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Calzavara-Pinton P, Bettolini L, Tonon F, Rossi M, Venturini M. The realistic positioning of UVA1 phototherapy after 25 years of clinical experience and the availability of new biologics and small molecules: a retrospective clinical study. Front Med (Lausanne) 2023; 10:1295145. [PMID: 38076241 PMCID: PMC10702775 DOI: 10.3389/fmed.2023.1295145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/08/2023] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Since the early 1990s, Ultraviolet (UV) A1 phototherapy has been described as an effective and safe treatment of a multitude of skin disorders. However, after 30 years, its use has remained limited to few dermatological centers. OBJECTIVE To analyze the changes over the years and the current position of UVA1 phototherapy through a Real-World Evidence (RWE) study at a single tertiary referral center. METHODS We reviewed the medical files of 740 patients treated between 1998 and 2022. Treatment results were collected, efficacy was assessed by a grading scale and acute adverse effects were registered. RESULTS We treated patients with 26 different diseases. We registered marked improvement (MI) or complete remission (CR) in 42.8% of patients with morphea, 50% with Urticaria Pigmentosa, 40.7% with Granuloma annulare and 85.7% with skin sarcoidosis. Good results were obtained also in the treatment of chronic Graft Versus Host Disease (GVHD), Eosinophilic Fasciitis, Sclero-atrophic Lichen, skin manifestations of systemic lupus erythematosus and psoriasis of HIV+ patients. Systemic Sclerosis, Romberg's Syndrome, Bushke's Scleredema, Nephrogenic Fibrosing Dermopathy, REM Syndrome, Follicular Mucinosis, Pretibial Myxedema, Scleromyxedema, pemphigus foliaceus, chronic cutaneous lupus erythematosus, erythroderma of Netherton Syndrome and Necrobiosis Lipoidica were no or poorly responsive. In clinical indications where UVA1 was used as a second line phototherapy after narrow-band (NB)-UVB, we saw good MI or CR rates in Mycosis Fungoides (57% of patients), Atopic Dermatitis (33.9%), Pitiryasis Lichenoides chronica (50%), Pityriasis Lichenoides et varioliformis acute (75%) and Lymphomatod Papulosis (62.5%). Short-term adverse events were uncommon and mild. CONCLUSION Over the past decade, the annual number of treated patients has progressively declined for several reasons. Firstly, UVA1 phototherapy has taken a backseat to the cheaper and more practical NB-UVB phototherapy, which has proven effective for common indications. Secondly, the emergence of new, safe, and effective drugs for conditions such as atopic dermatitis, GVHD, and connective tissue disorders. Finally, our research has shown that UVA1 therapy is often ineffective or minimally effective for some rare diseases, contrary to previous case reports and small case series. Nonetheless, UVA1 continues to be a valuable treatment option for patients with specific skin disorders.
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Affiliation(s)
- Piergiacomo Calzavara-Pinton
- Department of Dermatology, University of Brescia, Brescia, Italy
- Department of Dermatology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Luca Bettolini
- Department of Dermatology, University of Brescia, Brescia, Italy
- Department of Dermatology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Francesco Tonon
- Department of Dermatology, University of Brescia, Brescia, Italy
- Department of Dermatology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Mariateresa Rossi
- Department of Dermatology, University of Brescia, Brescia, Italy
- Department of Dermatology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Marina Venturini
- Department of Dermatology, University of Brescia, Brescia, Italy
- Department of Dermatology, ASST Spedali Civili di Brescia, Brescia, Italy
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Stege H, Ghoreschi K, Hünefeld C. [UV phototherapy : UV phototherapy and photodiagnostics-a practical overview]. Hautarzt 2021; 72:14-26. [PMID: 33394067 DOI: 10.1007/s00105-020-04744-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
UV phototherapy is an essential and efficient therapeutic option in the treatment of dermatological diseases. It is an integral part of multiple guidelines and maintains its high clinical significance despite the development of new therapeutic options for systemic treatment. Due to the difficult revenue situation, the market for ready-to-use products of psoralen and UV therapy devices is constantly changing.
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Affiliation(s)
- H Stege
- Klinik für Dermatologie, Klinikum Lippe, Röntgenstr. 18, 32756, Detmold, Deutschland.
| | - K Ghoreschi
- Klinik für Dermatologie, Venerologie u. Allergologie, Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Deutschland
| | - C Hünefeld
- Klinik für Dermatologie, Venerologie u. Allergologie, Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Deutschland.
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3
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Herzinger T, Berneburg M, Ghoreschi K, Gollnick H, Hölzle E, Hönigsmann H, Lehmann P, Peters T, Röcken M, Scharffetter-Kochanek K, Schwarz T, Simon J, Tanew A, Weichenthal M. S1-Leitlinie zur UV-Phototherapie und Photochemotherapie. J Dtsch Dermatol Ges 2018; 14:e1-e25. [PMID: 27509439 DOI: 10.1111/ddg.12912_g] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Die heilsame Wirkung des Sonnenlichts war teilweise schon im Altertum bekannt und fand in der zweiten Hälfte des 19. Jahrhunderts wieder zunehmend Beachtung. Den Beginn der modernen Phototherapien markiert die Entwicklung einer Apparatur zur ultravioletten Bestrahlung der Hauttuberkulose durch Finnsen zu Beginn des zwanzigsten Jahrhunderts. Zur Therapie von Hauterkrankungen finden beinahe ausschließlich die spektralen Bereiche unterhalb des sichtbaren Lichtes (ultraviolett) Anwendung. Seit den 1970er Jahren stehen zunehmend leistungsfähige künstliche Strahlenquellen bereit für die Therapie mit UVB, UVA und die Kombination von UVA mit Photosensibilisatoren (Photochemotherapie). Hohe strukturelle und prozedurale Qualitätsstandards sind unabdingbare Voraussetzung für die Durchführung einer gleichermaßen wirkungsvollen wie auch sicheren Phototherapie. Die Leitlinie formuliert den aktuellen Konsens führender Experten auf dem Gebiet der Phototherapie in Bezug auf die Indikationen für die jeweiligen Therapieverfahren, deren Gegenanzeigen und Nebenwirkungen und insbesondere für die Wahl der korrekten Dosis zu Beginn und im Verlauf einer Therapie sowie das Management von Nebenwirkungen.
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Affiliation(s)
- Thomas Herzinger
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München
| | - Mark Berneburg
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
| | | | - Harald Gollnick
- Universitätsklinik für Dermatologie und Venerologie, Otto-von-Guericke-Universität Magdeburg
| | - Erhard Hölzle
- Klinik für Dermatologie und Allergologie, Klinikum Oldenburg
| | - Herbert Hönigsmann
- Universitätsklinik für Dermatologie, Allgemeines Krankenhaus der Stadt Wien
| | - Percy Lehmann
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, HELIOS-Klinikum Wuppertal
| | - Thorsten Peters
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Ulm
| | | | | | | | - Jan Simon
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig
| | - Adrian Tanew
- Universitätsklinik für Dermatologie, Allgemeines Krankenhaus der Stadt Wien
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4
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Herzinger T, Berneburg M, Ghoreschi K, Gollnick H, Hölzle E, Hönigsmann H, Lehmann P, Peters T, Röcken M, Scharffetter-Kochanek K, Schwarz T, Simon J, Tanew A, Weichenthal M. S1-Guidelines on UV phototherapy and photochemotherapy. J Dtsch Dermatol Ges 2016; 14:853-76. [DOI: 10.1111/ddg.12912] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Thomas Herzinger
- Department of Dermatology and Allergology; Ludwig Maximilians University; Munich Germany
| | - Mark Berneburg
- Department of Dermatology; University Medical Center; Regensburg Germany
| | | | - Harald Gollnick
- Department of Dermatology and Venereology; University Hospital; Otto von Guericke University; Magdeburg Germany
| | - Erhard Hölzle
- Department of Dermatology and Allergology; Medical Center Oldenburg; Oldenburg Germany
| | | | - Percy Lehmann
- Department of Dermatology; Allergology and Dermatosurgery; HELIOS-Medical Center; Wuppertal Germany
| | - Thorsten Peters
- Department of Dermatology and Allergology; University Medical Center; Ulm Germany
| | | | | | | | - Jan Simon
- Department of Dermatology; Venereology and Allergology; University Medical Center; Leipzig Germany
| | - Adrian Tanew
- Department of Dermatology; General Hospital of Vienna; Vienna Austria
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6
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Tchernev G, Cardoso JC, Chokoeva AA, Verma SB, Tana C, Ananiev J, Gulubova M, Philipov S, Kanazawa N, Nenoff P, Lotti T, Wollina U. The "mystery" of cutaneous sarcoidosis: facts and controversies. Int J Immunopathol Pharmacol 2014; 27:321-30. [PMID: 25280023 DOI: 10.1177/039463201402700302] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The reason why the cutaneous form of sarcoidosis is well known in the literature is because of its spectrum of manifestations granting it the fame of a Great Imitator. The mystery shrouding the pathogenesis of this rare cutaneous disease is still there (in spite of the fundamental progress of the various diagnostic methods in current day medicine). The production of the morphological substrate - the epithelioid cell granuloma - which is considered to be characteristic of skin sarcoidosis, could, however, also be the end result of a reaction to i) various specific infectious agents such as Leishmaniasis cutis, coccidioidomycosis, etc., ii) certain residual bacterial or other mycobacterial antigens which, at the moment of setting the diagnosis are - by definition - non-infectious but still immunogenic, as well as iii) different tumor antigens in lesional tissue or other location. Often, differentiating between sarcodiosis and a sarcoid-like reaction, based on the updated criteria for cutaneous sarcoidosis, is problematic to downright impossible. A future characterization of the genetic signature of the two conditions, as well as the implementation of additional mandatory panels for i) the identification of certain infectious or ii) non-infectious but immunogenic and iii) tumor antigens in the epithelioid cell granuloma (or in another location in the organism), could be a considerable contribution to the process of differentiating between the two above-mentioned conditions. This will create conditions for greater accuracy when setting the subsequent therapeutic approaches.
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Affiliation(s)
- G Tchernev
- Policlinic for Dermatology and Venerology, Saint Kliment Ohridski University, Medical Faculty, University Hospital Lozenetz, Sofia, Bulgaria
| | - J C Cardoso
- Dermatology Department University Hospital of Coimbra, Pinto, Coimbra, Portugal
| | - A A Chokoeva
- Department of Dermatology and Venereology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | - C Tana
- Department of Medicine and Science of Aging "G. d'Annunzio" University, Chieti, Italy
| | - J Ananiev
- Department of General and Clinical Pathology, Medical Faculty, Trakia University, Stara Zagora, Bulgaria
| | - M Gulubova
- Department of General and Clinical Pathology, Medical Faculty, Trakia University, Stara Zagora, Bulgaria
| | - S Philipov
- Department of General and Clinical Pathology, Medical Faculty, "Saint Kliment Ohridski University", Sofia, Bulgaria
| | - N Kanazawa
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - P Nenoff
- Laboratory for Medical Microbiology, Mölbis, Germany
| | - T Lotti
- Dermatology Department, University of Rome "G. Marconi" Rome, Italy
| | - U Wollina
- Department of Dermatology and Allergology, Hospital Dresden-Friedrichstadt, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
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7
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Abstract
Sarcoidosis is a chronic inflammatory disorder that has the potential to affect multiple organs, including the skin. Its cutaneous manifestations are varied and can provide clues to underlying systemic manifestations. Unfortunately, they also can be disfiguring. Therapy is usually directed at the organ system most severely affected, which often may help cutaneous disease. However, cutaneous disease may be recalcitrant to treatment directed at extracutaneous disease, or it may be severe enough to require targeted therapy. This article focuses on the dermatologist's role in recognizing and diagnosing cutaneous sarcoidosis, evaluating patients for systemic disease involvement, and treating the skin manifestations of sarcoidosis.
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Affiliation(s)
- Karolyn A Wanat
- Department of Dermatology, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
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Treatment regimens, protocols, dosage, and indications for UVA1 phototherapy: Facts and controversies. Clin Dermatol 2013; 31:438-454. [DOI: 10.1016/j.clindermatol.2013.01.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Sarcoidosis: a comprehensive review and update for the dermatologist: part I. Cutaneous disease. J Am Acad Dermatol 2012; 66:699.e1-18; quiz 717-8. [PMID: 22507585 DOI: 10.1016/j.jaad.2011.11.965] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 11/14/2011] [Accepted: 11/17/2011] [Indexed: 11/23/2022]
Abstract
Sarcoidosis is a common systemic, noncaseating granulomatous disease of unknown etiology. The development of sarcoidosis has been associated with a number of environmental factors and genes. Cutaneous sarcoidosis, the "great imitator," can baffle clinicians because of its diverse manifestations and its ability to resemble both common and rare cutaneous diseases. Depending on the type, location, and distribution of the lesions, treatment can prevent functional impairment, symptomatic distress, scarring, and disfigurement. Numerous therapeutic options are available for the treatment of cutaneous sarcoidosis, but there are few well designed trials to guide practitioners on evidence-based, best practice management. In part I, we review the current knowledge and advances in the epidemiology, etiology, pathogenesis, and genetics of sarcoidosis, discuss the heterogeneous manifestations of cutaneous sarcoidosis, and provide a guide for treatment of cutaneous sarcoidosis.
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10
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Gleeson C, Morar N, Staveley I, Bunker C. Treatment of cutaneous sarcoid with topical gel psoralen and ultraviolet A. Br J Dermatol 2011; 164:892-4. [DOI: 10.1111/j.1365-2133.2010.10175.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Stagaki E, Mountford WK, Lackland DT, Judson MA. The Treatment of Lupus Pernio. Chest 2009; 135:468-476. [DOI: 10.1378/chest.08-1347] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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12
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Comte C, Picot E, Peyron JL, Dereure O, Guillot B. Les UVA-1 : propriétés et indications thérapeutiques. Ann Dermatol Venereol 2007; 134:407-15. [PMID: 17483769 DOI: 10.1016/s0151-9638(07)89204-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- C Comte
- Université Montpellier II, Service de Dermatologie, CHU Saint Eloi, Montpellier.
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13
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Beattie PE, Dawe RS, Ibbotson SH, Ferguson J. UVA1 phototherapy for treatment of necrobiosis lipoidica. Clin Exp Dermatol 2006; 31:235-8. [PMID: 16487100 DOI: 10.1111/j.1365-2230.2005.02059.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The primary cause of collagen degeneration in necrobiosis lipoidica (NL) is proposed to be immunologically mediated vascular disease. Ultraviolet (UV)A1 has been used successfully to treat scleroderma in which both vascular damage and collagen dysregulation also occur. We treated six patients with NL [(five women; mean age of 32 years (range 22-70) and mean disease duration of 2.9 years (range 6 months to 5 years)] with a high-output ultraviolet (UV)A1 2-kW filtered metal halide source (Dr Hönle; Dermalight ultrA 1) having an emission spectrum of 340-440 nm. All patients had NL on the shins, which had been unresponsive to potent topical corticosteroid therapy (n = 6) and had responded minimally or not at all to TL-01 UVB (n = 2), topical psoralen plus UVA (PUVA) soaking (n = 2) or oral PUVA (n = 1) therapy. Patients received a variable number of total exposures (15-51), given 3-5 times weekly. NL resolved completely in one patient; this patient had minimal improvement after the first course of 16 exposures, but after a further 13 exposures, resolution occurred 6 months later. Two subjects obtained moderate improvement in their overall disease severity after 15 and 24 exposures, while two had only minimal improvement after 15 and 51 exposures. The remaining patient had no improvement after 16 treatments. Patients with the shortest disease duration had the greatest response. UVA1 therapy may be of benefit for the treatment of NL as an adjuvant therapy to topical corticosteroids or as a second-line alternative to other phototherapies, and may have a superior outcome in a proportion of patients.
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Affiliation(s)
- P E Beattie
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
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14
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Affiliation(s)
- Renz Mang
- Department of Dermatology, Heinrich-Heine-University Düsseldorf gGmbH, Auf'm Hennekamp 50, D-40225 Düsseldorf, Germany
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15
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Gutzmer R, Kapp A, Werfel T. [Successful treatment of skin and lung sarcoidosis with fumaric acid ester]. Hautarzt 2004; 55:553-7. [PMID: 15098093 DOI: 10.1007/s00105-004-0728-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A 61-year old female patient with cutaneous sarcoidosis was treated with fumaric acid esters (Fumaderm). After 12 months of therapy, lesions were markedly improved and treatment was discontinued. 18 months later, the cutaneous lesions recurred, angiotensin converting enzyme (ACE) serum levels were increased and a chest X-ray demonstrated pulmonary involvement. Therapy with fumaric acid esters was again started. The skin showed improvement after 2 months and completely cleared within 17 months, within 4 months ACE levels normalized, and within 10 months radiologic changes markedly resolved. This case demonstrates a possible role for fumaric acid esters not only in the treatment of cutaneous but also systemic sarcoidosis.
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Affiliation(s)
- R Gutzmer
- Klinik und Poliklinik für Dermatologie und Venerologie der Medizinischen Hochschule Hannover, Hannover.
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Mahnke N, Medve-Koenigs K, Berneburg M, Ruzicka T, Neumann NJ. Cutaneous sarcoidosis treated with medium-dose UVA1. J Am Acad Dermatol 2004; 50:978-9. [PMID: 15153910 DOI: 10.1016/j.jaad.2003.09.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gutzmer R, Völker B, Kapp A, Werfel T. [Successful topical treatment of cutaneous sarcoidosis with tacrolimus]. DER HAUTARZT 2004; 54:1193-7. [PMID: 14634750 DOI: 10.1007/s00105-003-0626-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A 56-year old female patient with cutaneous sarcoidosis in the face was treated with fumaric acid esters and doxycycline without any effect. Topical tacrolimus led clinically and histologically to a nearly complete remission within three months, which continued after 4 months of follow-up.
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Affiliation(s)
- R Gutzmer
- Klinik und Poliklinik für Dermatologie und Venerologie der Medizinischen Hochschule Hannover, Hannover.
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18
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Abstract
Long-wavelength ultraviolet A (340-400 nm; UVA1) therapy is currently available in only a few dermatology departments. Equipment capable of delivering this waveband has been available since 1981, but it is only over the past decade that increasing numbers of studies assessing the potential of this as a therapy have been published. High-dose UVA1, which requires expensive and space-occupying apparatus, is effective as a monotherapy for acute flares of atopic dermatitis, but it has not yet been formally assessed as an adjunct, rather than as an alternative to conventional therapies including potent and very potent topical corticosteroids. Low-dose (which can be administered using a standard phototherapy cubicle fitted with appropriate lamps) and medium-dose UVA1 may be less effective for this indication. Another condition for which UVA1 is effective, and is particularly promising because we have no reliably effective treatment already, is localized scleroderma. It also appears to be effective in systemic lupus erythematosus (although it is not yet clear when it is indicated, and its safety needs to be assessed in more patients) and in polymorphic light eruption (although there have been no studies suggesting that UVA1 will have any advantages over standard prophylactic phototherapies). Open studies and case series suggest that UVA1 may prove beneficial for various other diseases, including cutaneous T-cell lymphoma, lichen sclerosus, keloids, systemic sclerosis and hand dermatitis. In the centres where it is available, UVA1 has already proved a useful addition to the range of phototherapies previously available. However, much more research is needed to confirm its efficacy for many of its potential indications, and to determine when and how it should be used.
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Affiliation(s)
- R S Dawe
- Photobiology Unit, Department of Dermatology, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
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Abstract
Sarcoidosis is a systemic granulomatous disease of unknown cause that most commonly affects the lungs, lymph nodes, skin, eyes, spleen, bone, and glandular tissue. The diagnosis is made when characteristic histologic findings are demonstrated and other granulomatous processes are excluded. It can be an acute or chronic debilitating disease, but in patients with acute disease the process can be self-limited. Multiple therapeutic options have been described both for the cutaneous and systemic lesions of sarcoidosis. Steroids, however, remain the cornerstone of therapy.
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Affiliation(s)
- T J Giuffrida
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, 1400 NW 12th Avenue, Miami, FL 33136, USA
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