Clinician-to-Clinician Update Clinician-to-Clinician Update

Ultraviolet A-1 Phototherapy Expands Options for Dermatology Patients

July 2016

Upgrades in phototherapy technology, including new UVA-1 devices, are providing relief for dermatology patients receiving photochemotherapy. Ultraviolet (UV) light suppresses the immune imbalance that drives inflammation in many skin diseases, making ultraviolet phototherapy a universal tool for dermatologists. Patients most often receive phototherapy in combination with photosensitizing medications. Newly available UVA-1 phototherapy lamps emit high-intensity ultraviolet light in the narrowband UVA-1 range (340-400 nm).1 UVA-1 penetrates more deeply into the dermis than the ultraviolet B (UVB, 280-315 nm), narrowband UVB (311-312 nm), and broadband UVA (320-400 nm) phototherapies do. UVA-1 phototherapy reaches inflammatory cells that drive many chronic skin diseases without requiring patients to take photosensitizing medications in support of treatment.2

At least one third of adults have some type of skin condition.3 Phototherapy patients have historically received either very short wavelength UVB irradiation treatments or broadband UVA phototherapy in combination with the drug psoralen (8-methoxypsoralen).4 For example, treatment with the Excimer laser, which emits narrowband UVB light (311 nm), is the indicated therapy for many patients with psoriasis. It is useful for treating individual lesions on the skin’s surface, such as those seen in vitiligo and psoriasis in focal patches.

Adult-Derm-July-2016-Main-Article-Image-Miller-Goldfarb
— University of Minnesota Health dermatologists Daniel Miller, MD, and Noah Goldfarb, MD, confer at the Clinics and Surgery Center. The new center houses one of the few UVA-1s in the region.

Alternatively, UVA phototherapy used with the medication psoralen (PUVA) can reach inflammatory cells that are inaccessible to UVB light, such as those found in patients with severe skin thickening. In PUVA, psoralen works by intercalating with the DNA of inflammatory cells, making it more sensitive to photodestruction by UVA light. However, PUVA patients can suffer nausea from psoralen and are required to avoid sunlight for 24 hours following phototherapy sessions, which are typically several times a week.

Although a high intensity form of phototherapy, UVA-1 poses a reduced risk of nausea and photosensitization, as it does not require accompanying treatment with psoralen. Data from several large clinical trials have suggested the efficacy of UVA-1, and it is now indicated for treatment of atopic dermatitis and localized scleroderma. Clinical consensus is also building for the use of UVA-1 as the standard of care in cutaneous T cell lymphoma with thick tumors, vitiligo, morphea, systemic sclerosis, and psoriasis.5 UVA-1 may also be an alternative for patients with certain autoimmune connective tissue disorders such as systemic lupus erythematosus.

University of Minnesota Health dermatologists have broad experience in transitioning patients to UVA-1 and have a broad range of phototherapy tools at their disposal, including the only UVA-1 in the Twin Cities.

References

  1. Choi D, Kannan S, Lim HW. Evaluation of patients with photodermatoses. Dermatol Clin. 2014; 32(3): 267-275.
  2. Zandi S, Kalia S, Lui H. UVA1 phototherapy: a concise and practical review. Skin Therapy Lett. 2012; 17(1): 1-4.
  3. Hay RJ, Johns NE, Williams, HC, et al. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol. 2014; 134(6): 1527-1534.
  4. Schneider LA, Hinrichs, R, Scharffer-Kochanek K. Phototherapy and photochemotherapy. Clin Dermatol. 2008; 26: 464-476.
  5. Gambichler T, Terras Sarah, Kreuter A. Treatment regimens, protocols, dosage, and indications for UVA1 phototherapy: facts and controversies. Clin Dermatol. 2013; 31(4): 438-454.

When to refer

University of Minnesota Health dermatology teams diagnose and treat a wide spectrum of skin conditions, including skin cancer, psoriasis and sclerodermatous diseases, pigmentary disorders, cutaneous lymphomas, and atopic dermatitis. We offer erythema-tolerance testing and comprehensive phototherapy care with UVA-1, UVB, Excimer lasering, and PUVA. University of Minnesota Health dermatologists are experts at weaning steroid-refractive sclerodermatous graft-versus-host disease patients from systemic immunosuppressive medications when UVA-1 phototherapy is the best course of treatment.

Our dermatologists provide care for adult patients at our Minneapolis and Maple Grove locations. The Phototherapy Center is housed in the new Clinics and Surgery Center in Minneapolis.

Multidisciplinary, Collaborative Care

Our dermatology team is committed to providing comprehensive care for every patient, from diagnosis to follow-up treatment. We collaborate with every specialty in the medical center, many of which are conveniently located within the new Clinics and Surgery Center. Our dermatology care teams include dermatologic surgeons and incorporate hematologists and oncologists, immunologists, rheumatologists for patients with connective tissue disorders, as well as transplant teams for graft-versus-host disease patients. We are also actively engaged in the Melanoma and Skin Cancer Program.

We understand the importance of continuity of care for every patient. Referring providers are integral members of the care team. We work together with referring physicians and their staff and patients to ensure timely communication and smooth transitions. Our goal is to provide optimal outcomes for patients at every stage of treatment.

To view current clinical trials available through M Health providers, visit studyfinder.umn.edu.

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