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Phototherapy: An Effective Treatment for Pediatric Atopic Dermatitis

August 26, 2013

Phototherapy: An Effective Treatment for Pediatric Atopic Dermatitis

  1. Craig A. Elmets, MD

Narrowband ultraviolet B therapy added substantially to improvement of childhood AD.

  1. Craig A. Elmets, MD

Childhood atopic dermatitis (AD) can be a difficult management problem when it fails to respond to aggressive topical therapy. Systemic medications, although effective, are associated with adverse effects and often require blood monitoring. Although phototherapy has demonstrated utility for adult eczema, and retrospective studies have suggested effectiveness of narrowband ultraviolet B (NBUVB) therapy in children, no prospective studies have evaluated NBUVB for pediatric AD. To address this knowledge gap, investigators compared NBUVB (twice weekly; total exposures, 24) plus topical therapy with topical therapy alone in 29 children aged 3 years to 16 years. The primary endpoint was the percent reduction in the Six Area Six Sign Atopic Dermatitis score, an objective measure of AD severity.

The NBUVB recipients had more severe disease and greater mean affected body surface area at baseline. At therapy completion, NBUVB recipients had a mean improvement of 61%, versus a worsening of disease of 6% in the topical therapy–only group, a statistically significant difference (P<0.0001). Of the phototherapy group, 41% were clear or nearly clear of disease. Results on secondary endpoint measures (Body Surface Area Involvement; Patient Outcome Eczema Measure; Children's Dermatology Life Quality Index; Scoring Atopic Dermatitis; Visual Analogue Score; Dermatitis Family Impact questionnaire) followed the same trend. The statistically significant difference in outcomes endured at evaluations 3 and 6 months after therapy completion, indicating that NBUVB's ameliorative effect persisted for at least 6 months. NBUVB was well-tolerated in this age group. Erythema severe enough to delay the next treatment was observed in only one child.

Comment

Atopic dermatitis can usually be controlled with appropriate skin care and topical steroids or topical calcineurin inhibitors. However, more severe disease can disrupt the life of the child and his or her family. All too often, patients receive repeated courses of systemic steroids, which can cause HPA axis suppression and growth retardation. Systemic immunosuppressives also have undesirable side effects. This study shows that NBUVB is a useful alternative for childhood atopic dermatitis, with few side effects. Compared with the alternatives, it is cost effective and well tolerated, and, most likely, underutilized.

  • Disclosures for Craig A. Elmets, MD at time of publication Consultant / Advisory board Astellas Pharmaceuticals Grant / research support NIH; NIH/NCI; Veteran’s Administration; Abbott Laboratories; Biogen; Clinuvel; Covan Basilea Pharmaceutica; Genentech; TenX Biopharma; University of California Editorial boards Cancer Prevention Research; Journal of the American Academy of Dermatology; Photodermatology, Photoimmunology, & Photomedicine; UpToDate Leadership positions in professional societies American Academy of Dermatology (Psoriasis Guidelines Subcommittee and Chair Designate, Clinical Guidelines and Research Committee); Photomedicine Society (Board of Directors)

Citation(s):

Reader Comments (4)

Alexis Dougherty Physician, Dermatology

Although UVB is a known carcinogen, its carcinogenic potential seems
to be lower than that of PUVA. A 16-center study conducted by Stern
and Laird23 did not detect a relationship between UVB phototherapy
and non-melanoma skin cancer. In a recent British study comprised of
3867 patients treated with narrowband UVB, no significant association
between narrowband UVB treatment and basal cell carcinoma (BCC),
squamous cell carcinoma (SCC) or melanoma was found.

Alexis Dougherty Physician, Dermatology

Long-term side effects include photoaging and carcinogenesis.
Although UVB is a known carcinogen, its carcinogenic potential seems
to be lower than that of PUVA. A 16-center study conducted by Stern
and Laird23 did not detect a relationship between UVB phototherapy
and non-melanoma skin cancer. In a recent British study comprised of
3867 patients treated with narrowband UVB, no significant association
between narrowband UVB treatment and basal cell carcinoma (BCC),
squamous cell carcinoma (SCC) or melanoma was found.
Hearn RM, Kerr AC, Rahim KF, et al. Incidence of skin cancers in 3867 patients treated with narrow-band ultraviolet B phototherapy. Br J Dermatol. 2008;159:
931–5.

Bridgett, Christopher Dr. Physician, Psychiatry, Chelsea & Westminster Hospital, London

Also relatively underutilized is habit reversal, the behaviour therapy intervention for habitual scratching, a common cause of treatment resistance in atopic eczema. Habit reversal is also cost effective, and feasible both in primary care and as a self help approach.

Zach Rosen, M.D. Physician, Family Medicine/General Practice, Clinic

UVB causes skin cancer and is being used with children for eczema?

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