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Phototherapy for atopic eczema.

Annelie H Musters1, Soudeh Mashayekhi2, Jane Harvey3

  • 1Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.

The Cochrane Database of Systematic Reviews
|October 28, 2021
PubMed
Summary
This summary is machine-generated.

Narrowband ultraviolet B (NB-UVB) phototherapy may improve atopic eczema (AE) signs and symptoms compared to placebo, with low-certainty evidence. Further research is needed to fully understand the safety and effectiveness of various phototherapy options for AE.

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Area of Science:

  • Dermatology
  • Photomedicine
  • Evidence-based medicine

Background:

  • Atopic eczema (AE), or atopic dermatitis, is a chronic inflammatory skin condition causing significant patient burden.
  • Phototherapy is an alternative treatment for AE when topical therapies are insufficient or not tolerated.

Purpose of the Study:

  • To systematically assess the efficacy and safety of phototherapy for treating atopic eczema.
  • To evaluate various forms of phototherapy against each other, placebo, or no treatment.

Main Methods:

  • A systematic review and meta-analysis of randomized controlled trials (RCTs) identified through comprehensive database searches.
  • Included 32 trials with 1219 participants (aged 5-83) comparing different phototherapy modalities (e.g., NB-UVB, UVA1, PUVA) against comparators.
  • Assessed risk of bias using RoB 2.0 and certainty of evidence using GRADE; primary outcomes were physician-assessed signs and patient-reported symptoms.

Main Results:

  • Narrowband ultraviolet B (NB-UVB) may improve physician-assessed signs, patient-reported itch, and Investigator Global Assessment (IGA) compared to placebo/no treatment, with low-certainty evidence.
  • Evidence comparing NB-UVB with UVA1 or PUVA, and UVA1 with PUVA, was of very low certainty due to risk of bias and imprecision.
  • Reported adverse events included low rates of phototoxic reactions, irritation, and UV burns; no significant difference in withdrawal rates due to adverse events was noted for NB-UVB vs. placebo.

Conclusions:

  • NB-UVB shows potential benefits for AE symptoms and signs compared to placebo, but the evidence is of low certainty.
  • The comparative effectiveness and safety of different phototherapy types (UVA1, PUVA) remain uncertain due to limited and low-quality evidence.
  • Further high-quality research is essential to clarify the role of phototherapy in managing atopic eczema.