UVA-1 phototherapy had the fewest side effects among three treatments for granuloma annulare, while all methods had similar response rates, according to a 10-year retrospective study.
In the study, conducted at the Medical University of Graz, researchers analyzed 73 completed phototherapy cycles in 58 patients who were diagnosed with granuloma annulare (GA) between 2011 and 2021. They compared oral-PUVA, bath-PUVA, and UVA-1 therapies by measuring complete and partial skin lesion responses and adverse events.
Complete clearance of lesions occurred in 37.5% of bath-PUVA cycles, 35.3% of UVA-1, and 25.7% of oral-PUVA treatments. Partial responses were seen in 62.9% of oral-PUVA, 50% of bath-PUVA, and 41.2% of UVA-1 cycles.
Overall, 88.6% of oral-PUVA, 87.5% of bath-PUVA, and 76.5% of UVA-1 treatments led to improvement.
The researchers explained that there were no significant differences in efficacy between UVA-1 therapy, oral-PUVA, and bath-PUVA.
Adverse events were most frequent in oral-PUVA (82.9%), followed by bath-PUVA (37.5%) and UVA-1 (23.5%). Common events included mild erythema and nausea. Treatment was discontinued in four oral-PUVA cases due to nausea or polymorphic light eruptions and in two UVA-1 cases due to erythema.
Patients in the study ranged from 17 to 83 years old. Most were female (79.3%), and the median disease duration was 2 years. Of the patients, 24.1% had hypertension, 12% had diabetes mellitus, and 6.8% had hepatitis.
Patients received an average of 25 oral-PUVA treatments, 23 bath-PUVA treatments, and 28 UVA-1 treatments. The highest cumulative UVA dose was recorded in UVA-1 therapy (median 1391 J/cm²). Most had previously tried topical corticosteroids (69%).
Recurrences were seen across all treatment types. In the oral-PUVA group, two of nine patients with complete response had a recurrence within 24 to 50 weeks. In bath-PUVA, two of six patients relapsed within 16 to 45 weeks. For UVA-1, recurrence occurred in two of six patients at 8 and 31 weeks. No significant difference in recurrence rates was found.
Treatment response was not linked to age, disease duration, comorbidities, or skin area affected. The researchers concluded that all therapies provided benefit.
“Given the frequent occurrence of recurrences, the risk–benefit profile of each therapy should be carefully assessed in advance,” wrote Ines Katharina Himmelstoss of the Medical University of Graz in Austria with colleagues. They continued, "Given their favorable adverse event profiles and demonstrated efficacy, both UVA-1 therapy and bath-PUVA therapy should be preferred treatment options for patients with GA. However, as these modalities may not be available at all phototherapy centers, oral-PUVA therapy, which has a somewhat higher adverse event profile, may also be a viable recommendation."
No conflicts of interest were declared.
