TherapyMedium-dose ultraviolet A1 therapy for pityriasis lichenoides et varioliformis acuta and pityriasis lichenoides chronica☆,☆☆,★
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). 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
References (15)
- et al.
High dose UVA1 therapy for atopic dermatitis: results of a multicenter trial
J Am Acad Dermatol
(1998) - et al.
High-dose versus medium-dose UVA1 phototherapy for patients with severe generalized atopic dermatitis
J Am Acad Dermatol
(2001) UVA1 radiation mediates singlet-oxygen and superoxide-anion production which trigger two different final apoptotic pathways: the S and P site of mitochondria
J Invest Dermatol
(1999)Therapeutic photoimmunology: photoimmunological mechanisms in photo(chemo)therapy
J Photochem Photobiol B
(1998)- et al.
Apoptosis induction by ultraviolet A and photochemotherapy in cutaneous T-cell lymphoma: relevance to mechanisms of therapeutic action
J Invest Dermatol
(1996) - et al.
Pityriasis lichenoides
Cutis
(2000) - et al.
Ultraviolet A1 (340-400 nm) phototherapy for cutaneous T-cell lymphoma
J Am Acad Dermatol
(1999)
Cited by (48)
A deep dive into UV-based phototherapy: Mechanisms of action and emerging molecular targets in inflammation and cancer
2021, Pharmacology and TherapeuticsTreatment regimens, protocols, dosage, and indications for UVA1 phototherapy: Facts and controversies
2013, Clinics in DermatologyCitation Excerpt :The pruritus of 12 of 15 patients decreased during the treatment period, and it was unchanged in the remaining 3 patients. The authors suggested that UVA1 phototherapy is a useful, well-tolerated treatment option for patients suffering from pityriasis rosea with extensive eruptions and considerable pruritus115; moreover, positive results following UVA1 phototherapy have been documented in patients with follicular mucinosis, reticular erythematous mucinosis, polymorphic light eruption, POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome, scleromyxedema, scleredema adultorum Buschke, hypereosinophilic syndrome, keratosis lichenoides chronica, pityriasis rubra pilaris, Netherton syndrome, pansclerotic porphyria tarda, and pityriasis lichenoides.8,11,12,115–126 Variable results have been reported for UVA1 treatment of keloids, eosinophilic fasciitis, and psoriasis8,11,12,127–131; however, in an open, uncontrolled trial, three HIV-positive psoriasis patients showed a beneficial response to UVA1 phototherapy, which was given on a daily basis as a high-dose regimen (130 J/cm2).132
The vasculopathic reaction pattern
2009, Weedon's Skin Pathology: Third EditionSystematic review of the efficacies and adverse effects of treatments for pityriasis lichenoides
2020, British Journal of DermatologyUltraviolet-A1 phototherapy in Asian skin: A review of 159 cases in Singapore
2020, Indian Journal of Dermatology, Venereology and Leprology
- ☆
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.