UVA1 Therapy

The UV spectrum of electromagnetic radiation comprises UVB (280-315 nm) and UVA (315-400 nm) light. UVA constitutes the majority (90%-95%) of UV radiation on the earth's surface (Gasparro 2000, McGrath 1994). The biological, immunologic, and photochemical effects of both wavelengths seem divergent and partly opposing. LE-aggravating properties seem to be mainly attributable to UVB and the shorter part of UVA (UVA2,315-340 nm). In contrast, UVA1 (340-400nm) demonstrates the greatest efficacy in the treatment of LE. In this respect, LE may be attributed to other photodermatoses in which UV irradiation can be used for prophylaxis and treatment. Consequently, several studies have been published recently that document beneficial effects of UVA1 on both CLE and SLE (McGrath 1994,1997,1999, McGrath et al. 1996, Molina and McGrath 1997, Sonnichsen et al. 1993). Disease activity, therapeutic drug use, and anti-double-stranded DNA titers in SLE were shown to decrease after a 3-week course of UVA1 at 60 J/cm2 per day for 5 days/week. Lower treatment frequencies of one or two irradiations per week for years seem to be effective as well (McGrath 1994, McGrath et al. 1996). In one case of SCLE, cutaneous symptoms improved after 9 weeks of treatment with UVA1 (Sonnichsen et al. 1993). In contrast to this, another case report described exacerbation in a patient with DLE on UVA1 treatment (McGrath 1999). As with other therapeutic regimens discussed in this chapter, UVA1 irradiation should only be implemented when other first-line therapies have failed, as, apart from possible LE aggravation, skin photocarcinogenesis and photoaging on long-term treatment have to be taken into account.

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