title: Medium-dose is more effective than low-dose ultraviolet A1 phototherapy for localized scleroderma as shown by 20-MHz ultrasound assessment.
abstract: BACKGROUND
  Recent studies suggest that ultraviolet (UV) A1 phototherapy is an effective treatment for localized scleroderma (LS); however, the optimum UVA1 dose remains to be determined.
  
  
  OBJECTIVE
  We sought to compare the immediate and long-term efficacy of low- versus medium-dose UVA1 phototherapy for plaque-type LS.
  
  
  METHODS
  Three comparable plaques in 16 patients were treated with 20 J/cm2 UVA1, 70 J/cm2 UVA1, or no irradiation. In total, 30 treatments were given. Skin thickness was determined by high-frequency ultrasound examination and clinical scoring. Assessments were done at baseline, immediately after treatment, and 3, 6, and 12 months thereafter.
  
  
  RESULTS
  Ultrasound measurement showed a significantly greater reduction of skin thickness with 70 J/cm2 than with 20 J/cm2 at all time points of the study except immediately after UVA1 treatment. The clinical score of the irradiated plaques also decreased substantially but failed to detect a significant difference between the two dose regimens.
  
  
  CONCLUSIONS
  Our results only pertain to plaque-type LS and are limited by a small sample size.
  
  
  CONCLUSIONS
  Medium-dose provides for better long-term results than low-dose UVA1 in LS as shown by ultrasound assessment. With clinical scoring, no significant difference between the two UVA1 dose regimens was detected, indicating that ultrasound measurement is a more sensitive method for quantifying treatment-induced skin changes in patients with LS.
authors.affiliation: Division of Special and Environmental Dermatology, Department of Dermatology, Medical University of Vienna, Vienna A-1090, Austria.
authors.forename: Paul-Gunther
authors.initials: PG
authors.lastname: Sator
authors.forename: Sonja
authors.initials: S
authors.lastname: Radakovic
authors.forename: Karl
authors.initials: K
authors.lastname: Schulmeister
authors.forename: Herbert
authors.initials: H
authors.lastname: Hönigsmann
authors.forename: Adrian
authors.initials: A
authors.lastname: Tanew
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012594:Scleroderma, Localized / Q000532:radiotherapy*; D012867:Skin / Q000000981:diagnostic imaging / Q000528:radiation effects; D016896:Treatment Outcome; D014463:Ultrasonography; D014467:Ultraviolet Therapy / Q000295:instrumentation / Q000379:methods*