RESUMO
BACKGROUND: Phototherapy is a treatment option for atopic dermatitis recommended by several guidelines. OBJECTIVE: To perform a systematic review of the efficacy of different modalities of phototherapy and photochemotherapy in moderate to severe atopic dermatitis. MATERIAL AND METHODS: We considered all randomized clinical trials (RCTs) performed in patients with atopic dermatitis, and accepted all outcome measures. Articles were identified via an online search of the MEDLINE (via Ovid) and Embase databases and the Cochrane Central Register of Controlled Trials. We also searched for clinical trials registered in Current Controlled Trials and in the World Health Organization's International Clinical Trials Registry Platform. RESULTS: Twenty-one RCTs (961 patients) were included in the qualitative analysis. Two of the trials included children and adolescents (32 patients). The efficacy of narrow-band UV-B and UV-A1 phototherapy was similar for the different outcome measures contemplated. Two RCTs assessed the efficacy of psoralen plus UV-A therapy (PUVA). No serious adverse events were described. In general, the publications reviewed were characterized by a high risk of bias and poor reporting of methodology and results. CONCLUSIONS: There is evidence for the use of narrow-band UV-B and UV-A1 phototherapy in moderate to severe atopic dermatitis. Evidence supporting the use of PUVA in atopic dermatitis is scarce and there is little information on the use of phototherapy in childhood. For the purpose of future studies, it would be advisable to use comparable criteria and scales for the evaluation of disease severity and patients, to standardize radiation methods, and to establish a minimum follow-up time.
Assuntos
Dermatite Atópica/terapia , Fototerapia , Adolescente , Adulto , Criança , Ensaios Clínicos Controlados como Assunto , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/radioterapia , Humanos , Terapia PUVA , Fototerapia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Terapia UltravioletaRESUMO
La urticaria de contacto localizada por calor es una enfermedad poco frecuente, de la que existen menos de 60 pacientes referidos. Presentamos el caso de una cocinera de 64 años con episodios de eritema y edema pruriginosos circunscritos a las zonas de contacto de la piel con el agua caliente. La positividad de la intradermo-reacción con suero autólogo a 55º C apoyaría la hipótesis que contempla la existencia de alguna molécula sérica, activada por el calor y responsable del cuadro clínico (AU)
Heat contact urticaria is an unusual disease, with nearly 60 cases reported. A 64 years old female, who works as a cook, and developed episodes of well-demarcated, reddish, itchy and edematous lesions, limited to areas of the skin exposed to hot water is reported. The autologous serum skin test(ASST) at 55ºC was performed and was positive, supporting the existing hypothesis of an unknown heat activated protein in serum, as responsible of the etiology of this disorder (AU)
