title: Recurrence of morphea after successful ultraviolet A1 phototherapy: A cohort study.
abstract: BACKGROUND
  Studies support efficacy of ultraviolet (UV)A1 phototherapy, but little is known about recurrence after successful UVA1 treatment.
  
  
  OBJECTIVE
  We sought to determine the frequency of recurrent activity after UVA1 phototherapy and variables associated with recurrence.
  
  
  METHODS
  This was a case series and prospective cohort study of patients treated with UVA1 phototherapy with minimum 6 months of follow-up. Demographics, clinical features, and cumulative UVA1 dose were analyzed for association with recurrence.
  
  
  RESULTS
  Of 37 patients, 46% (n = 17) had recurrence of active morphea lesions after successful UVA1 phototherapy. Two-year and 3-year (after the last UVA1 phototherapy treatment) recurrence rates were 44.5% (95% confidence interval 30.1%-62.2%) and 48.4% (95% confidence interval 33.2%-66.1%), respectively. The only variable associated with recurrence was duration of morphea before UVA1 (P value = .02, hazard ratio 1.15, 95% confidence interval 1.06-1.27).
  
  
  CONCLUSIONS
  The sample size limits conclusions.
  
  
  CONCLUSIONS
  With the exception of increased duration of morphea, risk of recurrence is no different in adults and children, or between morphea subtypes, skin types, and medium- to high-dose regimens. This indicates treatment doses in the medium-high UVA1 range are adequate with respect to frequency of recurrence.
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Vasquez
authors.affiliation: Paul L. Foster School of Medicine, Texas Tech University Health Science Center at El Paso, El Paso, Texas.
authors.forename: Aysha
authors.initials: A
authors.lastname: Jabbar
authors.affiliation: Paul L. Foster School of Medicine, Texas Tech University Health Science Center at El Paso, El Paso, Texas.
authors.forename: Fatima
authors.initials: F
authors.lastname: Khan
authors.affiliation: Department of Dermatology, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Douglas
authors.initials: D
authors.lastname: Buethe
authors.affiliation: Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Chul
authors.initials: C
authors.lastname: Ahn
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: heidi.jacobe@utsouthwestern.edu.
authors.forename: Heidi
authors.initials: H
authors.lastname: Jacobe
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D015331:Cohort Studies; D016001:Confidence Intervals; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010789:Phototherapy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012594:Scleroderma, Localized / Q000175:diagnosis* / Q000532:radiotherapy*; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014467:Ultraviolet Therapy / Q000379:methods*; D055815:Young Adult
keywords: localized scleroderma; morphea; phototherapy; ultraviolet A1 phototherapy