Scleroderma Clinical Trial
Official title:
The Effectiveness Of UVA1 Irradiation In The Treatment Of Skin Conditions With Altered Dermal Matrix: A Controlled, Cross-Over Study
The purpose of this investigation is to evaluate the effectiveness of an investigational device which is similar in appearance to a "tanning bed" but which emits ultraviolet irradiation of a specific wavelength known as UVA1. This device has not been approved by the FDA for general use in this country, as yet, but it has been used quite successfully in Europe for several years in treating such conditions as scleroderma, keloids, and other fibrosing conditions of the skin. Your participation in this study may yield important information regarding the safety and effectiveness of this form of light therapy for the treatment of these skin conditions which, at present, are difficult to treat.
Ultraviolet rays from the sun that reach the earth surface are divided into shorter
wavelength, hence high energy, UVB (290-320nm) and longer wavelength, hence low energy UVA
(320-400nm). The wavelengths of light that cause sunburn and are associated with skin cancer
causation is the high energy UVB. UVA wavelengths can be further divided into relatively
shorter wavelength, hence higher energy UVA2 (320-340nm) and longer wavelength, lower energy
UVA1 (340-400nm). Phototherapy light boxes used in our clinic for the treatment of
psoriasis, atopic dermatitis, and pruritus, as well as those used in tanning salons emit
both UVB and UVA wavelengths of light. The advantages of using UVA1 light source in the
treatment of skin conditions are 1) lack of skin cancer and sunburn causing rays (UVB/UVA2)
and 2) as a consequence, the ability to treat patients more safely.
Keloid, scleroderma, acne keloidalis nuchae, and burn scars are all characterized by
collagenous thickening of the skin resulting in superficial and deep cutaneous sclerosis.
Treatments for these disabling conditions are inadequate at present. Recently, in
non-controlled studies, UVA1 was shown to induce improvement in patients with scleroderma,
granuloma annulare and urticaria pigmentosa (1-3). The mode of action of UVA1 treatment is
not completely understood, however, local immuno-modulation appears to be important (4).
UVA1 has also been shown to stimulate collagenase activity in a dose dependent manner in the
dermis (5,6). We postulate, therefore, that UVA1 in appropriate doses can improve these
fibrosing skin conditions safely through collagenase-mediated removal of excess dermal
collagen.
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Crossover Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment
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