Ultraviolet A1 Phototherapy for Fibrosing Conditions

Abstract

In this article we describe efficacy and safety aspects of ultraviolet A1 (UV-A1) phototherapy in fibrosing conditions. UV-A1 is a specific phototherapeutic modality that is defined by a selective spectral range (340–400 nm). UV-A1 includes distinct modes of action qualifying this method for therapy of a variety of conditions, in particular fibrosing skin diseases. Concerning efficacy of UV-A1 phototherapy in fibrosing conditions, the best evidence obtained from randomized controlled trials exists for localized scleroderma. Moreover, fibrosing disorders such as lichen sclerosus and graft-vs.-host disease can be treated successfully by means of UV- A1. Regarding the optimal dosage regimen medium-dose UV-A1 seems to be linked to the best benefit/risk ratio. Possible acute adverse events of UV-A1 phototherapy include erythema and provocation of photodermatoses. Skin ageing and skin cancer formation belong to the chronic adverse events that may occur after long-term UV-A1 phototherapy.

Differences in phototherapy among skin diseases and genders in real‐life conditions—A retrospective analysis of the cumulative doses, numbers of sessions, side effects and costs in 561 patients

“…However, in some study protocols (particularly for fibrosing conditions) higher doses had been used. 53,54 Our analysis revealed that males have been treated both with significantly higher cumulative UV doses more sessions than females. The same was true for males treated with cabin NB-UVB for pruritus or an autoimmune/inflammatory dermatosis.…”

Biological effects of a new ultraviolet A1 prototype based on light‐emitting diodes on the treatment of localized scleroderma

“…[7][8][9][10][11][12][13] The development of UVA 1 phototherapy (340-400 nm) has highly improved treatment of LS. [14,15] Because UVA 1 light is less erythematogenic than broadband UVA, it is possible to apply much higher doses of UVA 1 without the risk of sunburn.UVA 1 light penetrates deeper into the skin than UVB and UVA 2. [16] In the first prospective study on LS, high-dose UVA 1 light (130 J/cm 2 ) was highly effective in reducing skin sclerosis, and some patients even showed complete clearance.…”

“…Lowdose to medium-dose UVA 1 phototherapy is usually conducted by means of fluorescent lamp cubicles, that is full-body UV cabins, allowing the irradiation of large body areas; in contrast, metal-halide lamps are more often used for high-dose UVA 1 treatments. [14,18,19] Despite…”

“…Low‐dose to medium‐dose UVA 1 phototherapy is usually conducted by means of fluorescent lamp cubicles, that is full‐body UV cabins, allowing the irradiation of large body areas; in contrast, metal‐halide lamps are more often used for high‐dose UVA 1 treatments. [ 14,18,19 ] Despite the therapeutic success of conventional lamps in the treatment of LS, these light sources should be further developed in terms of biosafety and patient comfort. For patients, conventional therapy involves long irradiation times per therapy session (up to 60 minutes) and treatment durations (up to 40 sessions) as well as possible discomfort due to severe heat from the light sources (up to 40°C).…”

Keloids: a review of therapeutic management

“…Ultraviolet A1 (UV‐A1) phototherapy in the spectral range of 340–400 nm induces increased collagenase activity 4 . Evidence supports its use for fibrosing disorders, including localized scleroderma, lichen sclerosus et atrophicus, and graft‐versus‐host disease 81 . Only a few studies to date have tested UV‐A1 phototherapy in treating keloids in a total of six patients with mixed results 82‐84 …”