UV-A1 phototherapy improves nephrogenic fibrosing dermopathy.

A 47-year-old woman presented with a 2-month history of progressive tightening of the skin on her legs. The tightening of her skin had begun 2 weeks after she was hospitalized for acute renal failure precipitated by therapy with nonsteroidal anti-inflammatory drugs. She had no history of renal disease or medical conditions that would predispose her to the organ failure. During her hospitalization, she was treated with supportive therapy only and did not require hemodialysis or peritoneal dialysis. Her renal function normalized, but the skin fibrosis continued to worsen. We initially examined her approximately 2 months after the onset of her skin disease. At the time, she had orangered indurated plaques on both thighs and the lower part of her legs. The range of motion of her knees was diminished so much that ambulation had become difficult. She denied any signs or symptoms of photosensitivity, Raynaud symptom, or esophageal dysfunction. Serologic evaluation includedanti-Scl70, anti-Sm,anti-ribonucleoprotein, anti-Ro, anti-La, and serum protein electrophoresis, the results of which were all negative. A skin biopsy specimen from an affected area revealed diffuse fibroblastic proliferation, with increased collagen and mucin in the dermis. These changes were consistent with nephrogenic fibrosing dermopathy (NFD). THERAPEUTIC CHALLENGE