Narrowband ultraviolet B phototherapy is associated with a reduction in topical corticosteroid and clinical improvement in atopic dermatitis: a historical inception cohort study

Abstract

Background. Despite decades of use, the magnitude of efficacy of narrowband ultraviolet B (NB-UVB) phototherapy for atopic dermatitis (AD) beyond industrysponsored trials remains unclear. Aim. To evaluate the clinical efficacy of NB-UVB in AD under real-world conditions. Methods. We conducted a historical inception cohort study using automated recording of dispensed drugs to provide an objective treatment outcome in a large population catchment of 420 000 people over 15 years. We analysed clinical treatment outcomes, recorded multicentre and prospectively over 15 years, of a large AD treatment cohort (n = 844), along with the drugs dispensed to this cohort. Results. The majority (70%) of patients with AD received significantly fewer topical corticosteroids (TCS) during the 12-month window after finishing NB-UVB compared with the 12-month window before starting the treatment (median reduction from 37.5 to 19.7 g/month). The number of patients dispensed with oral corticosteroids and antihistamines also dropped significantly (from 20% to 10% and from 69% to 31%, respectively), while all AD-unrelated drugs dispensed remained unchanged. Clinically, NB-UVB treatment achieved a 'clear' or 'almost clear' status in 48.7% of patients, while 20.4% achieved 'moderate clearance'. Treatment outcomes scores were validated by a strong correlation with reduction in AD-specific drug treatment. Conclusion. Our data confirm the significant efficacy of NB-UVB for AD under conditions of routine care.

Consensus on the therapeutic management of atopic dermatitis ‒ Brazilian Society of Dermatology: an update on phototherapy and systemic therapy using e-Delphi technique

“… 27 , 28 In chronic AD, it controls clinical signs, reduces bacterial colonization by Staphylococcus aureus ( S. aureus ) and Pityrosporum orbiculare, and improves insomnia, being a steroid-sparing measure as well. 27 , 29 , 30 …”

Oxidative Stress and Phototherapy in Atopic Dermatitis: Mechanisms, Role, and Future Perspectives

“…Although IL-10 is implicated in the anti-inflammatory response, its role in AD has been interpreted as part of the predominant Th2 microenvironment, increased levels of IL-10 have been postulated to indirectly contribute to the AMP deficiency in patients with AD, potentially accounting for an increased propensity for infections. Higher IL-10 expression levels were reported in the skin of patients with chronic AD compared with the acute stage, possibly because of an upregulation of the receptors by interferon-gamma (IFN-γ) [ 49 , 50 ].Clinically, the effects of phototherapy have been further demonstrated by the fact that 70% of AD patients received significantly fewer TCS during the 12-month window after finishing NB-UVB, compared to the 12-month window before starting [ 51 ]. Phototherapy with medium-dose UVA1 irradiation exerts a significant antipruritic effect, decreases the severity of the disease, and improves the QoL of AD-affected patients.…”

A Pragmatic Study on Nurse-Led Home Phototherapy

“…A large 2017 study that included 1,749 participants diagnosed with psoriasis found that 75% required less topical treatment 12 months after a clinic-based NBUVB treatment course (Foerster et al, 2017). Similarly, a 2021 multicenter, prospective cohort study of 844 patients with atopic dermatitis showed an overall reduction in topical corticosteroid use with the quantity dispensed reducing from 37.5 grams per month to 19.7 grams per month after the NBUVB treatment course (Choi et al, 2021). These studies analyzed data collected during routine care, similar to this study.…”