The purpose of the present study was to compare the effects of different doses of ultraviolet radiation A1 (UVA1) on human fibroblast proliferation and collagen level in a mouse model of scleroderma, so as to identi...The purpose of the present study was to compare the effects of different doses of ultraviolet radiation A1 (UVA1) on human fibroblast proliferation and collagen level in a mouse model of scleroderma, so as to identify appropriate irradiation doses for clinical treatment of scleroderma. Monolayer from human fibroblasts was cultured in vitro, and a mouse model of scleroderma was established by subcutaneous injection of 100 μL of 400 μg/mL bleomycin into the back of BALB/c mice for 4 weeks. The mouse models and human fibroblasts were divided into UVA1- exposed (100, 60 and 20 J/cm2) and UVA-unexposed groups. At 0, 24 and 48 h after exposure, cell proliferation and levels of hydroxyproline and collagen were detected. UVA1 irradiation was performed 3 times weekly for 10 weeks, and the pathological changes of skin tissues, skin thickness and collagen level were observed after phototherapy. Cell proliferation and the levels of hydroxyproline and collagen were inhibited after phototherapy, and there was a significant difference between the UVAl-exposed cells and UVAl-unexposed cells (P 〈 0.001). In addition, UVA1 phototherapy improved dermal sclerosis and softened the skin, and there were significant differences between the high-dose UVA1 group and the model group, and the negative group (P 〈 0.05). It is concluded that UVA1 radiation can reduce cell proliferation, and decrease hydroxyproline and collagen levels in a dose-dependent manner in vitro. High-dose UVA1 phototherapy has marked therapeutic effect on scleroderma in the mouse model. Decreased collagen level may be related to the reduced number and activity of cells, as well as inhibition of collagen synthesis.展开更多
Background: In previous trials, UV therapy has been demon- strated to be effective in the treatment of localized scleroderma (LS). To date, a randomized comparison study to evaluate the efficacy and safety of differen...Background: In previous trials, UV therapy has been demon- strated to be effective in the treatment of localized scleroderma (LS). To date, a randomized comparison study to evaluate the efficacy and safety of different, commonly used phototherapeutic modalities in LS is still outstanding. Objective: The aim of this study was to compare the safety and efficacy of lowdose (LD) UVA1, medium- dose (MD) UVA1, and narrowband (NB)UVB phototherapy in the treatment of LS.Methods: Sixty four patients with LS were consecutively included in a prospective, open, randomized controlled 3- arm study. Severity of LS was determined by means of a clinical score, and clinical improvement was also monitored by histopathologic analysis and 20- MHz ultrasound. Results: Atotal of 27 patients were treated with LD UVA1 (20 Jcm2), 18 patients receivedMD UVA1 (50 Jcm2), and 19 patients were treated with NB UVB dependent on their skin type. Phototherapy was performed 5 times weekly for 8 weeks. Two of the 64 patients included in this trial discontinued therapy. Skin status significantly improved in all patients who finished the treatment protocol, resulting in a reduction of the clinical score in all groups (LD UVA1, 7.6- 5.0 [P < .001,95% confidence interval 1.6- 3.4]; MD UVA1, 11.1- 6.6 [P < .001, 95% confidence interval 2.5- 6.2]; NB UVB, 7.3- 4.9 [P< .001, 95% confidence interval 1.6- 3.2]). The reduction of the score was accompanied by an improvement of the visual analog scale for itching and tightness, histologic score, and 20- MHz ultrasound. MD UVA1 was significantly more effective than NB UVB (P < .05). There were no significant differences between LDUVA1 and NBUVB and the former and MDUVA1 (P > .05). Limitations: We had a relatively small study sample and nonblinded assessment of primary outcome. Conclusion: Phototherapy, as previously reported in several noncontrolled trials, is an effective therapeutic option in LS, with a favorable riskbenefit ratio. UVA1 phototherapy should be considered among the first approaches in the management of LS.展开更多
Scleredema adultorum is a rare connective tissue disorder of unknown cause. Both bath- PUVA and cream- PUVA therapy were reported to be effective. We describe a patient with scleredema adultorum who showed a striking ...Scleredema adultorum is a rare connective tissue disorder of unknown cause. Both bath- PUVA and cream- PUVA therapy were reported to be effective. We describe a patient with scleredema adultorum who showed a striking clinical improvement with a medium- dose UVA1 phototherapy (single dose, 50 J/cm2;35 treatments).展开更多
Objective: To determine the time course and dose-response characteristics of UV-A1 erythema in the Tayside region of Scotland. Design: Adult volunteers (skin types I and II [n=13]- and III and IV [n=11])were exposed t...Objective: To determine the time course and dose-response characteristics of UV-A1 erythema in the Tayside region of Scotland. Design: Adult volunteers (skin types I and II [n=13]- and III and IV [n=11])were exposed to geometric dose series of UV-A1 irradiation from a high-output source on photoprotected lower back and inner forearm skin. Setting: Photobiology unit in a university hospital. MainOutcomeMeasures: The minimal erythema dose (MED) was recorded visually and erythema was assessed objectively by erythema meter at 4, 8, 24, and 48 hours after exposure. Results: Peak erythema (lowest visual MED) was seen at 8 hours on the back and arm in 11 subjects with skin types I and II and on the back at 8 hours in 9 subjects and on the arm at 4 hours in 10 subjects with skin types III and IV. The lowest median (range) MED was 20 J/cm2 (14- 56 J/cm2) on the back and 42 J/cm2 (20 to >80 J/cm2) on the arm at 8 hours for subjects with skin types I and II and 28 J/cm2 (20- 112 J/cm2) at 8 hours on the back and 56 J/cm2 (28- 80 J/cm2) at 4 hours on the arm for subjects with skin types III and IV. The D0.025, an objective measure that corresponds approximately to the visual MED, demonstrated a broad peak from 8 to 24 hours. Conclusions: Our local population is more erythemally sensitive to UV-A1 radiation than reports suggest. Daily dose regimens may risk cumulative erythema. Lower starting doses should be used in this population. The wide range of MEDs highlights the need for MED testing.展开更多
Background: St John s wort (SJW) is widely used as a treatment for depression. A phototoxic reaction, due to its content of hypericin, can occur in animals and in cell culture, and has been reported in humans. Hyper...Background: St John s wort (SJW) is widely used as a treatment for depression. A phototoxic reaction, due to its content of hypericin, can occur in animals and in cell culture, and has been reported in humans. Hypericin displays absorption within the ultraviolet (UV) A1 spectrum and there may therefore be a potential for phototoxicity if taken during high-dose UVA1 therapy. Objectives: To assess the phototoxicity risk of SJW ingestion. Methods: Eleven adult volunteers of skin types I and II were exposed to a geometric dose series of UVA1 irradiation from a high-output source (Dermalight Ultra 1; Dr H nle, Martinsreid, Germany; irradiance 70- 77 mW cm- 2) on the photoprotected lower back skin at eight 1.5-cm2 test areas. Irradiation was carried out at baseline and after 10 days of SJW extract 1020 mg (equivalent to 3000 μ g of hypericin) daily. Four, 8, 24 and 48 h after each exposure, the minimal erythema dose (MED) and the presence or absence of pigmentation were recorded visually and erythema was assessed objectively with an erythema meter. Results: The median MED and D0.025, an objective measure of MED, were lower at all time-points after SJW ingestion. The visual erythemal peak (lowest median MED), which was seen at 8 h postirradiation, was lower after SJW (median 14 J cm- 2, range 10- 56) than at baseline (median 20 J cm- 2, range 14- 56) (P = 0.047). Similarly, the median D0.025 at 8 h postirradiation was lower after SJW(median 22.0 J cm- 2, range 15.2- 53.9) than at baseline (median 33.7 J cm - 2, range 22.9- 136.0) (P = 0.014). The MED and D0.025 were also significantly different at the 48-h and 4-h time-points, respectively. Significance was not reached at the 24-h time-point. Median intensity of postirradiation erythema increased at all time-points after ingestion of SJW. Despite these differences, the maximum slope of the dose-response curve was not increased after SJW ingestion. Conclusions: These data suggest that SJW extract has the potential to lower the erythemal threshold to UVA1 irradiation in a significant proportion of individuals and highlight the importance of ascertaining a full drug history, including herbal remedies, before initiating UVA1 phototherapy.展开更多
The primary c ause of collagen degeneration in necrobiosis lipoidica (NL) is proposed to be immunologically mediated vascular disease. Ultraviolet (UV)A1 has been used successfully to treat scleroderma in which both v...The primary c ause of collagen degeneration in necrobiosis lipoidica (NL) is proposed to be immunologically mediated vascular disease. Ultraviolet (UV)A1 has been used successfully to treat scleroderma in which both vascular damage and collagen dysregulation also occur. We treated six patients with NL [(five women; mean age of 32 years (range 22-70) and mean disease duration of 2.9 years (range 6 months to 5 years)] with a high-output ultraviolet (UV)A1 2-kW filtered metal halide source (Dr; Dermalight ultrA 1) having an emission spectrum of 340-440 nm. All patients had NL on the shins, which had been unresponsive to potent topical corticosteroid therapy (n = 6) and had responded minimally or not at all to TL-01UVB (n = 2), topical psoralen plus UVA(PUVA) soaking (n = 2) or oral PUVA(n = 1) therapy. Patients received a variable number of total exposures (15-51), given 3-5 times weekly. NL resolved completely in one patient; this patient had minimal improvement after the first course of 16 exposures, but after a further 13 exposures, resolution occurred 6 months later. Two subjects obtained moderate improvement in their overall disease severity after 15 and 24 exposures, while two had only minimal improvement after 15 and 51 exposures. The remaining patient had no improvement after 16 treatments. Patients with the shortest disease duration had the greatest response. UVA1 therapy may be of benefit for the treatment of NL as an adjuvant therapy to topical corticosteroids or as a second-line alternative to other phototherapies, and may have a superior outcome in a proportion of patients.展开更多
Background. Lichen sclerosus (LS) is characterized histologically by an inflammatory T-cell infiltrate, sclerosis and thickening of the dermis, and epidermal atrophy. Ultraviolet (UV) A1 therapy has been shown to be e...Background. Lichen sclerosus (LS) is characterized histologically by an inflammatory T-cell infiltrate, sclerosis and thickening of the dermis, and epidermal atrophy. Ultraviolet (UV) A1 therapy has been shown to be effective in the management of morphea and scleroderma, diseases that have some histological and clinical similarities with LS, and more recently in extragenital LS. Aim. To determine the effectiveness of UVA1 therapy for genital LS. Methods. Seven women with severe genital LS uncontrolled by ultrapotent topical corticosteroids, with a median age of 62 years (range 48-78) and disease duration of 6-47 years, were treated with UVA1 therapy from a high output source. After completion of UVA1 therapy, a clinician and the patient graded the overall response of symptoms and physical signs. Results. Five patients improved with therapy. Three obtained moderate improvement in overall disease severity and two had minimal improvement. Of these five, one relapsed within 3 months and another after a year. Both had a further course of UVA1 therapy, resulting in minimal improvement in one and moderate improvement in the other. In the remaining three, disease severity had improved to a point where intermittent use of topical corticosteroids resulted in acceptable control. Discussion. UVA1 therapy may be of benefit in the management of vulval LS, a disease that is often poorly responsive to standard therapies. The therapy is well tolerated and could provide an acceptable therapeutic option for patients with severe disease.展开更多
Background:High-dose ultraviolet (UV) A1 therapy (doses in the order of 130 J cm-2) is effective for atopic dermatitis and scleroderma. UVA1 has been shown to induce a dose-dependent increase in p53 expression in kera...Background:High-dose ultraviolet (UV) A1 therapy (doses in the order of 130 J cm-2) is effective for atopic dermatitis and scleroderma. UVA1 has been shown to induce a dose-dependent increase in p53 expression in keratinocytes. Objectives:To examine the effect of UVA1 on the activation of p53 by phosphorylation, which has not yet been studied. Methods:Five adult volunteers were exposed to dose series of UVA1 (10-100 J cm-2) and, for comparison, narrowband UVB (TL-01) (25-550 mJ cm-2) and solar-simulated radiation (SSR) (5.6-30 J cm-2)on photoprotected buttock skin and the minimal erythema dose (MED) for each was determined at 24 h. Separate sites on the buttock were subsequently irradiated with a 3-MED dose of UVA1, TL-01 and SSR. At 24 h, punch biopsies (4 mm) were taken from each irradiated site and from an adjacent unirradiated control site, and immunohistochemical staining for p53 (Do-1), activation of p53 (assessed by phosphorylation at serine 12 and serine 392) and p21 was performed. Cell staining was expressed as the mean number of cells stained per three high-power fields (HPFs) and as a percentage of 1000 cells. Sunburn cells (SBCs)were also counted per HPF. Results UVA1 produced negligible numbers of SBCs, relatively little p53 (Do-1) staining (mean±.SD cell count per HPF 16±10),no p53 activation and very little evidence of p21 expression (mean±SD cell count per HPF 5.3±7), in contrast to TL-01 (mean±SD cell count per HPF of 11.83±2.1 SBCs, 146.3±38 for Do-1, 26.6±15 for serine 15, 14.9±12 for serine 392 and 77.9±30 for p21) or SSR irradiation (mean±SD cell count per HPF of 3.5±1.2 SBCs, 147.5±62 for Do-1, 54±50 for serine 15, 38.9±18 for serine 392 and 56.7±30 for p21). Conclusions:These data indicate that there are fundamental differences in the effects of UVA1 on p53 and its activation pathways compared with TL-01 and SSR, and may in part explain the differential effects of these phototherapies.展开更多
文摘The purpose of the present study was to compare the effects of different doses of ultraviolet radiation A1 (UVA1) on human fibroblast proliferation and collagen level in a mouse model of scleroderma, so as to identify appropriate irradiation doses for clinical treatment of scleroderma. Monolayer from human fibroblasts was cultured in vitro, and a mouse model of scleroderma was established by subcutaneous injection of 100 μL of 400 μg/mL bleomycin into the back of BALB/c mice for 4 weeks. The mouse models and human fibroblasts were divided into UVA1- exposed (100, 60 and 20 J/cm2) and UVA-unexposed groups. At 0, 24 and 48 h after exposure, cell proliferation and levels of hydroxyproline and collagen were detected. UVA1 irradiation was performed 3 times weekly for 10 weeks, and the pathological changes of skin tissues, skin thickness and collagen level were observed after phototherapy. Cell proliferation and the levels of hydroxyproline and collagen were inhibited after phototherapy, and there was a significant difference between the UVAl-exposed cells and UVAl-unexposed cells (P 〈 0.001). In addition, UVA1 phototherapy improved dermal sclerosis and softened the skin, and there were significant differences between the high-dose UVA1 group and the model group, and the negative group (P 〈 0.05). It is concluded that UVA1 radiation can reduce cell proliferation, and decrease hydroxyproline and collagen levels in a dose-dependent manner in vitro. High-dose UVA1 phototherapy has marked therapeutic effect on scleroderma in the mouse model. Decreased collagen level may be related to the reduced number and activity of cells, as well as inhibition of collagen synthesis.
文摘Background: In previous trials, UV therapy has been demon- strated to be effective in the treatment of localized scleroderma (LS). To date, a randomized comparison study to evaluate the efficacy and safety of different, commonly used phototherapeutic modalities in LS is still outstanding. Objective: The aim of this study was to compare the safety and efficacy of lowdose (LD) UVA1, medium- dose (MD) UVA1, and narrowband (NB)UVB phototherapy in the treatment of LS.Methods: Sixty four patients with LS were consecutively included in a prospective, open, randomized controlled 3- arm study. Severity of LS was determined by means of a clinical score, and clinical improvement was also monitored by histopathologic analysis and 20- MHz ultrasound. Results: Atotal of 27 patients were treated with LD UVA1 (20 Jcm2), 18 patients receivedMD UVA1 (50 Jcm2), and 19 patients were treated with NB UVB dependent on their skin type. Phototherapy was performed 5 times weekly for 8 weeks. Two of the 64 patients included in this trial discontinued therapy. Skin status significantly improved in all patients who finished the treatment protocol, resulting in a reduction of the clinical score in all groups (LD UVA1, 7.6- 5.0 [P < .001,95% confidence interval 1.6- 3.4]; MD UVA1, 11.1- 6.6 [P < .001, 95% confidence interval 2.5- 6.2]; NB UVB, 7.3- 4.9 [P< .001, 95% confidence interval 1.6- 3.2]). The reduction of the score was accompanied by an improvement of the visual analog scale for itching and tightness, histologic score, and 20- MHz ultrasound. MD UVA1 was significantly more effective than NB UVB (P < .05). There were no significant differences between LDUVA1 and NBUVB and the former and MDUVA1 (P > .05). Limitations: We had a relatively small study sample and nonblinded assessment of primary outcome. Conclusion: Phototherapy, as previously reported in several noncontrolled trials, is an effective therapeutic option in LS, with a favorable riskbenefit ratio. UVA1 phototherapy should be considered among the first approaches in the management of LS.
文摘Scleredema adultorum is a rare connective tissue disorder of unknown cause. Both bath- PUVA and cream- PUVA therapy were reported to be effective. We describe a patient with scleredema adultorum who showed a striking clinical improvement with a medium- dose UVA1 phototherapy (single dose, 50 J/cm2;35 treatments).
文摘Objective: To determine the time course and dose-response characteristics of UV-A1 erythema in the Tayside region of Scotland. Design: Adult volunteers (skin types I and II [n=13]- and III and IV [n=11])were exposed to geometric dose series of UV-A1 irradiation from a high-output source on photoprotected lower back and inner forearm skin. Setting: Photobiology unit in a university hospital. MainOutcomeMeasures: The minimal erythema dose (MED) was recorded visually and erythema was assessed objectively by erythema meter at 4, 8, 24, and 48 hours after exposure. Results: Peak erythema (lowest visual MED) was seen at 8 hours on the back and arm in 11 subjects with skin types I and II and on the back at 8 hours in 9 subjects and on the arm at 4 hours in 10 subjects with skin types III and IV. The lowest median (range) MED was 20 J/cm2 (14- 56 J/cm2) on the back and 42 J/cm2 (20 to >80 J/cm2) on the arm at 8 hours for subjects with skin types I and II and 28 J/cm2 (20- 112 J/cm2) at 8 hours on the back and 56 J/cm2 (28- 80 J/cm2) at 4 hours on the arm for subjects with skin types III and IV. The D0.025, an objective measure that corresponds approximately to the visual MED, demonstrated a broad peak from 8 to 24 hours. Conclusions: Our local population is more erythemally sensitive to UV-A1 radiation than reports suggest. Daily dose regimens may risk cumulative erythema. Lower starting doses should be used in this population. The wide range of MEDs highlights the need for MED testing.
文摘Background: St John s wort (SJW) is widely used as a treatment for depression. A phototoxic reaction, due to its content of hypericin, can occur in animals and in cell culture, and has been reported in humans. Hypericin displays absorption within the ultraviolet (UV) A1 spectrum and there may therefore be a potential for phototoxicity if taken during high-dose UVA1 therapy. Objectives: To assess the phototoxicity risk of SJW ingestion. Methods: Eleven adult volunteers of skin types I and II were exposed to a geometric dose series of UVA1 irradiation from a high-output source (Dermalight Ultra 1; Dr H nle, Martinsreid, Germany; irradiance 70- 77 mW cm- 2) on the photoprotected lower back skin at eight 1.5-cm2 test areas. Irradiation was carried out at baseline and after 10 days of SJW extract 1020 mg (equivalent to 3000 μ g of hypericin) daily. Four, 8, 24 and 48 h after each exposure, the minimal erythema dose (MED) and the presence or absence of pigmentation were recorded visually and erythema was assessed objectively with an erythema meter. Results: The median MED and D0.025, an objective measure of MED, were lower at all time-points after SJW ingestion. The visual erythemal peak (lowest median MED), which was seen at 8 h postirradiation, was lower after SJW (median 14 J cm- 2, range 10- 56) than at baseline (median 20 J cm- 2, range 14- 56) (P = 0.047). Similarly, the median D0.025 at 8 h postirradiation was lower after SJW(median 22.0 J cm- 2, range 15.2- 53.9) than at baseline (median 33.7 J cm - 2, range 22.9- 136.0) (P = 0.014). The MED and D0.025 were also significantly different at the 48-h and 4-h time-points, respectively. Significance was not reached at the 24-h time-point. Median intensity of postirradiation erythema increased at all time-points after ingestion of SJW. Despite these differences, the maximum slope of the dose-response curve was not increased after SJW ingestion. Conclusions: These data suggest that SJW extract has the potential to lower the erythemal threshold to UVA1 irradiation in a significant proportion of individuals and highlight the importance of ascertaining a full drug history, including herbal remedies, before initiating UVA1 phototherapy.
文摘The primary c ause of collagen degeneration in necrobiosis lipoidica (NL) is proposed to be immunologically mediated vascular disease. Ultraviolet (UV)A1 has been used successfully to treat scleroderma in which both vascular damage and collagen dysregulation also occur. We treated six patients with NL [(five women; mean age of 32 years (range 22-70) and mean disease duration of 2.9 years (range 6 months to 5 years)] with a high-output ultraviolet (UV)A1 2-kW filtered metal halide source (Dr; Dermalight ultrA 1) having an emission spectrum of 340-440 nm. All patients had NL on the shins, which had been unresponsive to potent topical corticosteroid therapy (n = 6) and had responded minimally or not at all to TL-01UVB (n = 2), topical psoralen plus UVA(PUVA) soaking (n = 2) or oral PUVA(n = 1) therapy. Patients received a variable number of total exposures (15-51), given 3-5 times weekly. NL resolved completely in one patient; this patient had minimal improvement after the first course of 16 exposures, but after a further 13 exposures, resolution occurred 6 months later. Two subjects obtained moderate improvement in their overall disease severity after 15 and 24 exposures, while two had only minimal improvement after 15 and 51 exposures. The remaining patient had no improvement after 16 treatments. Patients with the shortest disease duration had the greatest response. UVA1 therapy may be of benefit for the treatment of NL as an adjuvant therapy to topical corticosteroids or as a second-line alternative to other phototherapies, and may have a superior outcome in a proportion of patients.
文摘Background. Lichen sclerosus (LS) is characterized histologically by an inflammatory T-cell infiltrate, sclerosis and thickening of the dermis, and epidermal atrophy. Ultraviolet (UV) A1 therapy has been shown to be effective in the management of morphea and scleroderma, diseases that have some histological and clinical similarities with LS, and more recently in extragenital LS. Aim. To determine the effectiveness of UVA1 therapy for genital LS. Methods. Seven women with severe genital LS uncontrolled by ultrapotent topical corticosteroids, with a median age of 62 years (range 48-78) and disease duration of 6-47 years, were treated with UVA1 therapy from a high output source. After completion of UVA1 therapy, a clinician and the patient graded the overall response of symptoms and physical signs. Results. Five patients improved with therapy. Three obtained moderate improvement in overall disease severity and two had minimal improvement. Of these five, one relapsed within 3 months and another after a year. Both had a further course of UVA1 therapy, resulting in minimal improvement in one and moderate improvement in the other. In the remaining three, disease severity had improved to a point where intermittent use of topical corticosteroids resulted in acceptable control. Discussion. UVA1 therapy may be of benefit in the management of vulval LS, a disease that is often poorly responsive to standard therapies. The therapy is well tolerated and could provide an acceptable therapeutic option for patients with severe disease.
文摘Background:High-dose ultraviolet (UV) A1 therapy (doses in the order of 130 J cm-2) is effective for atopic dermatitis and scleroderma. UVA1 has been shown to induce a dose-dependent increase in p53 expression in keratinocytes. Objectives:To examine the effect of UVA1 on the activation of p53 by phosphorylation, which has not yet been studied. Methods:Five adult volunteers were exposed to dose series of UVA1 (10-100 J cm-2) and, for comparison, narrowband UVB (TL-01) (25-550 mJ cm-2) and solar-simulated radiation (SSR) (5.6-30 J cm-2)on photoprotected buttock skin and the minimal erythema dose (MED) for each was determined at 24 h. Separate sites on the buttock were subsequently irradiated with a 3-MED dose of UVA1, TL-01 and SSR. At 24 h, punch biopsies (4 mm) were taken from each irradiated site and from an adjacent unirradiated control site, and immunohistochemical staining for p53 (Do-1), activation of p53 (assessed by phosphorylation at serine 12 and serine 392) and p21 was performed. Cell staining was expressed as the mean number of cells stained per three high-power fields (HPFs) and as a percentage of 1000 cells. Sunburn cells (SBCs)were also counted per HPF. Results UVA1 produced negligible numbers of SBCs, relatively little p53 (Do-1) staining (mean±.SD cell count per HPF 16±10),no p53 activation and very little evidence of p21 expression (mean±SD cell count per HPF 5.3±7), in contrast to TL-01 (mean±SD cell count per HPF of 11.83±2.1 SBCs, 146.3±38 for Do-1, 26.6±15 for serine 15, 14.9±12 for serine 392 and 77.9±30 for p21) or SSR irradiation (mean±SD cell count per HPF of 3.5±1.2 SBCs, 147.5±62 for Do-1, 54±50 for serine 15, 38.9±18 for serine 392 and 56.7±30 for p21). Conclusions:These data indicate that there are fundamental differences in the effects of UVA1 on p53 and its activation pathways compared with TL-01 and SSR, and may in part explain the differential effects of these phototherapies.