor von; Freitag, Marcus; Dirschka, Thomas; Altmeyer, Peter

doi:10.1016/s0190-9622(98)70533-x

Cited by 185 publications

(154 citation statements)

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“…Furthermore, no patient discontinued MTX therapy due to adverse events. Over the years, many treatments of localized scleroderma have been reported, including topical and systemic corticosteroids (18,19), topical and systemic calcipotriol (18,(20)(21)(22), topical tacrolimus (23), interferon-␥ (24), phototherapy (25,26), and methotrexate (4)(5)(6)(7)(8)27,28). Only 2 double-blind placebo-controlled studies, both in adult patients, have been reported, and, perhaps because of small sample size and Type II error, neither demonstrated superior benefit of the tested treatment compared to placebo (22,24).…”

Section: Discussionmentioning

confidence: 99%

Methotrexate treatment in juvenile localized scleroderma: A randomized, double-blind, placebo-controlled trial

Zulian¹,

Martini²,

Vallongo³

et al. 2011

Arthritis & Rheumatism

190

151

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Objective. Juvenile localized scleroderma is a chronic progressive fibrotic disorder of the skin that causes permanent disability and aesthetic damage. This study was undertaken to assess the safety and efficacy of methotrexate (MTX) in the treatment of juvenile localized scleroderma.Methods. In this double-blind study, patients with active juvenile localized scleroderma were randomized (2:1) to receive oral MTX (15 mg/m 2 , maximum 20 mg) or placebo once weekly, for 12 months or until treatment failure. Both groups received oral prednisone (1 mg/kg/ day, maximum 50 mg) for the first 3 months. A target lesion was evaluated clinically, with infrared thermography and using a computerized scoring system with skin score rate (SSR) evaluation. Response to treatment was defined as the absence of new lesions, SSR <1, and a decrease in lesion temperature of at least 10% compared to baseline. Treatment failure was defined as the occurrence of new lesions, SSR >1, or increased lesion temperature. All analyses were done on the intent-totreat population.Results. Of the 85 patients screened, 70 (ages 6-17 years) were randomized (46 to the MTX group, 24 to the placebo group). The mean disease duration was 2.3 years. After an initial response in all patients, disease relapsed in 15 MTX-treated patients (32.6%) and 17 placebo-treated patients (70.8%) (P < 0.005). New lesions appeared in 3 MTX-treated patients (6.5%) versus 4 placebo-treated patients (16.7%). The mean SSR decreased from 1 to 0.79 in the MTX group and increased from 1 to 1.1 in the placebo group, and the mean target lesion temperature decreased by 44.4% in the MTX group versus 12.1% in the placebo group. Twenty-six patients in the MTX group (56.5%) and 11 patients in the placebo group (45.8%) developed mild side effects related to treatment. None of the side effects were severe enough to necessitate treatment discontinuation.Conclusion. Our findings indicate that MTX is efficacious in the treatment of juvenile localized scleroderma and is well tolerated.

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Section: Discussionmentioning

confidence: 99%

Methotrexate treatment in juvenile localized scleroderma: A randomized, double-blind, placebo-controlled trial

Zulian¹,

Martini²,

Vallongo³

et al. 2011

Arthritis & Rheumatism

190

151

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“…Shortly thereafter, Kerscher et al reported excellent results using low-dose UVA1 (20 J/cm 2 ) in 20 patients for a total of 30 sessions [23]. Since that time, similar results have been reported.…”

Section: Morphea (Localized Scleroderma)mentioning

confidence: 67%

“…In most studies, treatment was delivered five times per week. Outcome measures included change in clinical examination, skin score, ultrasound measurements, cutometer measurements, skin biopsy specimens or a composite of these measures [21,23,25,[27][28][29]. More recently, Sator et al conducted a randomized controlled study to evaluate the immediate-and long-term efficacy of low-dose versus medium-dose UVA1 phototherapy [29].…”

Section: Morphea (Localized Scleroderma)mentioning

confidence: 99%

Phototherapy for sclerosing skin conditions

Vasquez

Jacobe²

2011

Expert Review of Dermatology

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“…Phototherapy, particularly UVA1, has showed benefit in scleroderma in largely uncontrolled trials. 81 Kerscher et al 82 was among the first to report the benefit of low-dose UVA1 for patients with morphea. In terms of demonstration of efficacy, the use of UVA1 phototherapy for morphea is second only to methotrexate.…”

Section: Uv Phototherapy For Skin and Other Disordersmentioning

confidence: 99%