The effectiveness of high‐dose ultraviolet A‐1 phototherapy for acute exacerbation of atopic dermatitis in Asians

Abstract

Background/PurposeAtopic dermatitis (AD) is an inflammatory skin disease characterized by a chronic course of exacerbations and remissions. High‐dose ultraviolet A‐1 (UVA‐1) phototherapy has been effective in the treatment of acute exacerbations of AD. However, there have been no case studies in Asian patients to date. We investigated the effectiveness of high‐dose UVA‐1 phototherapy for treating acute exacerbation of AD in Asian patients.MethodThis study included 16 patients with acute exacerbation of AD. High‐dose (100 J/cm2) regimens of UVA‐1 therapy were employed. Therapeutic effectiveness was assessed based on the findings of clinical examinations and scoring of AD (SCORAD) index before treatment and after the 5th and 10th sessions of treatment. Additionally, side effects and recurrence during follow‐up were retrospectively evaluated.ResultsThe patients were between 7 and 50 years of age, with a mean age of 25.8 years. The SCORAD index was between 41 and 89.5, with a mean score of 64.9. Among the 16 patients, two patients discontinued treatment due to the aggravation of erythema and pruritus. Of the 14 patients who completed the 10 sessions of high‐dose UVA‐1 phototherapy, nine patients (64.3%) showed complete remission and five patients (35.7%) showed partial remission. The mean SCORAD index reduced from 64.9 (before treatment) to 23.3 (after the 10th session of treatment).ConclusionThis is the first case study of high‐dose UVA‐1 phototherapy for acute exacerbation of AD in Asian patients, suggesting that high‐dose UVA‐1 phototherapy can be a well‐tolerated and effective treatment for acute exacerbated AD. Future large‐scale prospective studies are needed.

Efficacy of ultraviolet A1 phototherapy for inflammatory, sclerotic and neoplastic dermatological diseases: A 10‐year tertiary referral center experience

“…Blind bilateral comparisons and randomized controlled studies performed in small populations of AD patients demonstrated high response rates reaching 90%–100%, without a significant difference between high‐dose and medium‐dose UVA1 phototherapy 13,23 . In retrospective studies, response rates to UVA1 phototherapy in AD patients were similar to those reported in this study, regardless of dosages 10–12 . However, in a large retrospective study performed in India, there were low improvement rates of 53% 9 .…”

“…13,23 In retrospective studies, response rates to UVA1 phototherapy in AD patients were similar to those reported in this study, regardless of dosages. [10][11][12] However, in a large retrospective study performed in India, there were low improvement rates of 53%. 9 The response rates in our patients are in the range of those reported in previous studies and even exceed the response rates of some studies.…”

“…In atopic dermatitis, UVA1 initiates apoptosis of dermis‐invading lymphocytes, reducing the number of CD4 + T cells and dendritic cells and increasing the number of CD8 + T cells 3,8 . Response rates for atopic dermatitis ranged between 53% and 100%, depending on the treating center and the protocol used, but these reports are based mainly on retrospective studies with a small number of patients 9–12 . Few reports showed that the efficacy of the medium and high dosages (above 40 J/cm 2 ) were as high as 90%, while the low dosage was less effective 13 …”

“…3,8 Response rates for atopic dermatitis ranged between 53% and 100%, depending on the treating center and the protocol used, but these reports are based mainly on retrospective studies with a small number of patients. [9][10][11][12] Few reports showed that the efficacy of the medium and high dosages (above 40 J/cm 2 ) were as high as 90%, while the low dosage was less effective. 13 In patients with sclerotic diseases, mainly morphea, UVA1 phototherapy resulted in softening and thinning of the fibrotic tissue, without any marked side effects.…”

Narrowband-ultraviolet B vs Broadband-ultraviolet B in Treatment of Chronic Pruritus: A Randomized, Single-blinded, Non-inferiority Study

“…However, treatment with ultraviolet (UV) light, i.e. UV phototherapy, is long known to be effective in the treatment of pruritic skin diseases such as psoriasis, atopic dermatitis (AD) and mycosis fungoides (9)(10)(11).…”