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• W2067799839 abstract "Although it is considered to be self-limiting, lichen planus (LP) may exist for many years and may be generalized and difficult to treat. Four patients with histologically proven, therapy-resistant, generalized LP were treated with ultraviolet A1 (UVA1). None used medication known to improve LP or induce lichenoid drug reactions. Treatment consisted of irradiation with 45 J/cm2 for 5 days per week during two 4-week treatment periods with a 3-week interval, with the Photomed 250 000 (Photomed World Industries, Hamburg, Germany) emitting 30 mW/cm2. Before and after treatment the affected body area, a 100-mm visual analogue score for itch, and the Dermatology Life Quality Index (DLQI) were determined.1Finlay A.Y. Khan G.K. Dermatology Life Quality Index (DLQI)—a simple practical measure for routine clinical use.Clin Exp Dermatol. 1994; 19: 210-216Crossref PubMed Scopus (3468) Google Scholar Case 1 was a 39-year-old woman who presented with a 4-month history of very itchy, generalized LP. Topical corticosteroids and retinoic acid had proven ineffective. After UVA1 therapy, 98% clearance was achieved and both itch and DLQI improved considerably. Thick plaques on her ankles resolved to thin patches. Histologically, all characteristic features of LP had normalized and only a sparse infiltrate was seen. Case 2 was a 38-year-old man who presented with an 8-month history of hardly itching, generalized LP. Potent corticosteroid ointments were ineffective. After UVA1 therapy, his LP had cleared for 88%. However, the patches on his ankles showed only some improvement. Cases 3 and 4 were a 54-year-old father and his 17-year-old daughter who had a history of generalized LP of 22 and 9 years, respectively, and had little effect from topical corticosteroids and tretinoin cream. Long-term psoralen plus UVA (PUVA) therapy had previously been successful for the father, but his LP was exacerbated during a second PUVA course. UVA1 therapy resulted in 82% clearance. The daughter had some temporary improvement with ultraviolet B treatment 7 years earlier. In her case, UVA1 therapy resulted in 41% clearance. The DLQI and visual analogue score improved in both. The thick patches on their ankles had not cleared completely. In all 4 patients, therapy-resistant LP lesions improved significantly (Table I). In the past, PUVA therapy has also shown to be effective in the treatment of LP.2Gonzalez E. Momtaz Y.K. Freedman S. Bilateral comparison of generalized lichen planus treated with psoralens and ultraviolet A.J Am Acad Dermatol. 1984; 10: 958-961Abstract Full Text PDF PubMed Scopus (47) Google Scholar Biological effects of ultraviolet rays are mediated by different photochemical mechanisms. UVA1 radiation is known to generate singlet-oxygen and superoxide anions.3Morita A. Werfel T. Stege H. Ahrens C. Karmann K. Grewe M. et al.Evidence that singlet oxygen-induced human T helper cell apoptosis is the basic mechanism of ultraviolet-A radiation phototherapy.J Exp Med. 1997; 186: 1763-1768Crossref PubMed Scopus (247) Google Scholar Extensive production of such radicals can lead to apoptotic death of lymphoid cells4Godar D.E. Lucas A.D. Spectral dependence of UV-induced immediate and delayed apoptosis the role of membrane and DNA damage.Photochem Photobiol. 1995; 62: 108-113Crossref PubMed Scopus (107) Google Scholar that have been shown to have a lower threshold for switching to the apoptotic program.5Vowels B.R. Yoo E.K. Gasparro F.P. Kinetic analysis of apoptosis induction in human cell lines by UVA and 8-MOP.Photochem Photobiol. 1996; 63: 572-576Crossref PubMed Scopus (29) Google Scholar At least part of the therapeutic response to UVA1 radiation may thus be because of an apoptosis-inducing effect on the inflammatory infiltrate.3Morita A. Werfel T. Stege H. Ahrens C. Karmann K. Grewe M. et al.Evidence that singlet oxygen-induced human T helper cell apoptosis is the basic mechanism of ultraviolet-A radiation phototherapy.J Exp Med. 1997; 186: 1763-1768Crossref PubMed Scopus (247) Google Scholar Whether other mechanisms also play a role in the therapeutic effect remains to be elucidated.Table IPatient characteristics and results of UVA1 treatmentPatient No.Gender/AgeDuration of disease% Body area affectedVASDLQIBeforeAfter (% reduction)BeforeAfter (% reduction)BeforeAfter (% reduction)1F/39 y4 mo792 (98)14.80.3 (98)92 (78)2*Patient 2 had hardly any subjective complaints. Consequently, improvement of these subjective parameters was not calculated.M/38 y8 mo658 (88)0.30.2*Patient 2 had hardly any subjective complaints. Consequently, improvement of these subjective parameters was not calculated.20*Patient 2 had hardly any subjective complaints. Consequently, improvement of these subjective parameters was not calculated.3M/44 y22 y275 (82)2.70.7 (74)71 (86)4F/17 y9 y2213 (41)5.24.2 (19)75 (29)DLQI, Dermatology Life Quality Index (0-30); UVA1, ultraviolet A1; VAS, visual analogue score (0-10).* Patient 2 had hardly any subjective complaints. Consequently, improvement of these subjective parameters was not calculated. Open table in a new tab DLQI, Dermatology Life Quality Index (0-30); UVA1, ultraviolet A1; VAS, visual analogue score (0-10). UVA1 therapy may be a promising additional therapy in the treatment of generalized LP, with no short-term side effects. Further studies with appropriate controls would be worthwhile." @default.
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• W2067799839 title "Ultraviolet A1 in the treatment of generalized lichen planus: A report of 4 cases" @default.
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