Linear morphea is a variant of scleroderma limited to the skin and underlying tissues secondary to an autoimmune inflammation leading to excess collagen deposition and fibrosis. Apart from topical or oral medications, successful light-based treatments have been reported using phototherapy including Psoralen plus ultraviolet A, photodynamic therapy, carbon dioxide laser, pulsed dye laser, and visible/infrared light.
Methods:
We report a patient with biopsy-proven infraorbital linear morphea responding to 940 nm near-infrared light photobiomodulation treatments.
Results:
The patient had excellent cosmesis without textural changes or hypopigmentation despite her darker skin complexion (Fitzpatrick phototype III) after tri-weekly treatments for 8 months.
Conclusions:
Linear morphea, therefore, may be potentially amenable to home use light-based therapy by using nonthermal nonablative 940 nm photons. To our knowledge, this home-based treatment approach has not been previously reported.
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References
1.
BadeaI, TaylorM, RosenbergA, FoldvariM. Pathogenesis and therapeutic approaches for improved topical treatment in localized scleroderma and systemic sclerosis. Rheumatology (Oxford), 2009; 48:213–221.
2.
ValancieneG, JasaitieneD, ValiukevicieneS. Pathogenesis and treatment modalities of localized scleroderma. Medicina (Kaunas, Lithuania), 2010; 46:649–656.
3.
ZwischenbergerBA, JacobeHT. A systematic review of morphea treatments and therapeutic algorithm. J Am Acad Dermatol, 2011; 65:925–941.
4.
VasquezR, JabbarA, KhanF, BuetheD, AhnC, JacobeH. Recurrence of morphea after successful ultraviolet A1 phototherapy: a cohort study. J Am Acad Dermatol, 2014; 70:481–488.
5.
ArkachaisriT, VilaiyukS, LiS, et al.The localized scleroderma skin severity index and physician global assessment of disease activity: a work in progress toward development of localized scleroderma outcome measures. J Rheumatol, 2009; 36:2819–2829.
6.
FettN, WerthVP. Update on morphea: part I. Epidemiology, clinical presentation, and pathogenesis. J Am Acad Dermatol, 2011; 64:217–228; quiz 229–230.
7.
PetersonLS, NelsonAM, SuWP, MasonT, O'FallonWM, GabrielSE. The epidemiology of morphea (localized scleroderma) in Olmsted County 1960–1993. J Rheumatol, 1997; 24:73–80.
8.
ChenK, SeeA, ShumackS. Epidemiology and pathogenesis of scleroderma. Australas J Dermatol, 2003; 44:1–7; quiz 8–9.
9.
FettN. Scleroderma: nomenclature, etiology, pathogenesis, prognosis, and treatments: facts and controversies. Clin Dermatol, 2013; 31:432–437.
10.
AsanoY, FujimotoM, IshikawaO, et al.Diagnostic criteria, severity classification and guidelines of localized scleroderma. J Dermatol, 2018; 45:755–780.
11.
Bielsa MarsolI. Update on the classification and treatment of localized scleroderma. Actas Dermosifiliogr, 2013; 104:654–666.
12.
ZandiS, KaliaS, LuiH. UVA1 phototherapy: a concise and practical review. Skin Therapy Lett, 2012; 17:1–4.
13.
ShalabySM, BosseilaM, FawzyMM, Abdel HalimDM, SayedSS, AllamRS. Fractional carbon dioxide laser versus low-dose UVA-1 phototherapy for treatment of localized scleroderma: a clinical and immunohistochemical randomized controlled study. Lasers Med Sci, 2016; 31:1707–1715.
14.
KinestonD, KwanJM, UebelhoerNS, ShumakerPR. Use of a fractional ablative 10.6-mum carbon dioxide laser in the treatment of a morphea-related contracture. Arch Dermatol, 2011; 147:1148–1150.
15.
TawfikAA, ShokirH, SolimanM, SalahL, FathyS. Pulsed dye laser in the treatment of localized scleroderma and its effects on CD34+ and factor XIIIa+ cells: an immunohistochemical study. Am J Clin Dermatol, 2013; 14:235–241.
16.
NgSS, TayYK. Inflammatory morphea mimicking an acquired port-wine stain initially treated with pulsed-dye laser. J Cosmet Laser Ther, 2015; 17:277–280.
17.
KimHS, LeeJY, KimHO, ParkYM. En coup de sabre presenting as a port-wine stain initially treated with a pulsed dye laser. J Dermatol, 2011; 38:209–210.
18.
KakimotoCV, Victor RossE, UebelhoerNS. En coup de sabre presenting as a port-wine stain previously treated with pulsed dye laser. Dermatol Surg, 2009; 35:165–167.
19.
SpecchioF, CarboniI, CannarozzoG, TamburiF, DattolaE, NisticòS. Excimer UV radiation in dermatology. Int J Immunopathol Pharmacol, 2014; 27:287–289.
20.
NisticòSP, SaracenoR, SchipaniC, CostanzoA, ChimentiS. Different applications of monochromatic excimer light in skin diseases. Photomed Laser Surg, 2009; 27:647–654.
21.
von FelbertV, SimonD, BraathenLR, MegahedM, HunzikerT. [Treatment of linear scleroderma with water-filtered infrared-A irradiation]. Hautarzt, 2007; 58:923–924.
22.
von FelbertV, Kernland-LangK, HoffmannG, WienertV, SimonD, HunzikerT. Irradiation with water-filtered infrared A plus visible light improves cutaneous scleroderma lesions in a series of cases. Dermatology, 2011; 222:347–357.
23.
EisenD, AlsterTS. Use of a 585 nm pulsed dye laser for the treatment of morphea. Dermatol Surg, 2002; 28:615–616.
24.
BianchiB, CampolmiP, MaviliaL, DanesiA, RossiR, CappugiP. Monochromatic excimer light (308 nm): an immunohistochemical study of cutaneous T cells and apoptosis-related molecules in psoriasis. J Eur Acad Dermatol Venereol, 2003; 17:408–413.
25.
IbbotsonSH, BilslandD, CoxNH, et al.An update and guidance on narrowband ultraviolet B phototherapy: a British Photodermatology Group Workshop Report. Br J Dermatol, 2004; 151:283–297.
26.
ChiricozziA, ZhangS, DattolaA, GabelliniM, ChimentiS, NisticoSP. Role of Th17 in the pathogenesis of cutaneous inflammatory diseases. J Biol Regul Homeost Agents, 2012; 26:313–318.
27.
PfaffS, LiebmannJ, BornM, MerkHF, von FelbertV. Prospective randomized long-term study on the efficacy and safety of UV-Free blue light for treating mild psoriasis vulgaris. Dermatology, 2015; 231:24–34.
28.
BaroletD. Light-emitting diodes (LEDs) in dermatology. Semin Cutan Med Surg, 2008; 27:227–238.
29.
BaroletD. Pulsed versus continuous wave low-level light therapy on osteoarticular signs and symptoms in limited scleroderma (CREST syndrome): a case report. J Biomed Opt, 2014; 19:118001.
30.
BaroletD. Photobiomodulation in Dermatology: harnessing light from visible to near infrared. Med Res Arch, 2018; 6.
31.
BaroletD, ChristiaensF, HamblinMR. Infrared and skin: friend or foe. J Photochem Photobiol B, 2016; 155:78–85.
32.
BaroletD. LLLT Beneficial effects for symptomatic calcinosis in CREST symdrome. Lasers Surg Med, 2009; 41:75.
33.
MokoenaD, Dhilip KumarSS, HoureldNN, AbrahamseH. Role of photobiomodulation on the activation of the Smad pathway via TGF-beta in wound healing. J Photochem Photobiol B, 2018; 189:138–144.
34.
MignonC, UzunbajakavaNE, Castellano-PellicenaI, BotchkarevaNV, TobinDJ. Differential response of human dermal fibroblast subpopulations to visible and near-infrared light: potential of photobiomodulation for addressing cutaneous conditions. Lasers Surg Med, 2018; 50:859–882.
35.
FekrazadR, SarrafzadehA, KalhoriKAM, KhanI, AranyPR, GiubellinoA. Improved wound remodeling correlates with modulated TGF-beta expression in skin diabetic wounds following combined red and infrared photobiomodulation treatments. Photochem Photobiol, 2018; 94:775–779.
36.
EpsteinJB, Raber-DurlacherJE, HuysmansMC, et al.Photobiomodulation therapy alleviates tissue fibroses associated with chronic Graft-versus-Host disease: two case reports and putative anti-fibrotic roles of TGF-beta. Photomed Laser Surg, 2018; 36:92–99.
37.
AranyPR, NayakRS, HallikerimathS, LimayeAM, KaleAD, KondaiahP. Activation of latent TGF-beta1 by low-power laser in vitro correlates with increased TGF-beta1 levels in laser-enhanced oral wound healing. Wound Repair Regen, 2007; 15:866–874.
38.
KreuterA, BreuckmannF, UhleA, et al.Low-dose UVA1 phototherapy in systemic sclerosis: effects on acrosclerosis. J Am Acad Dermatol, 2004; 50:740–747.
39.
KeyalU, BhattaAK, WangXL. UVA1 a promising approach for scleroderma. Am J Transl Res, 2017; 9:4280–4287.
40.
BreuckmannF, StueckerM, AltmeyerP, KreuterA. Modulation of endothelial dysfunction and apoptosis: UVA1-mediated skin improvement in systemic sclerosis. Arch Dermatol Res, 2004; 296:235–239.
41.
CamachoNR, SanchezJE, MartinRF, GonzalezJR, SanchezJL. Medium-dose UVA1 phototherapy in localized scleroderma and its effect in CD34-positive dendritic cells. J Am Acad Dermatol, 2001; 45:697–699.
