Phototherapy for atopic eczema with narrow-band UVB

Type:Uv phototherapy Time:2017-01-18 10:14:35

Management of atopic dermatitis has been less than satisfactory. Lack of response to conventional therapy is a difficult problem, especially in the treatment of severe atopic dermatitis. Prolonged use of topical corticosteroids as well as systemic immunosuppressant drugs (eg, corticosteroids, cyclosporine, azathioprine) can result in severe cutaneous and systemic effects. An alternative modality for treatment of atopic dermatitis is pho-totherapy including conventional UVA/UVB com-bination therapy, UVA₁ therapy, and pho-tochemotherapy with methoxsalen plus UVA (PUVA).^1,2 It has been proven that high-dose UVA₁ therapy has strong immunomodulating capacity³; however, there has been discussion of the risk of long-term carcinogenicity associated with its use. PUVA therapy requiring high UVA doses for clearance may lead to a wide range of severe side effects, including the development of cutaneous neoplasms.⁴ UVA/UVB combination therapy is less effective than UVA₁ and PUVA, thus requiring many treatment sessions.

METHODS

Five patients (3 women, 2 men; age range, 29-48 years) with moderate to severe atopic dermatitis, who had been resistant to at least one conventional treatment modality, were treated with narrow-band UVB (Table I). Atopic dermatitis was diagnosed according to the criteria described by Hanifin and Rajka.⁶ A wash-out period of 2 weeks after topical treatment and 4 weeks after systemic treatment was required before starting phototherapy. UVB irradiations were done once daily 5 times per week (irradiation equipment, Waldmann model 8001). Depending on the skin type and the min-imal erythema dose (MED), initial doses in individual patients ranged from 0.113 J/cm² up to 0.339 J/cm². Doses were gradually increased up to 1.696 J/cm² to induce slight erythema. No additional systemic or topi-cal treatment except emollient ointment was permitted.

Efficacy was assessed once a week by two independent investigators using modified SCORAD scores.⁷ The SCORAD index was developed in 1993 by the European Task Force on Atopic Dermatitis to create a standardized assessment method for atopic dermatitis. The scoring index combines the extent (rule of 9) and severity of 5 intensity items (erythema, edema/papula-tion, oozing/crusts, excoriations, and lichenifications) and subjective symptoms (daytime pruritus, sleep loss).

In each patient a mean cumulative dose of 9.2 J/cm² UVB at a wavelength of 311 nm was applied in a mean of 19 irradiations. Narrow-band UVB notably reduced atopic dermatitis after 3 weeks in all patients (mean SCORAD score, from 33.6 [before treatment] to 16.8 [after 3 weeks]; range, from 28-40 [before treatment] to 12-20 [after treatment]). After 4¹⁄2 weeks of treatment all patients had cleared completely. No relapse was seen during an 8-week follow-up period (see Table II).

DISCUSSION

Treatment with narrow-band UVB has been proven to be a sensible alternative to conventional broad-band UVB for clearing psorasis.⁸ Therefore

the effects of narrow-band UVB in the treatment of other inflammatory dermatoses susceptible to con-ventional phototherapy need to be explored. Recently narrow-band UVB air-conditioned pho-totherapy has been reported to be effective for adult atopic dermatitis after a pretreatment period with topical steroids.⁹ To optimize the patients�� personal comfort, air conditioning was incorporated into the irradiation cabin. Our data indicate that narrow-band UVB is very effective for treatment of moder-ate to severe atopic dermatitis even if no pretreat-ment with topical steroids is performed. Although it is desirable to maximize the patients�� personal com-fort by air conditioning, the narrow-band UVB air-conditioned therapy described herein will be limited to those dermatology centers capable of having air conditioning specially incorporated into standard narrow-band UVB irradiation cabins. However, our data indicate that narrow-band UVB phototherapy is a treatment protocol effective for patients with moderate to severe atopic dermatitis and favorably accepted by the patients.