High-Dose UVA1 Therapy of Atopic Dermatitis and Scleroderma

Abstract

For high-dose UVA1 therapy, patients are exposed to high-intensity irradiation devices, which allow exposure of patients skin to UV radiation at wavelengths >340 nm at single doses of up to 130 J/cm2 UVAI. This novel phototherapeutic regimen has first been used to treat patients with atopic dermatitis. In a pilot study conducted at the Department of Dermatology at the University of Freiburg it has been observed that high-dose UVA1 irradiation, if used as a monotherapy, is highly efficient and superior to conventional phototherapy for this indication. More recently, these promising results have been corroborated and extended in a randomized multicenter trial and high-dose UVA1 radiation may thus be regarded as an established alternative to glucocorticosteroids for the treatment of acute, severe atopic dermatitis. During the same time, substantial progress has been made in elucidating the effects, which high-dose UVA1 irradiation exerts on the skin immune system. These studies have been of direct clinical relevance because they have prompted the use of high-dose UVA1 therapy for other inflammatory skin diseases including urticaria pigmentosa and localized scleroderma. In this chapter, the clinical and photoimmunological aspects of high-dose UVA1 therapy for atopic dermatitis, the current status of clinical trials assessing the use of high-dose UVA1 therapy in localized scleroderma, as well as our current concepts about the mode of action of high-dose UVA1 therapy will be discussed.