Therapy
Medium-dose ultraviolet A1 therapy for pityriasis lichenoides et varioliformis acuta and pityriasis lichenoides chronica,☆☆,

https://doi.org/10.1067/mjd.2002.122199Get rights and content

Abstract

Background: Ultraviolet A1 (340-400 nm) was found to be effective in the treatment of cutaneous T-cell-mediated diseases. Objective: The purpose of the present study was to assess the efficacy of UVA1 phototherapy for pityriasis lichenoides et varioliformis acuta (PLEVA) and pityriasis lichenoides chronica (PLC). Methods: Eight patients (3 with PLEVA and 5 with PLC) received 60 J/cm2 UVA1 daily until remission. Four patients also had lesions inaccessible to UVA1 that were used as control lesions. Immunocytologic studies of skin infiltrates and circulating T cells were done. Results: Six patients showed complete clinical and histologic recovery. Two patients with PLC had a partial improvement. Unirradiated control lesions never improved. Serious short-term adverse effects were not encountered. No effects on circulating lymphocytes were reported. Conclusion: UVA1 therapy is an effective and well-tolerated treatment for PLEVA and PLC. The therapeutic activity seems to be related to direct effects on cutaneous inflammatory infiltrates because the lesions in nonexposed cutaneous areas did not respond. (J Am Acad Dermatol 2002;47:410-4.)

Section snippets

Patients

Eight patients (5 males and 3 females) were enrolled in the study, after they had given informed consent. Their mean age was 39.1 years (range, 20-58 years). Three patients were affected by PLEVA. Five patients had PLC. All patients had biopsy specimens obtained for histologic examination. Exclusion criteria were pregnancy; age younger than 18 years; use of systemic photosensitizing agents; and treatment with systemic corticosteroids, psoralen ultraviolet A (PUVA), or UVB within 3 months before

Results

The lesions exposed to UVA1 radiation completely disappeared in 3 of the 5 patients with PLC (Fig 1) and 3 patients with PLEVA (Fig 2).

. PLC before (A) and after (B) UVA1 treatment.

. PLEVA before (A) and after (B) UVA1 treatment.

The remaining 2 patients with PLC showed significant improvement with persistence of less than 25% of the lesions, which were then controlled with topical steroids.

Mean ± SD cumulative UVA1 doses were 1125.0 ± 525.8 J/cm2, and the mean ± SD number of daily exposures was

Discussion

Medium-dose UVA1 therapy seems to be an effective and well-tolerated treatment option for PLEVA and PLC with a sustained efficacy in case of relapses.

Mechanisms of action are largely unknown, but the therapeutic activity could be at least partly related to the UVA1 photophysical properties and photobiologic effects known so far. Approximately 10% to 40% of UVA1 applied to the skin can penetrate the epithelium, targeting CD4+ and CD8+ mononuclear cells infiltrating the epidermis, as well as deep

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Funding sources: None.

☆☆

Conflict of interest: None declared.

Reprint requests: Piergiacomo Calzavara-Pinton, MD, Department of Dermatology, Azienda Spedali Civili, P.le Spedali Civili 1, 25123 Brescia, Italy.

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