Phototherapy and Eczema

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Phototherapy and Eczema

Postby BigDaddy » Mon Oct 09, 2006 1:53 pm

Phototherapy and Eczema

#1 Narrow-band ultraviolet B and broad-band ultraviolet A phototherapy in adult atopic eczema: a randomised controlled trial. Reynolds, NJ. Lancet, 2001 Jun 23; Vol. 357 (9273), pp. 2012-6; PMID: 11438134.
BACKGROUND: Narrow-band ultraviolet B (UVB) is an effective treatment for psoriasis, and open studies suggest that this phototherapy might improve atopic eczema. We did a randomised controlled trial to compare narrow-band UVB, UVA, and visible light phototherapy as second-line, adjunctive treatments in adult patients with moderate to severe atopic eczema. METHODS: Phototherapy was administered twice a week for 12 weeks. 26 patients were randomly assigned narrow-band UVB, 24 were assigned UVA, and 23 visible fluorescent light. The primary endpoints were change in total disease activity (sum of scores at six body sites) and change in extent of disease after 24 treatments compared with baseline. Data were analysed by the method of summary measures. FINDINGS: 13 patients withdrew or were excluded from analysis. Mean reductions in total disease activity over 24 treatments in patients who received narrow-band UVB and UVA, respectively, were 9.4 points (95% CI 3.6 to 15.2) and 4.4 points (-1.0 to 9.8) more than in patients who received visible light. Mean reductions in extent of disease after 24 treatments with narrow-band UVB and UVA were 6.7% (1.5 to 11.9) and -1.0% (-5.3 to 3.3) compared with visible light. A small proportion of patients developed erythema after phototherapy or had a flare in their eczema sufficient to withdraw from treatment.

INTERPRETATION: Narrow-band UVB is an effective adjunctive treatment for moderate to severe atopic eczema, and the treatment is well tolerated by most patients.

#2 Systemic therapy in the treatment concept of atopic eczema. Reliable treatment methods and experimental developments Brockow K, Der Hautarzt; Zeitschrift Für Dermatologie, Venerologie, Und Verwandte Gebiete. Die systemische Therapie im Behandlungskonzept des atopischen Ekzems. Bewährte Behandlungsverfahren und experimentelle Entwicklungen. 1999 May; Vol. 50 (5), pp. 323-9; PMID: 10412628.

ABSTRACT: Our therapeutic approach to atopic eczema consists of a continuous topical dermatological basic therapy in combination with an antiinflammatory therapy in phases of exacerbations. In the treatment of exacerbated atopic eczema, systemic agents are added to achieve effective control more rapidly or to induce remissions in cases refractory to standard therapy. Antihistamines to control the pruritus, as well as antibiotics and acyclovir for antimicrobial superinfections are often used. In many patients exacerbations can be successfully controlled with phototherapy, especially with UVA1 light. The use of systemic immunosuppressants, like glucocorticosteroids, cyclosporine or azathioprine generally can be avoided and is a therapeutic alternative only in few selected cases.


#3 Narrowband ultraviolet B (UVB) phototherapy in children. Jury CS. Clinical And Experimental Dermatology [Clin Exp Dermatol], 2006 Mar; Vol. 31 (2), pp. 196-9; PMID: 16487089.

BACKGROUND: While narrowband ultraviolet B (UVB) phototherapy is a well-established treatment for a range of skin conditions in adults, there is little in the literature about its use in children and data regarding its long-term carcinogenic potential are lacking. Aim. We undertook a retrospective review of the use of narrowband UVB phototherapy in a paediatric population attending two Glasgow Hospitals. METHODS: Phototherapy case notes for all children aged 16 years and under at time of treatment were reviewed at two hospital sites between 1996 and 2002. Results. In total, 77 children had been treated (median age 12 years, range 4-16). The conditions treated most frequently were psoriasis (45%) and atopic eczema (32%). Other dermatoses treated included alopecia areata, acne, hydroa vacciniforme and polymorphic light eruption. Treatment courses for atopic conditions were longer than those required for psoriatic conditions: median number of treatments 24 for atopic eczema (range 3-46), and 17.5 for psoriasis (range 9-35). By the end of treatment, 68% of the atopic patients and 63% of the patients with psoriasis had cleared. The adverse event profile was similar to that in adults, with erythema, herpes simplex reactivation and PLE all recorded. Anxiety was a problem for five patients.

CONCLUSION: We conclude that narrowband UVB phototherapy is a useful and well-tolerated treatment for children with severe or intractable inflammatory skin disease, but concerns remain regarding long-term side-effects.
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