The impact of medium dose UVA1 phototherapy on pruritus, DLQI and SCORAD index in patients with atopic dermatitis

Abstract

Introduction: Atopic dermatitis (AD) is featured by pruritus, which causes diminished quality of life. Little clinical data exists concerning the use, efficacy and side effects of UVA1 phototherapy in AD patients. Aim: To determine the effectiveness of medium-dose UVA1 phototherapy in AD treatment. Material and methods: Thirty-six patients with AD were irradiated with medium-dose UVA1 (45 J/cm 2) as monotherapy for 4 weeks for a total of 20 sessions (daily irradiations during weekdays only). Clinical status was evaluated with the visual analogue scale for pruritus, Dermatology Life Quality Index (DLQI) for evaluating general well-being and the SCORAD index. All parameters were measured twice: before and after phototherapy. Results: UVA1 phototherapy resulted in a significant (p < 0.001) decrease in pruritus, improvement in DLQI (p < 0.001) and SCORAD (p < 0.001). Before phototherapy, the intensity of pruritus and SCORAD index correlated with DLQI (r = 0.34, p < 0.05 and 0.61, p < 0.05, respectively). Similarly, after irradiation, pruritus correlated with DLQI, and SCORAD index correlated with DLQI (r = 0.51, p < 0.05 and r = 0.55, p < 0.05, respectively). No severe adverse effects were noted during the study. Conclusions: Phototherapy with medium-dose UVA1 irradiation exerts a significant antipruritic effect, decreases the severity of the disease and improves the quality of life of AD patients. This technique can therefore be used as a safe and effective treatment method.

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 .…”

“…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.…”

Efficacy and Satisfaction of Low Doses UVA1 Phototherapy: A Spanish Experience from a Single Centre

“…Moreover, low-dose UVA1 (30 J/cm 2 ) was less effective than UVA/UVB therapy, whereas high-dose UVA1 therapy (130 J/cm 2 ) was superior to UVA/UVB phototherapy [ 26 ]. Malinowska K et al [ 31 ] reported that medium-dose UVA1 phototherapy had significant antipruritic effects, improved atopic dermatitis (as measured by the SCORAD index), and improved quality of life (as measured by the DLQI questionnaire). Our results support the usefulness of UVA1 phototherapy at low doses in atopic dermatitis, which could be positioned as a fast and effective alternative in the treatment of this field.…”

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

“…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. From this, it follows that this technique can be used as a safe and effective treatment [ 52 ].…”