UVA-1 cold light treatment of SLE: a double blind, placebo controlled crossover trial

Abstract

Objective-Treatment of patients with systemic lupus erythematosus (SLE) often implies strong drugs with possibly serious side eVects. Thus there is a need for new immunosuppressive treatments. Long wave ultraviolet A (UVA-1) cold light therapy is an anti-inflammatory, immunomodulatory treatment with a possible systemic eVect and few side eVects. In the current study low dose UVA-1 cold light treatment was tested to determine whether it reduces disease activity in SLE. Methods-Eleven patients with SLE were treated with UVA-1 cold light treatment and a placebo light treatment in a double blind, placebo controlled, crossover study. In two consecutive 12 week periods the patients were treated in the first three weeks with UVA-1 and placebo treatment or vice versa. The primary variables were the SLE Disease Activity Index (SLEDAI) and SLE Activity Measure (SLAM). Results-The mean SLAM and SLEDAI showed a significant decrease of 30.4% (p=0.0005) and 37.9% (p=0.016) respectively after three weeks of UVA-1 and a non-significant decline of 9.3% (p=0.43) and 12.2% (p=0.54) respectively after three weeks of placebo treatment. In this small trial the diVerence in reduction of the disease activity indices during UVA-1 compared with during placebo treatment failed to reach the conventional border of significance (p=0.07). The total score of quality of life measure RAND-36 did not improve significantly, but the subscore for vitality did improve. Conclusion-Low dose UVA-1 cold light treatment was strongly suggestive of lowering disease activity in this double blind placebo controlled study, and no side eVects occurred.

Chronic Graft-versus-Host-Disease-Like Dermopathy in a Child with CD4+ Cell Microchimerism

“…Both, scleroderma and lupus erythematosus respond well to low- or medium-dose UVA1 phototherapy [2, 3, 4, 5, 6, 7]. In our case displaying clinical features of both entities, we used a treatment schedule suggested by Sönnichsen et al [4]for subacute cutaneous lupus erythematosus.…”

“…We report here on a boy who had CD4+ cell microchimerism with maternal cells and who presented himself with a severe chronic progressive skin disease with clinical and histological features similar to features of chronic graft-versus-host disease. Since his skin did not respond well to systemic immunosuppressive drugs including prednisolone, azathioprine, cyclosporine A and mycophenolate mofetil alone, we decided to treat with UVA1 phototherapy which has been shown to improve scleroderma [2, 3], lupus erythematosus [4, 5, 6, 7]and chronic graft-versus-host disease [8]. We report here on the good clinical effect of this treatment on his skin involvement.…”

Granulomatous Slack Skin Responds to UVA1 Phototherapy

“…Its use has lately been documented mainly in atopic dermatitis [6,7,8], localized scleroderma [9,10] and in lichenoid dermatosis [11]. Other diseases responding to UVA1 phototherapy include keloids [12], urticaria pigmentosa [13] and systemic lupus erythematosus [14]. The value of using UVA1 in the treatment of cutaneous lymphomas has also been qualified by several authors [15,16,17,18].…”

Cutaneous lupus erythematosus: Update of therapeutic options

“…56 In another published double-blind, placebocontrolled (visible light), crossover study, which was performed in 11 patients with SLE in two consecutive 1-week periods, it was strongly suggested that low-dose UVA1 treatment reduces disease activity. 57 Recently, UV-hardening therapy was claimed as a novel intervention in patients with photosensitive CLE. In a retrospective study of continuous, homebased, UVB hardening therapy, 44 patients with confirmed photosensitivity and cutaneous manifestations of LE were included (9 SLE, 21 DLE, 10 SCLE, 4 not-specified CLE).…”