The realistic positioning of UVA1 phototherapy after 25 years of clinical experience and the availability of new biologics and small molecules: a retrospective clinical study

Effect of UV-A1 Phototherapy Treatment on Scleroderma: A Systematic Review

Scleroderma is an autoimmune disease characterized by thickened and hardened skin, Raynaud's phenomenon, calcinosis, telangiectasias, joint and muscle problems, as well as respiratory, cardiac, renal, and gastrointestinal disturbances. Scleroderma can be classified as either localized or systemic. Localized scleroderma refers to sclerosis of isolated areas of the body confined to the skin and subcutaneous layer, but it does not involve the distal extremities. However, an exception to this in some cases is morphea, which may progress to organs. In comparison, systemic scleroderma affects both cutaneous and visceral organs. Diagnosis of the condition is made by clinical presentation, medical history, and diagnostic tests. Current treatment options for scleroderma include cyclophosphamide, methotrexate, azathioprine, mycophenolate mofetil, and hematopoietic stem cell transplant. However, immunosuppressive agents used to treat scleroderma are associated with adverse effects. An unmet need exists for alternative therapies that are tied to a lower risk of adverse events. Ultraviolet (UV)-A1 phototherapy has increasingly been analyzed for use within autoimmune conditions as both a potential first-line or adjuvant treatment option. As such, we conducted a systematic literature review of a total of 293 articles using Ovid, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Based on our inclusion and exclusion criteria, we included 11 articles in this review, which consisted of a total of 166 patients, the majority being female at 140 (84.3%) patients and only 26 males (15.7%). Overall, patients who received UV-A1 phototherapy saw beneficial effects, including improvements in skin elasticity, mobility of extremities, reduction of skin thickness within sclerotic areas, ulcer improvement, skin softening, reduction of skin tightness, and reduction in collagen bundle size and thickness. UV-A1 phototherapy has the potential to become an integral component of scleroderma management, offering a non-invasive and effective option for patients.

Diffuse Cutaneous Mastocytosis: A Current Understanding of a Rare Disease

Mastocytosis is a heterogeneous disease characterized by the expansion and accumulation of neoplastic mast cells in various tissues. Diffuse cutaneous mastocytosis (DCM) is a rare and most severe form of cutaneous mastocytosis, which typically occurs in childhood. There have been reports of a familial DCM with specific gene mutations, indicating both sporadic and hereditary factors involved in its pathogenesis. DCM is associated with severe MC mediator-related symptoms and an increased risk of anaphylaxis. The diagnosis is based on the appearance of skin lesions, which typically show generalized thickening, erythroderma, blistering dermographism, and a positive Darier's sign. Recognition, particularly in infants, is challenging due to DCMs resemblance to other bullous skin disorders. Therefore, in unclear cases, a skin biopsy is crucial. Treatment focuses on symptom management, mainly including antihistamines and mast cell stabilizers. In extremely severe cases, systemic steroids, tyrosine kinase inhibitors, phototherapy, or omalizumab may be considered. Patients should be equipped with an adrenaline autoinjector. Herein, we conducted a comprehensive review of literature data on DCM since 1962, which could help to better understand both the management and prognosis of DCM, which depends on the severity of skin lesions, intensity of mediator-related symptoms, presence of anaphylaxis, and treatment response.