Treatment of moderate and severe adult chronic atopic dermatitis with narrow-band UVB and the combination of narrow-band UVB/UVA phototherapy

Abstract

The phototherapy is a safe and effective technique for the treatment of adult patients with atopic dermatitis (AD). The treatment of chronic forms of the disease is most often done with narrow-band UVB (NB-UVB). There also exist effective phototherapy options against the AD. The aim of this study was to asses if the combination of NB-UVB with UVA was more effective than the treatment with only NB-UVB against adult chronic AD. We carried out a prospective and observational study. Adult patients with chronic AD with more than 50% of the total body surface area affected (TBSA) were included. The affected TBSA was calculated using the so-called "rule of nines." Patients with a clearance rate >75% of the initial affected TBSA or complete clearance rate were considered as complete response (CR). An analogue scale from 0 to 10 was used to measure the improvement grade of the pruritus. The treatments were repeated three times a week. The initial doses of NB-UVB and UVA were determined by patient's phototype. The treatments were performed using a phototherapy booth (UV7002, Walmann, Villingen-Schwenningen, Germany(®) ) with TL01 and UVA fluorescent lamps. Statistical analysis was performed with SPSS(®) (IBM, New York, NY) for Windows 21.0. A total of 26 patients with adult chronic AD were included in the study, 16 patients were treated with UVB-BE and 10 patients with the combined treatment option NB-UVB/UVA. The mean value of cumulative doses and the mean number of performed treatments were similar between both groups of patients (p > 0.05). The mean value of duration of response was significantly higher in the patients treated only with NB-UVB, 101 versus 6.8 months (p ≥ 0.05). No differences were observed for the patients that showed complete response (p = 0.42) and in the analogue scale of pruritus (p > 0.005). In our study, the patients treated with the combination of NB-UVB and UVA were similar to the patient that were only treated with NB-UVB e. Further prospective and controlled studies have to be performed in order to determine the dosing regimens of phototherapy in adult patients with AD.

Systemic Treatment of Adult Atopic Dermatitis: A Review

“…As a rule, phototherapy is not indicated in the acute stage of AD (except UVA1, which is also effective in managing AD flares) [38–40], but is more apt to treat chronic, pruritic, lichenified forms [24, 35], and should not be prescribed in those patients who experience a worsening of their dermatosis during sun exposure as in the case of other common chronic inflammatory diseases such as psoriasis [41]. In general, NB-UVB has been indicated for chronic-moderate forms of AD and is currently preferred to broadband UV because it is less erythemogenic; a recent study reported that the combination with UVA did not show any further benefits [42]. On the other hand, medium-dose UVA1 appears to be similar to NB-UVB in terms of efficacy, as shown in different studies [43, 44].…”

A Perspective on the Use of NB-UVB Phototherapy vs. PUVA Photochemotherapy

“…Given the response of atopic eczema to several types of light-based therapy and if NB-UVB phototherapy fails or there is early relapse after discontinuation of treatment, then the options of either PUVA or UVA1 exist, although given the lack of evidence of superiority of UVA1, the latter would likely only be considered if PUVA was contraindicated. Indeed, a combination of NB-UVB and UVA or UVA1 could be considered for some patients, although whether this is advantageous compared with UVB alone is unclear and this needs further study ( 58 ).…”

Dead Sea ultraviolet climatotherapy for children with atopic dermatitis

“…Since narrow‐band UVB (NB‐UVB) treatment became the option of choice for many skin conditions including AD , it is difficult to compare cumulative doses between artificial and natural UVB doses. The same remark can be done regarding UVA doses, as UVA is never used solely but only with prior additional psoralen intake, orally or in bath or together with NB‐UVB .…”