PMID- 38076241
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231211
IS  - 2296-858X (Print)
IS  - 2296-858X (Electronic)
IS  - 2296-858X (Linking)
VI  - 10
DP  - 2023
TI  - The realistic positioning of UVA1 phototherapy after 25 years of clinical 
      experience and the availability of new biologics and small molecules: a 
      retrospective clinical study.
PG  - 1295145
LID - 10.3389/fmed.2023.1295145 [doi]
LID - 1295145
AB  - BACKGROUND: Since the early 1990s, Ultraviolet (UV) A1 phototherapy has been 
      described as an effective and safe treatment of a multitude of skin disorders. 
      However, after 30 years, its use has remained limited to few dermatological 
      centers. OBJECTIVE: To analyze the changes over the years and the current 
      position of UVA1 phototherapy through a Real-World Evidence (RWE) study at a 
      single tertiary referral center. METHODS: We reviewed the medical files of 740 
      patients treated between 1998 and 2022. Treatment results were collected, 
      efficacy was assessed by a grading scale and acute adverse effects were 
      registered. RESULTS: We treated patients with 26 different diseases. We 
      registered marked improvement (MI) or complete remission (CR) in 42.8% of 
      patients with morphea, 50% with Urticaria Pigmentosa, 40.7% with Granuloma 
      annulare and 85.7% with skin sarcoidosis. Good results were obtained also in the 
      treatment of chronic Graft Versus Host Disease (GVHD), Eosinophilic Fasciitis, 
      Sclero-atrophic Lichen, skin manifestations of systemic lupus erythematosus and 
      psoriasis of HIV+ patients. Systemic Sclerosis, Romberg's Syndrome, Bushke's 
      Scleredema, Nephrogenic Fibrosing Dermopathy, REM Syndrome, Follicular Mucinosis, 
      Pretibial Myxedema, Scleromyxedema, pemphigus foliaceus, chronic cutaneous lupus 
      erythematosus, erythroderma of Netherton Syndrome and Necrobiosis Lipoidica were 
      no or poorly responsive. In clinical indications where UVA1 was used as a second 
      line phototherapy after narrow-band (NB)-UVB, we saw good MI or CR rates in 
      Mycosis Fungoides (57% of patients), Atopic Dermatitis (33.9%), Pitiryasis 
      Lichenoides chronica (50%), Pityriasis Lichenoides et varioliformis acute (75%) 
      and Lymphomatod Papulosis (62.5%). Short-term adverse events were uncommon and 
      mild. CONCLUSION: Over the past decade, the annual number of treated patients has 
      progressively declined for several reasons. Firstly, UVA1 phototherapy has taken 
      a backseat to the cheaper and more practical NB-UVB phototherapy, which has 
      proven effective for common indications. Secondly, the emergence of new, safe, 
      and effective drugs for conditions such as atopic dermatitis, GVHD, and 
      connective tissue disorders. Finally, our research has shown that UVA1 therapy is 
      often ineffective or minimally effective for some rare diseases, contrary to 
      previous case reports and small case series. Nonetheless, UVA1 continues to be a 
      valuable treatment option for patients with specific skin disorders.
CI  - Copyright (c) 2023 Calzavara-Pinton, Bettolini, Tonon, Rossi and Venturini.
FAU - Calzavara-Pinton, Piergiacomo
AU  - Calzavara-Pinton P
AD  - Department of Dermatology, University of Brescia, Brescia, Italy.
AD  - Department of Dermatology, ASST Spedali Civili di Brescia, Brescia, Italy.
FAU - Bettolini, Luca
AU  - Bettolini L
AD  - Department of Dermatology, University of Brescia, Brescia, Italy.
AD  - Department of Dermatology, ASST Spedali Civili di Brescia, Brescia, Italy.
FAU - Tonon, Francesco
AU  - Tonon F
AD  - Department of Dermatology, University of Brescia, Brescia, Italy.
AD  - Department of Dermatology, ASST Spedali Civili di Brescia, Brescia, Italy.
FAU - Rossi, Mariateresa
AU  - Rossi M
AD  - Department of Dermatology, University of Brescia, Brescia, Italy.
AD  - Department of Dermatology, ASST Spedali Civili di Brescia, Brescia, Italy.
FAU - Venturini, Marina
AU  - Venturini M
AD  - Department of Dermatology, University of Brescia, Brescia, Italy.
AD  - Department of Dermatology, ASST Spedali Civili di Brescia, Brescia, Italy.
LA  - eng
PT  - Journal Article
DEP - 20231121
PL  - Switzerland
TA  - Front Med (Lausanne)
JT  - Frontiers in medicine
JID - 101648047
PMC - PMC10702775
OTO - NOTNLM
OT  - GVHD
OT  - atopic dermatitis
OT  - morphea
OT  - phototherapy
OT  - ultraviolet A1
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest. The author(s) declared that they were an editorial board 
      member of Frontiers, at the time of submission. This had no impact on the peer 
      review process and the final decision.
EDAT- 2023/12/11 12:42
MHDA- 2023/12/11 12:43
PMCR- 2023/11/21
CRDT- 2023/12/11 06:07
PHST- 2023/09/15 00:00 [received]
PHST- 2023/11/08 00:00 [accepted]
PHST- 2023/12/11 12:43 [medline]
PHST- 2023/12/11 12:42 [pubmed]
PHST- 2023/12/11 06:07 [entrez]
PHST- 2023/11/21 00:00 [pmc-release]
AID - 10.3389/fmed.2023.1295145 [doi]
PST - epublish
SO  - Front Med (Lausanne). 2023 Nov 21;10:1295145. doi: 10.3389/fmed.2023.1295145. 
      eCollection 2023.