Phototherapy in Scleroderma

Abstract

Systemic and localized scleroderma are difficult to manage diseases with no accepted gold standard of therapy to date. Phototherapeutic modalities for scleroderma show promise. A PubMed search of information on phototherapy for scleroderma was conducted. The information was classified into effects on pathogenesis and clinical outcomes. Studies on photopheresis were excluded. There were no randomized, double-blind, placebo-controlled studies, and only three controlled studies. The vast majority of identified studies evaluated ultraviolet A1 (UVA1) phototherapy. More rigorous studies are needed to evaluate phototherapy in the treatment of scleroderma. Based on the limited studies available, 20–50 J/cm2 of UVA1 therapy 3–4 times a week for 30 treatments is recommended.

Localized scleroderma – current treatment options

“…immune dysregulation, collagen overproduction and endothelial cell dysfunction [9]. UVA-1 increases the concentration of collagenases (MMP, extracellular matrix metalloproteinases), decorin and interferon γ (INF-γ), and inhibits the production of TGF-β, hydroxyproline, IL-6 and IL-8 [10]. The frequency of UVA-1 is 3-5 times a week, and the total number of treatments is usually ≥ 30 [2,3].…”

“…Działanie terapeutyczne odbywa się poprzez wpływ na czynniki, które indukują włóknienie tkanek, takie jak dysregulacja immunologiczna, nadprodukcja kolagenu i dysfunkcja komórek śródbłonka [9]. UVA1 zwiększa stężenie kolagenaz (MMP, metaloproteinaz macierzy pozakomórkowej), dekoryny i interferonu γ (INF-γ), a także hamuje produkcję TGF-β, hydroksyproliny, IL-6 i IL-8 [10]. Naświetlania wykonywane są 3-5 razy w tygodniu, najczęściej w łącznej liczbie ≥ 30 [2,3].…”

“…puVA PUVA comprises UVA phototherapy in combination with psoralen which can be administered either topically (PUVA-bath, PUVA-soak) or orally. PUVA's mechanism of action is based on decreasing the concentration of vascular cell adhesion molecules (VCAM) and increasing the serum level of tumour necrosis factor α (TNF-α) in patients with localized scleroderma [10]. Systemic therapy should begin with a dose equivalent to 50-70% of MPD, and topical therapy with a dose corresponding to 30% of MPD [3,7].…”

“…The method exerts antiinflammatory properties by increasing the synthesis of IL-10, and inhibits the process of fibrosis through its effect on TGF-β [14]. A study conducted in a group of 6 patients with localized scleroderma treated with PDT has demonstrated a significant therapeutic effect in 4 subjects [10]. Photodynamic therapy treatments were applied at weekly intervals (6 treatments in total) with light at a wavelength of 570-670 nm, at a dose of 25 J/cm 2 [10].…”

Drug Delivery Systems for Phthalocyanines for Photodynamic Therapy

“…In dermatology, topical PDT is effective for dermatooncological or precancerous skin conditions like squamous cell carcinoma (6,7) and superficial basal cell carcinoma (8)(9)(10), actinic keratosis (11,12), Bowen's disease (4,5,(13)(14)(15), mycosis fungoides (an indolent subtype of cutaneous T cell lymphoma) (9,(16)(17)(18)(19), Kaposi's sarcoma, extramammary Paget's disease, and cutaneous B cell lymphoma (20) as well as for other proliferative disorders, such as vascular malformations (21) or keloid scars (22)(23)(24). In aesthetic dermatology PDT is extensively used for the treatment of inflammatory dermatoses that have a high psychological impact, like localized scleroderma (25,26), acne vulgaris (27)(28)(29), rosacea (30,31) and granuloma annulare (32)(33)(34), as well as for aesthetic indications like photo aged skin or sebaceous gland hyperplasia (4,35,36). PDT is useful for the treatment of various viral diseases such as warts (human papilomavirus) (37)(38)(39) or viral skin lesions (molluscum contagiosum and herpes simplex) (4,5,40), various mycotic disea...…”