Skip to main content
SpringerLink
Log in
Book cover

Dermatological Phototherapy and Photodiagnostic Methods pp 295–310Cite as

Ultraviolet A-1 Phototherapy: Indications and Mode of Action

  • Chapter

Abstract

› The indications for UVA-1 phototherapy fall into four major categories: T-cellmediated skin diseases, mast-cell-mediated skin diseases, connective tissue diseases, and phototherapy in HIV+ patients.

› UVA-1 radiation-induced T-helper cell apoptosis constitutes the basis of UVA-1 phototherapy in patients with atopic dermatitis.

› UVA-1 phototherapy has the potential to replace PUVA as the therapy of choice for urticaria pigmentosa patients.

› UVA-1 is an effective treatment for psoriasis in HIV+ patients.

› UVA-1 phototherapy may not be performed in patients with UVA-sensitive photodermatoses or photosensitive atopic dermatitis.

› Children should not be treated with UVA-1 phototherapy except in severe cases of scleroderma where other treatment options do not exist.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Asawonando P, Khoo LSW, Fitzpatrick TB, Taylor CR (1999) UVA-1 for keloid. Arch Dermatol 135:348–349

    Article  Google Scholar 

  2. Beattie PE, Dawe RS, Ferguson J, Ibbotson SH (2006) UVA-1 phototherapy for genital lichen sclerosus. Clin Exp Dermatol 31:343–347

    Article  PubMed  CAS  Google Scholar 

  3. Calzavara Pinton P (2000) High-dose UVA1 therapy of large plaques and nodular lesions of cutaneous T-cell lymphoma. J Am Acad Dermatol (in press)

    Google Scholar 

  4. Costa C, Rillet A, Nicolet M, Saurat JH (1989) Scoring atopic dermatitis: the simpler the better. Acta Derm Venereol (Stockh) 69:41–47

    CAS  Google Scholar 

  5. Christophers E, Hönigsmann H, Wolff K, Langner A (1978) PUVA treatment of urticaria pigmentosa. Br J Dermatol 98:701–702

    Article  PubMed  CAS  Google Scholar 

  6. Cruz P Jr, Dougherty I, Dawson B, Krutmann J (2000) Unlike UVB, UVA-1 radiation does not activate HIV in human skin. J Invest Dermatol (in press)

    Google Scholar 

  7. Czech W, Krutmann J, Schöpf E, Kapp A (1992) Serum eosinophil cationic protein is a sensitive measure for disease activity in atopic dermatitis. Br J Dermatol 126:351–355

    Article  PubMed  CAS  Google Scholar 

  8. Fleischmajer R (1993) Localized and systemic scleroderma. In: Lapiere CM, Krieg T (eds) Connective tissue diseases of the skin. Dekker, New York, pp 295–313

    Google Scholar 

  9. Godar DE (1999) UVA 1 radiation mediates singlet-oxygen and superoxide-anion production which trigger two different final apoptotic pathways: the S and P site of mitochondria. J Invest Dermatol 112:3–12

    Article  PubMed  CAS  Google Scholar 

  10. Grabbe J, Welker P, Humke S, Grewe M, Schöpf E, Henz BM, Krutmann J (1996) High-dose UVA1 therapy, but not UVA/UVB therapy, decreases IgE binding cells in lesional skin of patients with atopic eczema. J Invest Dermatol 107:419–423

    Article  PubMed  CAS  Google Scholar 

  11. Granerus G, Roupa G, Swanbeck G (1981) Decreased urinary histamine levels after successful PUVA treatment of urticaria pigmentosa. J Invest Dermatol 76:1–3

    Article  PubMed  CAS  Google Scholar 

  12. Grewe M, Gyufko K, Schöpf E, Krutmann J (1994) Lesional expression of interferon-γ in atopic eczema. Lancet 343:25–26

    Article  PubMed  CAS  Google Scholar 

  13. Grewe M, Bruijnzeel-Koomen CAFM, Schöpf E, Thepen T, Langeveld-Wildschut AG, Ruzicka T, Krutmann J (1998) A role for Th1 and Th2 cells in the immunopathogenesis of atopic dermatitis. Immunol Today 19:359–361

    Article  PubMed  CAS  Google Scholar 

  14. Gruss C, Strucker M, Kobyletzki G, Kerscher M, Altmeyer P (1997) Low dose UVA1 phototherapy in disabling pansclerotic morphea. Br J Dermatol 136:293–294

    Article  PubMed  CAS  Google Scholar 

  15. Herbst RA, Vogelbruich M, Ehnis A, Kiehl P, Kapp A, Weiss J (2000) Combined ultraviolet A1 radiation and acitretin therapy as a treatment option for pityriasis rubra pilaris. Br J Dermatol 142:574–575

    Article  PubMed  CAS  Google Scholar 

  16. Jekler J, Larkö O (1990) Combined UV-A-UV-B versus UVB phototherapy for atopic dermatitis. J Am Acad Dermatol 22:49–53

    Article  PubMed  CAS  Google Scholar 

  17. Kerscher M, Dirschka T, Volkenandt M (1995) Treatment of localized scleroderma by UVA1 phototherapy. Lancet 346:1166

    Article  PubMed  CAS  Google Scholar 

  18. Kerscher M, Volkenandt M, Gruss C, Reuther T, Kobyletzki G, Freitag M, Dirschka T, Altmeyer P (1998) Low-dose UVA1 phototherapy for treatment of localized scleroderma. J Am Acad Dermatol 38:21–26

    Article  PubMed  CAS  Google Scholar 

  19. Kobyletzki G, Pieck C, Hoffmann K, Freitag M, Altmeyer P (1999) Medium-dose UVA1 cold-light phototherapy in the treatment of severe atopic dermatitis. J Am Acad Dermatol 41:931–937

    Article  Google Scholar 

  20. Kolde G, Frosch PJ, Czarnetzki BM (1984) Response of cutaneous mast cells to PUVA in patients with urticaria pigmentosa: histophotometric, ultrastructural, and biochemical investigations. J Invest Dermatol 83:175–178

    Article  PubMed  CAS  Google Scholar 

  21. Kowalzick L, Kleinhenz A, Weichenthal M, Ring J (1995) Low dose versus medium dose UVA-1 treatment in severe atopic dermatitis. Acta Derm Venereol (Stockh) 75:43–45

    CAS  Google Scholar 

  22. Krutmann J, Schöpf E (1992) High-dose UVA1 therapy: a novel and highly effective approach for the treatment of patients with acute exacerbation of atopic dermatitis. Acta Derm Venereol (Stockh) 176:120–122

    CAS  Google Scholar 

  23. Krutmann J, Czech W, Diepgen T, Niedner R, Kapp A, Schöpf E (1992) High-dose UVA1 therapy in the treatment of patients with atopic dermatitis. J Am Acad Dermatol 26:225–230

    Article  PubMed  CAS  Google Scholar 

  24. Krutmann J (1995) UVA1-induced immunomodulation. In: Krutmann J, Elmets CA (eds) Photoimmunology. Blackwell Science, Oxford, pp 246–256

    Google Scholar 

  25. Krutmann J (1996) Phototherapy for atopic dermatitis. Dermatol Ther 1:24–31

    Google Scholar 

  26. Krutmann J, Diepgen T, Luger TA, Grabbe S, Meffert H, Sönnichsen N, Czech W, Kapp A, Stege H, Grewe M, Schöpf E (1998) High-dose UVA1 therapy for atopic dermatitis: results of a multicenter trial. J Am Acad Dermatol 38:589–593

    Article  PubMed  CAS  Google Scholar 

  27. Krutmann J (1999) Therapeutic photomedicine: phototherapy. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, Fitzpatrick TB (eds) Fitzpatrick’s dermatology in general medicine, 5th edn. McGraw-Hill, New York, pp 2870–2879

    Google Scholar 

  28. LeRoy EC (1979) Increased collagen synthesis by scleroderma skin fibroblasts in vitro. J Clin Invest 54:880–889

    Article  Google Scholar 

  29. McGrath H Jr (1994) Ultraviolet-A1 irradiation decreases clinical disease activity and autoantibodies in patients with systemic lupus erythematosus. Clin Exp Rheumatol 12:129–135

    PubMed  Google Scholar 

  30. McGrath Jr H, Martinez-Osuna P, Lee FA (1996) Ultraviolet A-1 (340–400?nm) irradiation in systemic lupus erythematosus. Lupus 5:269–274

    Article  PubMed  CAS  Google Scholar 

  31. Meffert H, Soennichsen N, Herzog M, Hutschenreuther A (1992) UVA-1 cold light therapy of severe atopic dermatitis. Dermatol Monatsschr 78:291–296

    Google Scholar 

  32. Morita A, Sakakibara S, Sakakibara N, Yamauchi R, Tsuji T (1995) Successful treatment of systemic sclerosis with topical PUVA. J Rheumatol 22:2361–2365

    PubMed  CAS  Google Scholar 

  33. Morita A, Werfel T, Stege H, Ahrens C, Karmann K, Grewe M, Grether-Beck S, Ruzicka T, Kapp A, Klotz LO, Sies H, Krutmann J (1997) Evidence that singlet oxygen-induced human T helper cell apoptosis is the basic mechanism of ultraviolet-A radiation phototherapy. J Exp Med 186:1763–1768

    Article  PubMed  CAS  Google Scholar 

  34. Morita A, Kobayashi K, Isomura I, Tsuji T, Krutmann J (2000) Ultraviolet A-1 (340–400?nm) phototherapy for systemic sclerosis. J Am Acad Dermatol 43:670–674

    Article  PubMed  CAS  Google Scholar 

  35. Morita A, Yamauchi Y, Yasuda Y, Tsuji T, Krutmann J (2000) Malignant T-cells are exquisitely sensitive to ultraviolet A-1 (UVA-1) radiation-induced apoptosis. J Invest Dermatol 114:751

    Google Scholar 

  36. Mutzhas MF, Hölzle E, Hofmann C, Plewig G (1981) A new apparatus with high radiation energy between 320–460?nm: physical description and dermatological applications. J Invest Dermatol 76:42–47

    Article  PubMed  CAS  Google Scholar 

  37. Petersen MJ, Nasen C, Craig S (1992) Ultraviolet A irradiation stimulates collagenase production in cultured human fibroblasts. J Invest Dermatol 99:440–442

    Article  PubMed  CAS  Google Scholar 

  38. Plettenberg H, Stege H, Megahed M, Ruzicka T, Hosokawa Y, Tsuji T, Morita A, Krutmann J (1999) Ultraviolet A1 (340–400?nm) phototherapy for cutaneous T-cell lymphoma. J Am Acad Dermatol 41:47–50

    Article  PubMed  CAS  Google Scholar 

  39. Plettenberg H, Stege H, Mang R, Ruzicka T, Krutmann J (2001) A comparison of Ultraviolet A-1 and PUVA therapy for early stages of cutaneous T-cell lymphoma. Photodermatol Photoimmunol Photomed 17:149–155

    Article  Google Scholar 

  40. Rodnan GP, Lipinski I, Luksick J (1979) Skin collagen content in progressive systemic sclerosis (scleroderma) and localized scleroderma. Arthritis Rheum 22:130–140

    Article  PubMed  CAS  Google Scholar 

  41. Rosenwasser TA, Eisen AZ (1993) Scleroderma. In: Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM, Austen KF (eds) Dermatology in general medicine, 4th edn. McGraw-Hill, New York, pp 2156–2167

    Google Scholar 

  42. Sakakibara N, Sugano S, Morita M (2008) Ultrastructural changes induced in cutaneous collagen by ultraviolet-A1 and psoralen plus ultraviolet A therapy in systemic sclerosis. J Dermatol 35:63–69

    Article  PubMed  Google Scholar 

  43. Scharffetter K, Wlaschek M, Hogg A, Bolsen K, Schothorst A, Goerz G, Krieg T, Plewig G (1991) UVA irradiation induces collagenase in human dermal fibroblasts in vitro and in vivo. Arch Dermatol Res 283:506–511

    Article  PubMed  CAS  Google Scholar 

  44. Scharfetter-Kochanek K, Goldermann R, Lehmann P, Hölzle E, Goerz G (1995) PUVA therapy in disabling pansclerotic morphea of children. Br J Dermatol 132:830–831

    Article  Google Scholar 

  45. Schmidt T, Abeck D, Boeck K, Mempel M, Ring J (1998) UVA1 irradiation is effective in treatment of chronic vesicular dyshidrotic hand eczema. Acta Derm Venereol (Stockh) 78:318–319

    Article  CAS  Google Scholar 

  46. Setlow RB, Grist E, Thompson K, Woodhead AD (1993) Wavelengths effective in induction of malignant melanoma. Proc Natl Acad Sci USA 90:6666–6670

    Article  PubMed  CAS  Google Scholar 

  47. Soennichsen N, Meffert H, Kunzelmann V (1993) UV-A-1 Therapie bei subakut-kutanem Lupus erythematodes. Hautarzt 44:723–725

    Google Scholar 

  48. Stege H, Schöpf E, Ruzicka T, Krutmann J (1996) High-dose-UVA1 for urticaria pigmentosa. Lancet 347:64

    Article  PubMed  CAS  Google Scholar 

  49. Stege H, Humke S, Berneburg M, Klammer M, Grewe M, Grether-Beck S, Dierks K, Goerz G, Ruzicka T, Krutmann J (1996) High-dose ultraviolet A1 radiation therapy of localized scleroderma. J Am Acad Dermatol 36:938–943

    Article  Google Scholar 

  50. Stege H, Budde M, Kürten V, Ruzicka T, Krutmann J (1999) Induction of apoptosis in skin-infiltrating mast cells by high-dose ultraviolet A-1 radiation phototherapy in patients with urticaria pigmentosa. J Invest Dermatol 112:561

    Google Scholar 

  51. Sterenbroigh HCJM, van der Leun JC (1990) Tumorigenesis by a long wavelength UV-A source. Photochem Photobiol 51:325–330

    Article  Google Scholar 

  52. Takeda K, Hahamochi A, Ueki H, Nakata M, Oishi Y (1994) Decreased collagenase expression in cultured systemic sclerosis fibroblasts. J Invest Dermatol 103:359–363

    Article  PubMed  CAS  Google Scholar 

  53. Tuchinda C, Kerr HA, Taylor CR, Jacobe H, Bergamo BM, Elmets C, Rivard J, Lim HW (2006) UVA1 phototherapy for cutaneous diseases: an experience of 92 cases in the United States. Photoderm Photoimmunol Photomed 22:247–253

    Article  Google Scholar 

  54. Zmudzka BZ, Olvey KM, Lee W, Beer JZ (1994) Reassessment of the differential effects of ultraviolet and ionizing radiation on HIV promoter: the use of cell survival as the basis for comparisons. Photochem Photobiol 59:643–649

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institut für Umweltmedizinische Forschung (IUF) gGmbH, Universität Düsseldorf, Auf´m Hennekamp 50, 40225, Düsseldorf, Germany

    Jean Krutmann

  2. Dermatologie, Klinikum Lippe-Lemgo, Rintelner Straße 85, 32657, Lemgo, Germany

    Helger Stege

  3. Graduate School of Medical Sciences, Department of Geriatric and Environmental Dermatology, Nagoya City University, 467-8601, Nagoya, Japan

    Akimichi Morita

Authors
  1. Jean Krutmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Helger Stege
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akimichi Morita
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jean Krutmann .

Editor information

Editors and Affiliations

  1. Dermatologische Klinik, Abt. Spezielle Dermatologie, Universitätsklinikum Wien, Wahringer Gürtel 18-20, 1090, Wien, Austria

    Herbert Hönigsmann

  2. Department of Dermatology, University of Alabama, Birmingham, 35294-0007, Birmingham, AL, USA

    Craig A. Elmets

  3. Institut für Umweltmedizinische Forschung (IUF) gGmbH, Universität Düsseldorf, Auf'm Hennekamp 50, 40225, Düsseldorf, Germany

    Jean Krutmann

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Krutmann, J., Stege, H., Morita, A. (2009). Ultraviolet A-1 Phototherapy: Indications and Mode of Action. In: Hönigsmann, H., Elmets, C., Krutmann, J. (eds) Dermatological Phototherapy and Photodiagnostic Methods. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-36693-5_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-36693-5_13

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-36692-8

  • Online ISBN: 978-3-540-36693-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation