A retrospective review of phototherapy in children, at a tertiary paediatric dermatology unit

Abstract

Background/Purpose: To examine the efficacy, tolerability and safety of phototherapy in children, in whom there is currently a paucity of data. Materials and Methods: Retrospective review of children under 18 years who received narrowband UVB (NB-UVB), broadband UVB (BB-UVB) phototherapy or psoralen with UVA (PUVA) photochemotherapy between 2003 and 2017 at a tertiary Paediatric dermatology centre in Southampton, UK. Results: 100 children aged 6-17 years were included. The majority of children had psoriasis (74), atopic dermatitis (10) or vitiligo (8), with others having rarer dermatoses. Grade 2 erythema or above occurred in 46% of all included children and 42% (36/86) of those receiving NB-UVB; however, grade 3 and 4 reactions were infrequent and only 3 children stopped treatment due to burning. NB-UVB was particularly effective in those with psoriasis; 55/65 (85%) significantly improved, and 72% had not relapsed after 2 years. However, its effectiveness in atopic dermatitis was less convincing; in a small group of children, 6/10 (60%) significantly improved, but 66% relapsed within 3 months. Conclusions: Our analysis demonstrates that NB-UVB is effective in children with psoriasis and vitiligo, with potential to achieve extended periods of remission in psoriasis. Its usefulness in atopic dermatitis is less clear. The long-term safety of NB-UVB in children is still unknown, but it appears to be a well-tolerated treatment and should be considered in children for a variety of inflammatory dermatoses before progressing to immunosuppressive therapies.

Vitiligo: A focus on pathogenesis and its therapeutic implications

“…UV light–based treatment is the most common therapy for vitiligo; and it is associated with an improved outcome when combined with an additional therapy 177,226 …”

Long-Term Narrowband UV-B Efficacy in Moderate to Severe Atopic Dermatitis

“…The median total number of sessions needed for the response was 31.5 (IQR, 20.5–45.5) and 32 (IQR, 18–41) respectively, with a median cumulative dose of 21 J/cm 2 (IQR, 9–46 and 9–34 J/cm 2 , respectively). Other reports (only some including intention to treat analysis) indicated somewhat lower response rates of 59% to 81%, 30,34–36 and studies on pediatric patients reported response rates of 60% to 76% 37–42 . Two cited studies reported higher efficiency with a response rate of 87.5% to 90% 43,44 …”

“…Other reports (only some including intention to treat analysis) indicated somewhat lower response rates of 59% to 81%, 30,[34][35][36] and studies on pediatric patients reported response rates of 60% to 76%. [37][38][39][40][41][42] Two cited studies reported higher efficiency with a response rate of 87.5% to 90%. 43,44 These reports showed a median number of treatments that ranged from 22 to 33.4 for responders, 30,37,38,41 whereas 1 study on Asian children reported a median of 60 treatments for this group.…”

Update on the Management of Pediatric Psoriasis: An Italian Consensus

“…The effectiveness of phototherapy in psoriasis has long been established [21]. Retrospective studies in psoriatic children aged 5-17 years reported [ 50% skin clearance rates with very few, mild adverse events [58][59][60]. Pretreatment of psoriasis lesions with an emollient was associated with greater efficacy of the NB-UVB treatment, as shown by a reduction in lesion extension, scaling, and induration, and with a lower UV dosage required to achieve skin clearance, compared with no pretreatment [61].…”