Stege H, Berneburg M, Humke S, Klammer M, Grewe M, Grether-Beck S, Boedeker R, Diepgen T, Dierks K, Goerz G, Ruzicka T, Krutmann J
Department of Dermatology, Heinrich-Heine-University, Düsseldorf, Germany.
J Am Acad Dermatol. 1997 Jun;36(6 Pt 1):938-44. doi: 10.1016/s0190-9622(97)80277-0.
Fibrotic skin lesions in patients with localized scleroderma can cause muscle atrophy, disfigurement, and flexion contractures. There is no effective therapy for this disease. Skin fibrosis is thought to be caused by decreased collagenase activity. Collagenase activity can be induced in dermal fibroblasts by UVA1 irradiation.
Our purpose was to assess whether UVA1 radiation therapy is effective for patients with localized scleroderma.
Patients with localized scleroderma (n = 17) were exposed 30 times to 130 J/cm2 UVA1 (high-dose UVA1 therapy; n = 10) or 20 J/cm2 UVA1 (low-dose UVA1 therapy; n = 7). Therapeutic effectiveness was assessed by evaluation of (1) clinical features, (2) thickness of sclerotic plaques, and (3) cutaneous elastometry. Sequential biopsy specimens from treated lesions were analyzed for collagenase I messenger RNA (mRNA) expression by semiquantitative reverse transcriptase-polymerase chain reaction.
In all patients, high-dose UVA1 therapy softened sclerotic plaques, and complete clearance was observed in four of 10 patients. High-dose UVA1 therapy significantly reduced thickness and increased elasticity of plaques. These changes could not be detected in unirradiated control plaques and were still present in 9 of 10 patients 3 months after cessation of therapy. For all factors assessed, high-dose UVA1 was superior to low-dose UVA1 therapy (p = 0.001). High-dose UVA1 therapy increased collagenase I mRNA expression about 20-fold in treated plaques.
High-dose UVA1 therapy is effective in the treatment of localized scleroderma. Effectiveness is UVA1 dose dependent and is associated with induction of collagenase I expression.
局限性硬皮病患者的皮肤纤维化病变可导致肌肉萎缩、毁容和屈曲挛缩。目前尚无针对该病的有效治疗方法。皮肤纤维化被认为是由胶原酶活性降低所致。UVA1照射可诱导真皮成纤维细胞中的胶原酶活性。
我们旨在评估UVA1放射治疗对局限性硬皮病患者是否有效。
17例局限性硬皮病患者接受30次130 J/cm2 UVA1照射（高剂量UVA1治疗；n = 10）或20 J/cm2 UVA1照射（低剂量UVA1治疗；n = 7）。通过评估（1）临床特征、（2）硬化斑块厚度和（3）皮肤弹性测定来评估治疗效果。采用半定量逆转录聚合酶链反应分析经治疗病变的连续活检标本中胶原酶I信使核糖核酸（mRNA）的表达。
在所有患者中，高剂量UVA1治疗使硬化斑块变软，10例患者中有4例斑块完全清除。高剂量UVA1治疗显著降低了斑块厚度并增加了其弹性。这些变化在未照射的对照斑块中未检测到，且在治疗停止3个月后，10例患者中有9例仍然存在。对于所有评估因素，高剂量UVA1治疗均优于低剂量UVA1治疗（p = 0.001）。高剂量UVA1治疗使经治疗斑块中的胶原酶I mRNA表达增加约20倍。
高剂量UVA1治疗对局限性硬皮病有效。疗效呈UVA1剂量依赖性，且与胶原酶I表达的诱导有关。
