Phototherapy for Atopic Eczema

Musters AH, Mashayekhi S, Harvey J, Axon E, Lax SJ, Flohr C, Drucker AM, Gerbens L, Ferguson J, Ibbotson S, Dawe RS, Garritsen F, Brouwer M, Limpens J Prescott LE, Boyle RJ, Spuls PI. Phototherapy of atopic eczema. Cochrane Database of Systematic Reviews 2021, No. 10. Art. No.: CD013870. doi: 10.1002 /14651858.CD013870.pub2. Accessed November 1, 2021.

Commentary

This study was conducted to evaluate the efficacy of phototherapy for treating atopic eczema (AE). Thirty-two studies, including 1219 randomized participants aged 5 to 83 years (mean: 28 years), were recruited from secondary care dermatology clinics, and the study duration averaged 13 weeks (range: 10 days to 1 year).

The interventions evaluated included

Narrow-band ultraviolet B (NB-UVB; 13 studies)

Ultraviolet A1 (UVA1; 6 studies)

Broad-band ultraviolet B (BB-UVB; 5 trials)

Ultraviolet AB (UVAB; 2 studies)

Solarene and UV-A

These interventions will include.

NB-UVB vs. placebo/no treatment

After 12 weeks of treatment, there may be a significant reduction in physician-assessed signs with NB-UVB compared to placebo. (Mean difference (MD) -9.4, 95% confidence interval (CI) -3.62 to -15.18; 1 study, 41 participants; scale: 0 to 90)

NB-UVB may increase the number of people reporting a reduction in itching after 12 weeks of treatment, compared to placebo. (Risk ratio (RR) 1.72, 95% CI 1.10 to 2.69; 1 trial, 40 participants)

NB-UVB and UVA1

We judged the evidence for NB-UVB compared with UVA1 to be very low certainty for all outcomes because of the risk of bias and imprecision. In addition, there was no evidence of a difference in physician-rated signs after 6 weeks. (MD -2.00, 95% CI -8.41 to 4.41; 1 study, 46 participants; scale: 0 to 108)

NB -UVB vs. PUVA

The evidence for NB-UVB compared to PUVA (8-methoxysolarene in baths and UVA) was judged to be of very low certainty for all reported results due to the risk of bias and imprecision There was no evidence of difference in signs assessed by physicians after 6 weeks. There was no evidence of a difference in signs assessed by the physician after 6 weeks (64.1% reduction with NB-UVB versus 65.7% reduction with PUVA; 1 study, 10 participants, 20 sides).

UVA1 vs. PUVA

Due to the serious risk of bias and imprecision, there was very low certainty evidence that PUVA (oral 5-methoxsoralen and UVA) reduced physician-rated signs more than UVA1 after 3 weeks. (MD 11.3, 95% CI -0.21 to 22.81; one trial, 40 participants, scale: 0 to 103)

There were no eligible trials for the primary comparison of UVA1 and PUVA compared to no treatment.

Adverse event reports included low rates of phototoxic reactions, severe irritation, UV burns, heavy bacterial infections, worsening of disease, and herpetic eczema.