Ultraviolet A1 phototherapy: a British Photodermatology Group workshop report

Abstract

SummaryWhole-body ultraviolet (UV)A1 (340-400 nm) phototherapy was first introduced 30 years ago, but is currently available in the UK in only three dermatology departments. A workshop to discuss UVA1 was held by the British Photodermatology Group in May 2009, the aim of which was to provide an overview of UVA1 phototherapy and its role in practice, and to identify areas in which further studies are required. The conclusions were that UVA1 phototherapy is an effective treatment in several inflammatory skin diseases, including localized scleroderma and atopic eczema (AE); however, deficiencies and limitations exist in the published evidence base. For most diseases, such as AE, other treatments also exist, which are generally more effective than UVA1. However, for some diseases, particularly morphoea, the evidence of efficacy is stronger for UVA1 than for other treatments. Acute adverse effects of UVA1 are minimal. The risk of long-term adverse effects, particularly skin cancer, is unknown. Medium to high doses of UVA1 are needed for efficacy in most situations, but the equipment to deliver such doses is large, expensive and difficult to install. UVA1 is currently underprovided, and the recommendation of the workshop is that more tertiary centres should have access to UVA1 phototherapy in the UK.

Ultraviolet A1 Phototherapy in the Treatment of Early Mycosis Fungoides

“…UVA1 light has a deeper penetrance depth and provides much more tanning than PUVA and narrowband UVB, and thus initial uses were for phototesting or cosmetic purposes [5][6][7][8][9] . However, in the early 1990s, Krutmann and Schöpf [10] described for the first time that UVA1 phototherapy can be effectively used to treat atopic dermatitis.…”

Current Approach to Phototherapy Applications in Dermatology Practice: Part 1. History, Lamps, Ultraviolet Radiation Levels Measurement and Phototherapy Modalities

“…Lupus eritematozusta düşük doz, diğerlerinin tümünde orta doz UVA1 önerilmektedir. Etkili olabileceği diğer hastalıklar arasında kutanöz T hücreli lenfoma, sklerödem, nefrojenik sistemik fibrozis, nekrobiyozis lipoidika, kronik ürtiker, granüloma anülare, kutanöz sarkoidoz ve Graft versus host hastalığı sayılabilir (51)(52)(53).…”

“…Eritem, herpes simpleks reaktivasyonu, polimorf ışık erüpsiyonu diğer yan etkiler arasında sayılabilir. İlaçlarla indüklenen fotosensitivite başlıca UVA spektrumunda gerçekleştiği için, UVA1 tedavisi sırasında fotoaktif ilaç kullanımı fototoksisiteye yol açabilir (51)(52)(53).…”

“…Ancak bugüne kadar bu konuyla ilgili kesin bir veri yoktur. Yine de, İngiliz Fotodermatoloji Grubu, 200 seanstan fazla tedavi uygulanmış hastalarda, deri kanseri açısından düzenli izlem önermektedir (51).…”

Ultraviolet light A irradiation induces immunosuppression associated with the generation of reactive oxygen species in human neutrophils

“…The deeper penetration and lower phototoxicity of long-wavelength Ultraviolet light A (UVA, 320-400 nm) compared to that of shortwavelength UV light (200-320 nm) provided a rational for scientists to investigate the di®erent e®ects of UVA on human health. 1,2 UVA has been demonstrated to be e®ective in the treatment of sclerotic skin diseases 3 and, at appropriate doses, resulted in the up-regulation of the heme oxygenase-1, which played an important role in protection of skin. 4,5 EI-Mofty et al suggested that the e±cacy of UVA phototherapy in the treatment of localized scleroderma was mainly obtained by the increased production of collagenase.…”