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A Quick Glance at Phototherapy for Various Sclerosing Skin Conditions

 
Research demonstrates that various sclerosing skin conditions respond positively to phototherapy treatments.  These treatments are especially helpful for patients who cannot tolerate systemic immunosuppressive medications or those whose conditions do not respond to other therapies.  Phototherapy uses UVB and UVA range radiation and can be used to treat a variety of skin diseases.  
 
In this article we will cover some general notes on phototherapies as treatment for various sclerosing skin conditions.
 
+ UVA1 Phototherapy
 
While UVA1 is the most studied therapy for sclerosing skin conditions, it is not easily accessible or available in the USA.  
 
Doses Available:
 
Low (20–40 J/cm2)
Medium (40–80 J/cm2) 
High  (80–120 J/cm2)
 
Unit Types:
 
(1) Fluorescent lamp cubicles (delivers low and moderate dosage)
(2) High-output metal halide bulb units (delivers high dosages)
 
+BB UVA & PUVA Phototherapy
 
BB UVA phototherapy is available with or without Psoralens.  Psoralens can be applied orally or topically and used along with BB UVA phototherapy.  It should be noted that Psoralen can be inconvenient and tends to show significant side effects.
 
Dosing:
 
Thereapeutic response is seen with a mean cumulative dose of less than 400 J/cm2.  
 
+ NB UVB Phototherapy
 
Studies lean toward UVA 1 or BB UVA therapy over NB UVB therapy due to the extensive evidence in support of the two former. Superficial or largely inflammatory sclerosis are candidates for NB UVB, but conditions requiring deeper penetration should find alternative treatment.
 
++ Phototherapy and Specific Sclerosing Skin Conditions 
 
+ Morphea (Localized Scleroderma)
 
UVA1 therapy has shown positive results in morphea since 1995. Studies have proven that medium-dose UVA1 therapy is superior to NB UVB therapy. Dose dependency suggested that medium-dose UVA1 phototherapy provides better long-term results than low-dose UVA1.  Data for pediatric patients is limited, however the evidence that is available points to UVA1 phototherapy as an efficacious treatment for morphea.
 
+ Systemic Sclerosis (Scleroderma)
 
Various studies have been conducted to evaluate the efficiency of UV therarpy on scleroderma.  Because there is no therapy with evidence of efficiency, UVA should be used despite evidence as scleroderma is debilitating with limited treatment options.  UVA1 may be helpful in slowing disease progression and also assist in treating other features of scleroderma such as pruritus.
 
 
++ Phototherapy and Other Sclerosing Skin Conditions
 
+ Lichen Sclerosus
 
Phototherapy treatment should be chosen with strict caution in extragenital Lichen Sclerosus and optioned only after first-line treatments have failed.  If phototherapy is administered, it is important to inform patients on the pertinence of lifelong skin cancer screenings in all cases of LS.
 
+ Sclerodermoid GVHD
 
If sclerodermoid GVHD proves resistant to conventional therapy, UVA1 and PUVA have shown success as adjunctive therapies.  As suggested above, skin cancer screening and counseling should be coupled with these treatments, as patients are immunosuppressed.  
 
+ Nephrogenic Systemic Fibrosis
 
When kidney transplant is not an option, UVA1 and PUVA are fine options for nephrogenic systemic fibrosis.
 
[source: Medscape]
 
[image by Mike Behnken]