■自1990年代初以来,紫外线(UV)A1光疗已被描述为多种皮肤病的有效且安全的治疗方法。然而,30年后,它的使用仍然限于少数皮肤病学中心。
■通过在单个三级转诊中心进行的Real-WorldEvidence(RWE)研究,分析多年来的变化以及UVA1光疗的当前位置。
■我们回顾了1998年至2022年间接受治疗的740名患者的医疗档案。收集治疗结果,通过分级量表评估疗效,并记录急性不良反应.
■我们治疗了26种不同疾病的患者。我们记录了42.8%的硬伤患者的显着改善(MI)或完全缓解(CR),50%有色素性荨麻疹,40.7%为环状肉芽肿,85.7%为皮肤结节病。在慢性移植物抗宿主病(GVHD)的治疗中也获得了良好的结果,嗜酸细胞性筋膜炎,巩膜萎缩性地衣,HIV+患者的系统性红斑狼疮和银屑病的皮肤表现。系统性硬化症,Romberg综合征,Bushke\的Scleedema,肾源性纤维性皮肤病,REM综合征,滤泡黏液病,胫骨前黏液水肿,巩膜水肿,天疱疮,慢性皮肤红斑狼疮,Netherton综合征和脂类坏死菌病的红皮病没有或反应不佳。在窄带(NB)-UVB后使用UVA1作为第二线光疗的临床适应症中,我们在真菌病中看到了良好的MI或CR率(57%的患者),特应性皮炎(33.9%),慢性苔藓(50%),急性糠疹(75%)和淋巴瘤丘疹病(62.5%)。短期不良事件不常见且轻微。
■在过去的十年中,由于几个原因,每年接受治疗的患者人数逐渐下降。首先,UVA1光疗已经取代了更便宜、更实用的NB-UVB光疗,这已被证明对常见适应症有效。其次,新的出现,安全,和治疗特应性皮炎等疾病的有效药物,GVHD,和结缔组织疾病。最后,我们的研究表明,UVA1治疗通常对一些罕见疾病无效或效果最低,与以前的病例报告和小病例系列相反。尽管如此,对于患有特定皮肤病的患者,UVA1仍然是有价值的治疗选择。
UNASSIGNED: Since the early 1990s, Ultraviolet (UV) A1 phototherapy has been described as an effective and safe treatment of a multitude of skin disorders. However, after 30 years, its use has remained limited to few dermatological centers.
UNASSIGNED: To analyze the changes over the years and the current position of UVA1 phototherapy through a Real-World Evidence (RWE)
study at a single tertiary referral center.
UNASSIGNED: We reviewed the medical files of 740 patients treated between 1998 and 2022. Treatment results were collected, efficacy was assessed by a grading scale and acute adverse effects were registered.
UNASSIGNED: We treated patients with 26 different diseases. We registered marked improvement (MI) or complete remission (CR) in 42.8% of patients with
morphea, 50% with Urticaria Pigmentosa, 40.7% with Granuloma annulare and 85.7% with skin sarcoidosis. Good results were obtained also in the treatment of chronic Graft Versus Host Disease (GVHD), Eosinophilic Fasciitis, Sclero-atrophic Lichen, skin manifestations of systemic lupus erythematosus and psoriasis of HIV+ patients. Systemic Sclerosis, Romberg\'s Syndrome, Bushke\'s Scleredema, Nephrogenic Fibrosing Dermopathy, REM Syndrome, Follicular Mucinosis, Pretibial Myxedema, Scleromyxedema, pemphigus foliaceus, chronic cutaneous lupus erythematosus, erythroderma of Netherton Syndrome and Necrobiosis Lipoidica were no or poorly responsive. In clinical indications where UVA1 was used as a second line phototherapy after narrow-band (NB)-UVB, we saw good MI or CR rates in Mycosis Fungoides (57% of patients), Atopic Dermatitis (33.9%), Pitiryasis Lichenoides chronica (50%), Pityriasis Lichenoides et varioliformis acute (75%) and Lymphomatod Papulosis (62.5%). Short-term adverse events were uncommon and mild.
UNASSIGNED: Over the past decade, the annual number of treated patients has progressively declined for several reasons. Firstly, UVA1 phototherapy has taken a backseat to the cheaper and more practical NB-UVB phototherapy, which has proven effective for common indications. Secondly, the emergence of new, safe, and effective drugs for conditions such as atopic dermatitis, GVHD, and connective tissue disorders. Finally, our research has shown that UVA1 therapy is often ineffective or minimally effective for some rare diseases, contrary to previous case reports and small case series. Nonetheless, UVA1 continues to be a valuable treatment option for patients with specific skin disorders.