title: High-dose UVA1 radiation therapy for localized scleroderma.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  Our purpose was to assess whether UVA1 radiation therapy is effective for patients with localized scleroderma.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Dermatology, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Stege
authors.forename: M
authors.initials: M
authors.lastname: Berneburg
authors.forename: S
authors.initials: S
authors.lastname: Humke
authors.forename: M
authors.initials: M
authors.lastname: Klammer
authors.forename: M
authors.initials: M
authors.lastname: Grewe
authors.forename: S
authors.initials: S
authors.lastname: Grether-Beck
authors.forename: R
authors.initials: R
authors.lastname: Boedeker
authors.forename: T
authors.initials: T
authors.lastname: Diepgen
authors.forename: K
authors.initials: K
authors.lastname: Dierks
authors.forename: G
authors.initials: G
authors.lastname: Goerz
authors.forename: T
authors.initials: T
authors.lastname: Ruzicka
authors.forename: J
authors.initials: J
authors.lastname: Krutmann
mesh_terms: D000328:Adult; D000368:Aged; D017364:Collagenases / Q000378:metabolism / Q000528:radiation effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012594:Scleroderma, Localized / Q000201:enzymology / Q000473:pathology / Q000532:radiotherapy*; D012867:Skin / Q000201:enzymology / Q000473:pathology; D014467:Ultraviolet Therapy
chemical_list: D017364:Collagenases