Background: Cutaneous scleroderma is a chronic inflammatory disease of the dermal and subcutaneous connective tissue leading to sclerosis. Sclerosis of the skin can lead to dysmorphism, contractures and restrictions of movement. Objective: The purpose of the study was to evaluate sclerosis in cutaneous scleroderma patients and to determine the efficacy of water-filtered infrared A plus visible light treatment, wIRA(+VIS), in 10 patients. Methods: Hardness of the normal and diseased skin was measured by durometry in 10 controls and 8 patients. Moreover, circumscribed scleroderma (CS) was treated with wIRA(+VIS) irradiations in 10 patients who had not responded to conventional therapies. Results: wIRA(+VIS) therapy led to a marked improvement, persistent even during long-term follow-up, in 7 out of 10 patients with CS. Of the other patients, 1 showed decreased sclerosis and disease activity and developed a worsening after cessation of therapy. In 2 further patients, where previous UVA1 treatment had failed to reduce disease activity, wIRA(+VIS) produced a slight decrease in sclerosis, but disease activity was still present. Conclusion: wIRA(+VIS) appears to be effective in the treatment of CS. Durometry proved to be helpful in assessing the degree of sclerosis and in documenting the response to therapy in these patients.

1.
Kreuter A, Krieg T, Worms M, Wenzel J, Gambichler T, Kuhn A, Aberer E, Scharffetter-Kochanek K, Hunzelmann N: Deutsche Dermatologische Gesellschaft: AWMF guideline No 013/066 – diagnosis and therapy of circumscribed scleroderma. J Dtsch Dermatol Ges 2009;7(suppl 6):1–4.
2.
Sehgal VN, Srivastava G, Aggarwal AK, Behl PN, Choudhary M, Baja P: Localized scleroderma/morphea. Int J Dermatol 2002;41:467–475.
3.
Distler O, Gay S: Sklerodermie. Internist 2010;51:30–38.
4.
Andres C, Kollmar A, Mempel M, Hein R, Ring J, Eberlein B: Successful ultraviolet A1 phototherapy in the treatment of localized scleroderma: a retrospective and prospective study. Br J Dermatol 2010;162:445–447.
5.
Seyger MM, van den Hoogen FH, de Boo T, de Jong EM: Low-dose methotrexate in the treatment of widespread morphea. J Am Acad Dermatol 1998;39:220–225.
6.
Wienert V, Wittkopf-Baumann C, Lentner A: Untersuchungen zur Objektivierung des Bestrahlungseffektes eines Infrarot-Hyperthermie-Projektors mit Wasserfilter auf die menschliche Hautmikrozirkulation; in Vaupel P, Krüger W (eds): Wärmetherapie mit wassergefilterter Infrarot-A-Strahlung: Grundlagen und Anwendungsmöglichkeiten. Stuttgart, Hippokrates, 1992, pp 77–83.
7.
Foerster J, Fleischanderl S, Wittstock S, Storch A, Meffert A, et al: Infrared-mediated hyperthermia is effective in the treatment of scleroderma-associated Raynaud‘s phenomenon. J Invest Dermatol 2005;125:1313–1316.
8.
Geissler E, Schumann H: Wassergefiltertes Infrarot A (wIRA) bei ulzerierter Morphea. Z Wundheil 2009;14:177–180.
9.
Hartel M, Hoffmann G, Wente MN, Martignoni ME, Büchler MW, Friess H: Randomized clinical trial of the influence of local water-filtered infrared-A irradiation on wound healing after abdominal surgery. Br J Surg 2006;93:952–960.
10.
Von Felbert V, Schumann H, Mercer JB, Strasser W, Daeschlein G, Hoffmann G: Therapy of chronic wounds with water-filtered infrared-A (wIRA). GMS Krankenhaushyg Interdiszip 2007;2:Doc52.
11.
Hoffmann G: Principles and working mechanisms of water-filtered infrared-A (wIRA) in relation to wound healing. GMS Krankenhaushyg Interdiszip 2007;2:Doc54.
12.
Von Felbert V, Hoffmann G, Hoff-Lesch S, Abuzahra F, Renn CN, Braathen LR, Merk HF: Photodynamic therapy of multiple actinic keratoses: reduced pain through use of visible light plus water-filtered infrared A compared with light from light-emitting diodes. Br J Dermatol 2010;163:607–615.
13.
Fuchs SM, Fluhr JW, Bankova L, et al: Photodynamic therapy (PDT) and water-filtered infrared A (wIRA) in patients with recalcitrant common hand and foot warts. Ger Med Sci 2004;2:Doc8.
14.
Murray AK, Moore TL, Manning JB, Taylor C, Griffiths CEM, Herrick AL: Noninvasive imaging techniques in the assessment of scleroderma spectrum disorders. Arthritis Rheum 2009;61:1103–1111.
15.
Mercer JB, de Weerd L: The effect of water-filtered infrared-A (wIRA) irradiation on skin temperature and skin blood flow as evaluated by infrared thermography and scanning laser Doppler imaging. Thermol Int 2005;15:89–94.
16.
Schieke SM, Stege H, Kürten V, et al: Infrared-A radiation-induced matrix-metalloproteinase 1 expression is mediated through extracellular signal-regulated kinase 1/2 activation in human dermal fibroblasts. J Invest Dermatol 2002;119:1323–1329.
17.
Piazena H, Kelleher DK: Effects of infrared-A irradiation on skin: discrepancies in published data highlight the need for an exact consideration of physical and photobiological laws and appropriate experimental settings. Photochem Photobiol 2010;86:687–705.
18.
Park CH, Lee MJ, Ahn J, et al: Heat shock-induced matrix metalloproteinase (MMP)-1 and MMP-3 are mediated through ERK and JNK activation and via an autocrine interleukin-6 loop. J Invest Dermatol 2004;123:1012–1019.
19.
Gebbers N, Hirt-Buri N, Scaletta C, Hoffmann G, Applegate LA: Water-filtered infrared-A (wIRA) is not implicated in cellular degeneration of human skin. GMS Ger Med Sci 2007;5:Doc8.
20.
Jung T, Höhn A, Piazena H, Grune T: Effects of water-filtered infrared A irradiation on human fibroblasts. Free Radic Biol Med 2010;48:153–160.
21.
Karrer S, Abels C, Landthaler M, Szeimies RM: Topical photodynamic therapy for localized scleroderma. Acta Derm Venereol 2000;80:26–27.
22.
Von Felbert V, Simon D, Braathen LR, Megahed M, Hunziker T: Treatment of linear scleroderma with water-filtered infrared-A irradiation. Hautarzt 2007;58:923–924.
23.
Seyger MM, van den Hoogen FH: Reliability of two methods to assess morphea: skin scoring and the use of a durometer. J Am Acad Dermatol 1997;37:793–796.
24.
Kissin EY, Schiller AM, Gelbard RB, Anderson JJ, Falanga V, Simms RW, Korn JH, Merkel PA: Durometry for the assessment of skin disease in systemic sclerosis. Arthritis Rheum 2006;55:603–609.
25.
Merkel PA, Silliman NP, Denton CP, Furst DE, Khanna D, Emery P, et al: Validity, reliability, and feasibility of durometer measurements of scleroderma skin disease in a multicenter treatment trial. Arthritis Rheum 2008;59:699–705.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.