Introduction: Background on Morphea/Scleroderma
Phototherapy in Dermatology
Mechanism Behind Phototherapeutic Modalities Used in Scleroderma
The Use of Phototherapy in Dermatology
Clinical Evidence of Phototherapy’s Efficacy
Search Method
UVA1
Study (clinical trial, case report, etc.) | Patientsa
| Disease | Treatment modality | Treatment duration | Cumulative dose (J/cm2) | Duration of phototherapy | Total treatments | Improvement outcome (clinical, radiologic) | Was the patient(s) reported to be on another treatment concurrently? | Author |
---|---|---|---|---|---|---|---|---|---|---|
Randomized, controlled, single-blinded controlled study | 9 | Systemic sclerosis (acrosclerosis) | UVA1 | 40 J/cm2 3 times a week | 1680 | 14 weeks | 42 | Modified Rodnan skin scoring: no improvement seen in control vs. placebo | No | Durand et al. [69] |
Randomized, controlled trial | 64 | Localized scleroderma | UVA1/UVB | Twenty-seven patients received 20 J/cm2 UVA1; 18 patients received 50 J/cm2 UVA1; 19 patients received narrowband UVB. All phototherapy was performed 5 times a week | Low dose 800, medium dose 2000 | 8 weeks | 40 | Reduction in clinical scores in all groups. No statistical difference between the UVA groups. There was a statistically significant difference between UVB and medium dose UVA1 | No | Kreuter et al. [70] |
Controlled study | 8 | Localized scleroderma | UVA1 | 48 J/cm2 4 times a week | 960 | 5 weeks | 20 | At 12 weeks no significant difference between skin elasticity in treated versus control skin. Fast Fourier transform did not show a significant change after 12 weeks. Skin softening was clinically noted after 7 weeks | No | de Rie et al. [71] |
Prospective uncontrolled study | 18 | Systemic sclerosis (acrosclerosis) | UVA1 | 30 J/cm2 4 times a week for 8 weeks, then 3 times a week for 6 weeks | 1500 | 14 weeks | 50 | Improvement in clinical score and dermal thickness in 16 patients with softening of the skin and increased finger mobility. Follow-up in 6 months showed stable clinical outcome in most patients | Eight patients were on other systemic medications | Kreuter et al. [17] |
Prospective uncontrolled study | 14 | Localized scleroderma | UVA1 | 20 and 70 J/cm2 were given 4 times a week for 5 weeks, then 2 times a week for 5 weeks | Low dose 600, medium dose 2100 | 10 weeks | 30 | Skin thickness decreased in patients in both groups, but more so in the higher dosage group at a 12-month follow-up | No | Sator et al. [45] |
Prospective uncontrolled study | 35 | Localized scleroderma | UVA1 | 30 J/cm2 3–5 times a week | 900–1350 (mean 1180.29) | 10–15 weeks | 30–45 (mean 41.14) | The mean follow-up period was 21.63 months. In five patients, a partial relapse was observed. Two of the five patients reported reappearance of new lesions after 12 months. Softening of plaques and improvement in 29 of 35 patients (82.85%). Dermal thickness decreased after therapy in 14 of 35 patients | No | Su et al. [46] |
Prospective uncontrolled study | 20 | Localized scleroderma | UVA1 | 20 J/cm2 4 times a week for 6 weeks and once a week for another 6 weeks | 600 | 12 weeks | 30 | More than 80% of the lesions disappeared in 18 patients. Decreased dermal thickness | No | Kerscher et al. [47] |
Prospective uncontrolled study | 10 | Localized scleroderma | UVA1 | 20 J/cm2 4 times a week | 480 | 6 weeks | 24 | Lesions started to regress after 15 treatments. More than 80% of lesions regressed after 24 treatments | No | Kerscher et al. [43] |
Prospective uncontrolled study | 34 | Localized scleroderma | UVA1 | 6 patients were treated with medium dose and 28 were treated with high dose. Both groups treated 3 times a week | 5234 ± 3611 | Unavailable | Unavailable | Patients reported an improvement of at least 25% | Unknown | Jacobe et al. [48] |
Prospective uncontrolled study | 17 | Localized scleroderma | UVA1 | Ten patients with high dose 130 J/cm2. Seven patients with low-dose 20 J/cm2. Patients treated 4 times a week during 5 weeks, then twice a week for 5 weeks | Low dose 600, high dose 3900 | 10 weeks | 30 | Softening of skin lesions in all high dose patients, and complete clearance in four of ten patients. Three months after treatment, nine of ten patients have clinical stability. Two of seven patients in the low-dose group reported improvement or had clinical signs of improvement. Skin thickness by ultrasound was reduced in all patients | No | Stege et al. [72] |
Prospective uncontrolled study | 13 | Localized scleroderma | UVA1 | Unavailable | 750–1250 | 3–5 weeks | 20.8 ± 4.0 | Modified Rodnan score improvement. Reduction of skin thickness in 11 patients. Skin elasticity increased in ten patients | No | Andres et al. [73] |
Prospective uncontrolled study | 7 | Morphea | UVA1 | 30 J/cm2 3 times a week | 900 | 10 weeks | 30 | Clinical improvement in induration of all patients. One patient reported improved elbow joint mobility. After a 6–9-month follow-up, there was clinical stability | No | Camacho et al. [20] |
Prospective uncontrolled study | 3 | Morphea | UVA1 | 20 J/cm2 4 times a week for 6 weeks, then once a week for 6 weeks | 600 | 12 weeks | 30 | Resolution of sclerotic plaques in all patients. No signs of recurrence after 2 year follow-up | No | Gruss et al. [74] |
Prospective uncontrolled study | 19 | Childhood morphea | UVA1 | 20 J/cm2 4 times a week | 800 | 10 weeks | 40 | Mean clinical score (skin inspection and palpation every week) improved–relative reduction of 67.1%. The treatment outcome remained stable for at least 1 year in all patients | Topical calcipotriol 0.005% twice a day | Kreuter et al. [64] |
Prospective uncontrolled study | 47 | Morphea | UVA1 | Six were treated with medium dose (50–60 J) and 41 were treated with high dose (120 J) UVA1; 3 times a week | 5329 ± 4398 | Unavailable | Unavailable | Patients reported an improvement of at least 25% | May/may not | Jacobe et al. [48] |
Prospective uncontrolled study | 30 | Morphea | UVA1 | 3 times a week, 21 cases of morphea were treated with UVA 20 J/cm2 for 20 sessions. Nine cases of morphea received 10 J/cm2
| High dose 400, low dose 200 | 6 + weeks | 20 | No difference in improvement between the 10 and 20 J/cm2 group. Overall, 18 patients reported softening of the skin lesions. Twelve patients reported moderate improvement, four patients reported good improvement, and two patients reported very good improvement | No | El-Mofty et al. [9] |
Prospective uncontrolled study | 49/M | Morphea | UVA1 | 70 J/cm2 5 times a week | 1400 | 4 weeks | Unavailable | Durometer scores improved significantly during first 3 weeks, and borderline significantly the last week. Improvements were maintained at 4-month follow-up | No | Kroft et al. [44] |
Prospective uncontrolled study | 4 | Systemic sclerosis | UVA1 | 60 J/cm2 5 times a week | 510–1740 | Unavailable | 9–29 | Skin elasticity before treatment was improved as assessed by cutometer. The mean thermography and joint passive range of motion both increased after treatment | Unknown | Morita et al. [75] |
Prospective uncontrolled study | 83 | Morphea (63), systemic sclerosis (15) | UVA | 5, 10, and 20 J/cm2
| 100, 200, 400 | 6 + weeks | 20 | Clinical improvement. No difference between the groups | No | El-Mofty et al. [51] |
Prospective uncontrolled study | 12 | Morphea | UVA | 20 J/cm2 3 times a week | 400 | 6 + weeks | 20 | 90% cure of early lesions, 50% cure of “late” lesions | No | El-Mofty et al. [12] |
Prospective uncontrolled study | 11 | Scleroderma | Oral + topical PUVA, Narrowband UVB | Unavailable | Unavailable | Unavailable | Mean 10 | Most lesions had a decreased dermal thickness on ultrasound at 12 weeks | Unknown | Buense et al. [56] |
Prospective uncontrolled study | 12 | Systemic sclerosis | PUVA, bath or oral | Unavailable | Median cumulative exposure 68.25 | Unavailable | Median 24 | Improvement in 11 patients | No | Usmani et al. [29] |
Prospective uncontrolled study | 4 | Localized scleroderma | PUVA cream | 4 times a week. Maximum single dose of 3.5 J/cm2
| 89.5 (range 67.5–121) | Unavailable | 30 | Decrease in dermal thickening | No | Grundmann-Kollmann et al. [76] |
Prospective uncontrolled study | 4 | Systemic sclerosis | PUVA oral | 3 times a week for 10 weeks | Mean of 70.5 (range 50.5–92.0) | 10 weeks | 30 | Improvement of skin, joint mobility, grip strength, and skin thickness in three of four patients | No | Hofer and Soyer [77] |
Prospective uncontrolled study | 17 | Localized scleroderma | PUVA bath | 0.2–0.5 J/cm2 up to 1.2–3.5 J/cm2 per treatment. First 20 treatments 4 times a week, twice a week for the following ten treatments, and once a week for the last four treatments | Mean UVA dose of 41.5 (range 15.7–64.3) | 15 weeks | 25–35 | Clinical and ultrasound improvement noted in 13 patients. In most patients, softening of sclerotic lesions was noted at the 15th treatment. Patients were followed up regularly for more than a year; there were two cases of recurrence | No | Kerscher et al. [54] |
Prospective uncontrolled study | 5 | Localized scleroderma | 3% ALA + PDT (10 J/cm2) | Once or twice weekly | Unavailable | 3–6 months | 25–43 | A reduction of skin hardness and pruritus in lesions. In two patients, joint mobility was improved. One control plaque was untreated, and showed no signs of regression | No | Karrer et al. [78] |
Retrospective study | 8 | Localized and systemic scleroderma | UVA1 | 15 J/cm2 3 times a week. Then increased up to maximum dose of 30 J/cm2 for seven patients and 40 J/cm2 for three patients | Range 529–1029.4 | Unavailable | Range 26–32 | Modified Rodnan skin score percentage improvement was 57%. One in remission for 12 months, four were in remission for 24 months | One patient on mycophenolate mofetil, one patient on pulsed cyclophosphamide, methotrexate, and ciclosporin. One patient on azathioprine | Rose et al. [79] |
Retrospective study | 17 | Localized scleroderma | UVA1 | 5 times weekly | 750–1400 | 3–6 weeks | 19.3 ± 3.8 | Fourteen patients reported clinical improvement | No | Andres et al. [73] |
Retrospective study | 3 | Systemic scleroderma | UVA1 | Mean dose of 29.5 J/cm2
| Mean cumulative dose 1160 (range 660–1695) | Unavailable | Mean 26 | Patients showed an improvement in the modified Rodnan scoring system. One patient had complete remission | Unknown | Pereira et al. [80] |
Retrospective study | 18 | Morphea | UVA1 | Mean dose of 31 J/cm2
| Mean cumulative dose of 1662 (range 310–4270) | Unavailable | Mean 33 | 77.8% had marked improvement, 11.1% had moderate improvement, 5.6% had slight improvement, and 5.6% had no improvement | Unknown | Pereira et al. [80] |
Case series | 8 | Systemic sclerosis | UVA1 | 30 J/cm2 4 times a week for 8 weeks, then 3 times a week for 6 weeks | 1500 | 14 weeks | 50 | Modified Rodnan skin score improved after treatment. Seven patients experienced improvement in sclerosis in 6 months. Resulting in marked softening of skin and clinically significant improvement including finger mobility | Unknown | Von Kobyletzki et al. [81] |
Case series | 37 | Morphea | UVA1 | Treatments varied 2–5 times a week; 13 patients received 20 J/cm2 of UVA1. Eleven patients received 50–60 J/cm2 UVA1. Ten patients received medium-dose increased to high-dose 50–120 J/cm2. One patient received low-dose, followed by medium-dose UVA1 (60 treatments), and two patients received low-dose increased to high-dose UVA1 (mean 23.5 treatments, mean cumulative dose 2090 J/cm2) | 20 J/cm2 group mean 683.9, 50–60 J/cm2 group mean 1468.5, 50–120 J/cm2 group 2560 | Ranged | 20 J/cm2 group 11–78 (mean 35), 50–60 J/cm2 group 13–36 (mean 27.8), 50–120 J/cm2 group 9–41 (mean 20.7) | 26–100% improvement was found in 46.2% of patients treated with low-dose UVA1 phototherapy compared with 72.7% and 70% treated with medium and medium to high-dose UVA1, respectively | Unknown | Tuchinda et al. [85] |
Case series | 6 | Morphea/SS/CREST | UVA1 | Unavailable | Unavailable | Unavailable | 30–60 | Dermal thickness had decreased in five patients | No | Oikarinen and Knuutinen [82] |
Case series | 54 | Scleroderma | UVA1 | 59.81 ± 27.40 J/cm2
| 1203.15 ± 1133.95 | Unavailable | 21.10 ± 13.1 | Clinical improvement was noted by physician in 79.6% of patients | Unknown | Rombold et al. [83] |
Case series | 8 | Localized scleroderma | UVA1 | 50 J/cm2 5 times a week | 2000 | 8 weeks | 40 | The modified skin score improved in all patients | Unknown | Kreuter et al. [84] |
Case series | 14 | Localized scleroderma | UVA1 | 20 J/cm2 5 times a week | 800 | 8 weeks | 40 | The modified skin score improved in all patients | Unknown | Kreuter et al. [6] |
Case series | 12 | Systemic sclerosis/CREST | UVA1 | Treatments varied 2–5 times a week | Unavailable | Unavailable | Unavailable | 41.7% of patients experienced 51–100% improvement | Unknown | Tuchinda et al. [85] |
Case series | 2 | Localized scleroderma | PUVA | 0.2 J/cm2 up to a maximum dose of 20 J/cm2, 4 times a week over 5 weeks, then 2 times per week for an additional 5 weeks | Unavailable | 10 weeks | 30 | Skin lesions cleared, ultrasound revealed normal ratio of treated skin thickness to uninvolved skin | No | Kerscher et al. [42] |
Case series | 4 | Localized scleroderma | PUVA | The initial daily UVA doses were 1–1.5 J/cm2
| Range 242–405.5 | 12 weeks of PUVA daily, then maintenance PUVA treatment given twice or once per week for 3 months | 57–72 | The modified skin score improved after therapy | Acitretin | Ozdemir et al. [86] |
Case series | 13 | Localized morphea | PUVA | Two patients treated with bath PUVA and all other patients with oral PUVA. Treatment was given twice weekly. | Mean 135 (range 42–244) | 7–15 weeks | 14–30 | Mean reduction of 62.9% in modified Rodnan score | Five patients had concurrent therapies | Usmani et al. [30] |
Case series | 23 | Localized morphea | PUVA | Patients were treated with a weekly regimen of bath immersion in 0.2 mg/l water solution of 8-methoxypsoralen, followed by irradiation with UVA 3 times a week with an initial UVA dose of 0.3 J/cm2, with subsequent increments of 0.3 J/cm2 added every 2–3 treatments up to a maximum dose of 10.0 J/cm2
| Mean 115 | Unavailable | Mean 71 | Eleven patients (39%) showed complete remission. Partial response in 14 patients (50%). In the complete remission group; no recurrence was observed in seven patients after a mean follow-up period of 7 months (range 1–18 months) | No | Pavlotsky et al. [87] |
Case series | 4 | Linear and generalized morphea | PUVA oral | 3 times a week. UVA dose ranged from 42.5–94 J/cm2. After improvement (loss of induration), then maintenance treatment weekly and biweekly was given | Unavailable | Unavailable | 44–88 | Number of treatments to show clearance ranged from 44–88. UVA dose to clear lesions ranged from 358–838.5 J/cm2
| No | Morison et al. [88] |
Case series | 2 | En coup de sabre | PUVA topical | Initial dose was 0.3 J/cm2. 3 times a week. And UVA dose was increased after 3 days with 0.2 J/cm2
| 71 | Unavailable | 40 | Softening of lesions after 90 days | Topical calcipotriol twice a day | Gambichler et al. [100] |
Case series | 7 | Six with localized scleroderma, one with systemic scleroderma | PUVA topical | 4 times a week. Highest UVA dose per treatment mean was 3.5 J/cm2
| Mean 53.5 | Unavailable | Mean 25 (range 14–39) | Marked improvement in softening of sclerotic plaques in all patients | Unknown | Pasic et al. [89] |
Case series | 10 | Scleroderma | Water-filtered infrared A plus visible light treatment | Total irradiance was 180–200 mW/cm2. Treatment was done 2–5 times a week. | Unavailable | Unavailable | 16–48 | Seven patients reported improvement, follow-up was 1–7.5 years after treatment | Unknown | Von Felbert et al. [90] |
Case report | 16/F | Nodular morphea | PUVA topical | Unavailable | 2.32 | Unavailable | Unavailable | Slight improvement of regression of nodules. The patient was lost to follow-up | Penicillin G for 10 days | Kauer et al. [91] |
Case report | 12/F | Localized scleroderma | PUVA topical | 0.2–4.0 J/cm2 to total dose of 62.8 J/cm2. Initiated for 10 days, then subsequently once a week for 4 months | Unavailable | 4 months | Unavailable | Rodnan score + range of motion of affected joint improvement | Oral prednisolone | Uchiyama et al. [92] |
Case report | 43/F | Systemic sclerosis | PUVA topical | UVA dose started at 0.6 J/cm2 then gradually increased to 2.4 J/cm2. Treatments were given once a week | 167.3 | Unavailable | 107 | Significant softening of the affected areas, and normalization of skin temperature | No | Morita et al. [93] |
Case report | 58/M | Systemic sclerosis | PUVA topical | 0.10 J/cm2 3 times a week, increasing to a maximum single dose of 8 J/cm2
| 272.3 | 29 weeks | Unavailable | Decreased necrosis in fingers, reduced symptoms of swelling, erosions, crusting, and induration in fingers. Follow-up at 5 months showed slight swelling of both hands without new fingertip lesions | Sildenafil 150 mg daily | Mohanna et al. [94] |
Case report | 65/F | Generalized morphea | PUVA | 0.4 J/cm2 3 times a week | Unavailable | 8 weeks | 24 | Hand closure and skin sclerosis index. Score went from three to one. Disease free after 2-year follow-up with weekly maintenance therapy | No | Kanekura et al. [95] |
Case report | 61/M | Progressive systemic sclerosis | PUVA | 0.25 J/cm2 4 times a week. Total dose of 5 J/cm2. | Unavailable | 5 weeks | 20 | Hand closure and skin sclerosis index improved from 4 to 1 | No | Kanekura et al. [95] |
Case report | 42/M | Progressive systemic sclerosis | PUVA | PUVA 0.4 J/cm2 6 times a week. Total dose of 7.2 J/cm2. | Unavailable | 3 weeks | 18 | Hand closure and skin sclerosis index improved from 3 to 0 | No | Kanekura et al. [95] |
Case report | 32/F | Progressive systemic sclerosis | PUVA | PUVA 0.25 J/cm2 twice a week. Total dose of 3.5 J/cm2. | Unavailable | 7 weeks | 14 | Skin sclerosis index improved from 3 to 1 | No | Kanekura et al. [95] |
Case report | 80/M | Localized scleroderma | PUVA | Initial 3 times weekly UVA dose of 4 J/cm2, which was gradually increased, weekly, to a maximal single dose of 18 J/cm2
| Unavailable | 11 months | 127 | After 9 months, the skin plaques were softening. Treatment was then continued twice every week for another 2 months. After 127 treatments, there was clearance of the lesion. Clinical stability remained after 8 months | No | Garcia-Bustinduy et al. [96] |
Case report | 7/F | Pansclerotic morphea | PUVA | 0.6 mg/kg for 4 times a week. Dose started at 0.5 J/cm2 and was gradually increased to 2.0 J/cm2 over 2 months | Unavailable | 10 weeks | Unavailable | After 10 weeks her condition worsened with spread of disease, ulceration and contraction deformities | Penicillamine 20 mg/kg/day | Todd et al. [97] |
Case report | 56/F | Systemic sclerosis | PUVA | 3 times a week. Then once a week for maintenance therapy once improvement seen | 483 | 19 months | Unavailable | 100% improvement (patient self-evaluation) | No | Baum et al. [98] |
Case report | 66/M | Systemic sclerosis | PUVA | 3 times a week then once a week for maintenance therapy once improvement seen | 20 | 1.5 months | Unavailable | >70% response rate (patient self-evaluation) | No | Baum et al. [98] |
Case report | 27/M | Generalized morphea | PUVA | 3 times a week, then once a week for maintenance therapy once improvement seen | 288 | 10 months | Unavailable | >70% response rate (patient self-evaluation) | No | Baum et al. [98] |
Case report | 40/M | Diffuse morphea | PUVA | Twice weekly at 5 J/session | 115 | 23 months | N/A | Increased mobility, reduced progression of plaques and sclerosis | Cyclosporine for 2 years. Then transitioned to mycophenolate mofetil for 1 year and phototherapy discontinued | Rose and Goodfield [99] |
Case report | 64/F | Disseminated scleroderma | PUVA | Initial dose of 0.76 J/cm2, maximum tolerated dose 10 J/cm2. The first 28 treatments were conducted 4 times a week. Then twice a week during the following ten treatments | Unavailable | Unavailable | Unavailable | The skin sclerosis index was a four before therapy, and a one or two after therapy. Improvement was also noted from infrared thermography before and after treatment. No recurrence approximately 2 years later | No | Aragane et al. [101] |
Case report | 27/F | Localized scleroderma | PUVA | 0.4 J/cm2 up to a total dose of 5 J/cm2
| Unavailable | Unavailable | Unavailable | Clinical improvement observed with reduced hardness. No recurrence after 20-month follow-up | No | Yamaguchi et al. [102] |
Case report | 12/M | Pansclerotic morphea | PUVA | Unavailable | Unavailable | Unavailable | Unavailable | Improvement in skin and ulceration that lasted 1.5 years | Unknown | Wollina et al. [103] |
Case report | 40/F | Post-radiation morphea | PUVA | Twice weekly for 22 treatments (107.8 J/cm2). Patient subsequently had 47 treatments of UVA1. This was started at medium dose (35 treatments at 50 J/cm2) and progressed to high dose (12 treatments at 80 J/cm2
| 2633.6 | Unavailable | 69 | Patient reported better improvement with high-dose UVA1 then medium-dose UVA1 | No | Lim et al. [104] |
Case report | 8/F | Pansclerotic morphea | PUVA | UVA dose 0.5 J/cm2, which was gradually increased to 1.8 J/cm2 during the next 2 months using four irradiations weekly. She was maintained on two treatments per week for 6 months | Unavailable | Unavailable | 68 | Softening of skin was observed within 1st month. Improved healing of ulcers and joint mobility. No evidence of relapse after a 14 month follow-up | No | Scharffetter-Kochanek et al. [105] |
Case report | 72/F | Traumatic scleroderma | UVA1 | 70 J/cm2 5 times a week | 1400 | 4 weeks | Unavailable | Durometer scores improved significantly during first 3 weeks and borderline significantly the last week. Remission after >31 months | No | Kroft et al. [44] |
Case report | 8/F | Pansclerotic morphea | UVA1 | 5 J/cm2 3 times a week. Then the doses were increased gradually to a maximum of 20 J/cm2
| 480 | Unavailable | Unavailable | Improvement was seen at 10–12 sessions. Softening of sclerotic lesions. Hypopigmented areas began to have pigmentation | No | Yildirim et al. [106] |
Case report | 45/F | Systemic sclerosis | UVA1 | 50 J/cm2 2–3 times a week | 2222 | Unavailable | 40 | Microstomia had improved; all of her sclerotic lesions were softer. She could articulate words normally and had reduced furrowing around the mouth | Unknown | Tewari et al. [107] |
Case report | 19/F | Scleroderma | UVA1 | 20 J/cm2 5 times a week | Unavailable | Unavailable | Unavailable | Softening of fibrotic skin, improved mobility of joints | Methylprednisolone, methotrexate, pentoxiflyin, asprin, and piascledine | Forsea, et al. [108] |
Case report | 71/M | Pansclerotic morphea | UVA1 | 30 J/cm2 3 times a week | 1350 | 15 weeks | 45 | Softening, increased elasticity | No | Herzinger et al. [109] |
Case report | 16/M | Pansclerotic morphea | UVA1 | 20 J/cm2 4 times a week | 640 | 8 weeks | 32 | Within 3 weeks there was softening of the skin on the trunk and head. There was an increase in joint mobility. Therapeutic effects lasted for 6 months | No | Gruss et al. [110] |
Case report | 42/F | Progressive systemic sclerosis | UVA | 20 J/cm2 3 times a week | Unavailable | Unavailable | Unavailable | Softening of facial sclerosis softening and decreased pruritus at 3 week. At 2 months, lesions on her abdomen and upper legs softened | Unknown | Steger and Matthews [111] |
Case report | 11/M | Localized scleroderma | UVA | 20 J/cm2 4 times a week for 6 weeks, then once weekly for 6 weeks | Unavailable | 12 weeks | Unavailable | Lesion cleared with softening, tanning, and thinning of the skin. At 3-month follow-up the lesion is still in remission | No | Steger and Matthews [111] |
Case report | 32/F | En coup de sabre | Narrowband UVB | 3 times a week | Unavailable | 24 weeks | N/A | Prevented progression of disease. Patient remained stable for a year off of UVB, but then disease recurred and had to resume UVB and oral colchicine | No | Brownell et al. [112] |
Case report | 22/F | Secondary cicatricial alopecia/scleroderma | Non-ablative fractional laser | Fluence of 6–8 mJ and a density of 300 spots/cm2/pass. For ablative fractional laser, a fluence of 30–50 mJ was delivered to the affected area 150 spots/cm2
| Unavailable | Non-ablative/ablative laser with a 4 week interval between treatments | 15 | Eight treatments before clinical improvement observed. 26–50% clinical improvement assessment | Topical calcipotriol cream 0.005% | Cho et al. [113] |
Case report | 34/M | Secondary cicatricial alopecia/scleroderma | Non-ablative fractional laser | Fluence of 6–8 mJ and a density of 300 spots/cm2/pass. For ablative fractional laser, a fluence of 30–50 mJ was delivered to the affected area 150 spots/cm2
| Unavailable | Non-ablative/ablative laser with a 4 week interval between treatments | 20 | Five treatments before clinical improvement observed. 26–50% clinical improvement | Topical calcipotriol cream 0.005% | Cho et al [113] |
Case report | 41/F | Morphea | 585-nm long pulsed (1.5 ms) dye laser | Four treatments, 2 weeks between treatments. 5 J/cm2 fluence | Unavailable | 8 weeks | 4 | Softening of the plaque noted after each treatment. 6 months after 1st treatment, there was clinical stability | No | Eisen and Alster [114] |