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Safety and Efficacy of Phototherapy in the Management of Eczema

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Ultraviolet Light in Human Health, Diseases and Environment

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 996))

Abstract

Atopic Dermatitis (AD), a common skin disease, can occur in patients of all age, gender and ethnicity. It is an inflammatory affection, characterized by chronic and highly debilitating behavior. First-line interventions against AD include environmental measures and topical emollients, corticosteroids or calcineurin inhibitors. When these measures are not sufficient, phototherapy represents an efficient second-line option of treatment; it can be administered on its own, or in the most severe cases combined with systemic medicaments such as corticosteroids.

Different types of light therapy, including photochemotherapy, have been tested in the past and in recent years for AD: in particular, ultraviolet A1 (UVA1) and narrow band ultraviolet B (NB-UVB) have been reported in the literature as the most effective resources, respectively for acute and chronic AD. However, to date, no guidelines have been realized concerning the use of phototherapy for AD, as no light form has been defined superior to the others. The most reliable protocols and dosimetry are standardized within the American Academy of Dermatology (AAD) psoriasis guidelines.

In adults and children over 12 years (8 years for NB-UVB) phototherapy is recommended with strength B and level of evidence II (excluding home phototherapy, which is recommended with strength C and level of evidence III). It is usually safe and well tolerated; however its short- and long-term adverse effects are the same as those observed when light therapy is performed for other pathologic conditions. Erythema and photodamage are in particular quite frequent; moreover it has not been clarified whether UV radiation may induce neoplastic cellular transformation. For all these reasons, the use of phototherapy must be chosen only after a comprehensive and careful evaluation of the patient’s features and compliance, as well as of the limitations of the procedure due to costs and availability.

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Abbreviations

8-MOP:

8-methoxypsoralen

AAD:

American Academy of Dermatology

AD:

atopic dermatitis

AE:

atopic eczema

DLQI:

Dermatology Life Quality Index

EASI:

Eczema Area and Severity Index

ECP:

extracorporeal photopheresis

FLG:

filaggrin

HD:

high dose

IgE:

immunoglobulin E

LD:

low dose

LDH:

lactate dehydrogenase

MD:

medium dose

MED:

minimal erythema dose

mRNA:

messenger ribonucleic acid

NB-UVB:

narrow band ultraviolet B

PUVA:

psoralen plus ultraviolet A

QoL:

quality of life

SCORAD:

Severity Scoring of Atopic Dermatitis

TARC/CCL17:

thymus and activation-regulated chemokine/chemockine (C-C motif) ligand 17

TEWL:

transepidermal water loss

Th:

T helper

UVA:

ultraviolet A

UVA1:

ultraviolet A1

UVA2:

ultraviolet A2

UVAB:

ultraviolet AB

UVB:

ultraviolet B

VAS:

visual analog scale

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All authors give their consent to the publication of the article and declare no conflict of interest.

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Authors and Affiliations

  1. Department of Specialized, Diagnostic and Experimental Medicine, Division of Dermatology, University of Bologna, via Massarenti 1, 40138, Bologna, Italy

    Annalisa Patrizi, Beatrice Raone & Giulia Maria Ravaioli

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  1. Annalisa Patrizi
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  2. Beatrice Raone
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Correspondence to Annalisa Patrizi .

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  1. Faculty of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom

    Shamim I. Ahmad

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Patrizi, A., Raone, B., Ravaioli, G.M. (2017). Safety and Efficacy of Phototherapy in the Management of Eczema. In: Ahmad, S. (eds) Ultraviolet Light in Human Health, Diseases and Environment. Advances in Experimental Medicine and Biology, vol 996. Springer, Cham. https://doi.org/10.1007/978-3-319-56017-5_27

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