Sator Paul-Gunther, Radakovic Sonja, Schulmeister Karl, Hönigsmann Herbert, Tanew Adrian
Division of Special and Environmental Dermatology, Department of Dermatology, Medical University of Vienna, Vienna A-1090, Austria.
J Am Acad Dermatol. 2009 May;60(5):786-91. doi: 10.1016/j.jaad.2008.12.013. Epub 2009 Feb 10.
Recent studies suggest that ultraviolet (UV) A1 phototherapy is an effective treatment for localized scleroderma (LS); however, the optimum UVA1 dose remains to be determined.
We sought to compare the immediate and long-term efficacy of low- versus medium-dose UVA1 phototherapy for plaque-type LS.
Three comparable plaques in 16 patients were treated with 20 J/cm2 UVA1, 70 J/cm2 UVA1, or no irradiation. In total, 30 treatments were given. Skin thickness was determined by high-frequency ultrasound examination and clinical scoring. Assessments were done at baseline, immediately after treatment, and 3, 6, and 12 months thereafter.
Ultrasound measurement showed a significantly greater reduction of skin thickness with 70 J/cm2 than with 20 J/cm2 at all time points of the study except immediately after UVA1 treatment. The clinical score of the irradiated plaques also decreased substantially but failed to detect a significant difference between the two dose regimens.
Our results only pertain to plaque-type LS and are limited by a small sample size.
Medium-dose provides for better long-term results than low-dose UVA1 in LS as shown by ultrasound assessment. With clinical scoring, no significant difference between the two UVA1 dose regimens was detected, indicating that ultrasound measurement is a more sensitive method for quantifying treatment-induced skin changes in patients with LS.
近期研究表明，紫外线A1（UVA1）光疗是局限性硬皮病（LS）的一种有效治疗方法；然而，最佳UVA1剂量仍有待确定。
我们试图比较低剂量与中等剂量UVA1光疗对斑块型LS的即刻和长期疗效。
16例患者的3个可比斑块分别接受20 J/cm² UVA1、70 J/cm² UVA1照射或不照射。共进行30次治疗。通过高频超声检查和临床评分确定皮肤厚度。在基线、治疗后即刻以及此后3、6和12个月进行评估。
超声测量显示，在研究的所有时间点，除UVA1治疗后即刻外，70 J/cm²组的皮肤厚度减少幅度显著大于20 J/cm²组。照射斑块的临床评分也大幅下降，但未检测到两种剂量方案之间的显著差异。
我们的结果仅适用于斑块型LS，且受样本量小的限制。
超声评估显示，中等剂量UVA1在LS治疗中比低剂量能提供更好的长期效果。通过临床评分，未检测到两种UVA1剂量方案之间的显著差异，这表明超声测量是量化LS患者治疗引起的皮肤变化的更敏感方法。
