Phototherapy for atopic dermatitis.

ABSTRACT

Background: The aim of these guidelines is to review the available published literature regarding the effectiveness of phototherapy and photochemotherapy in atopic dermatitis and put forward recommendations regarding their use in atopic dermatitis. Materials and Methods: A literature search was performed to collect data from PubMed, EMBASE, and the Cochrane Library published till March 2014. Keywords used were “phototherapy”, “photochemotherapy”, “NB-UVB”, “BBUVB”, “PUVA”, “UVA1”, “atopic dermatitis”, and “atopic eczema”. Systematic reviews, meta‑analysis, national guidelines, randomized controlled trials, prospective open label studies, and retrospective case series in English literature mentioning use of above‑mentioned keywords were reviewed. Results: Six hundred and eighty eight studies were evaluated, 38 of which fulfilled the criteria for inclusion in the guidelines. Conclusions and Recommendations: Both UV1 and narrow‑band UVB are effective in significantly decreasing the eczema severity although UV1 may be preferred in acute flares and narrow‑band UVB in chronic eczema, especially in adults (Level of evidence 1+, Grade of recommendation A). Among various doses of UVA1, medium dose UVA1 may be preferred over others as its efficacy is similar to high dose and better than low dose UVA1 phototherapy. Narrow‑band UVB is preferred to broad‑band UVB (Level of evidence 1+, Grade of recommendation A). Medium‑dose UVA1 is similar in efficacy to narrow‑band UVB (Level of evidence 1+, Grade of recommendation A). In children, despite its efficacy, narrow‑band UVB phototherapy should be used only as a second line therapy due to its potential for long‑term adverse effects (Level of evidence 2+, Grade of recommendation B).