No firm conclusions about effectiveness of phototherapy for atopic eczema

Wednesday 15 December 2021

Vanessa Jordan

PEARLS No.

690

Clinical question

What are the effects of phototherapy regimens (eg, narrowband ultraviolet B [NB‐UVB], broadband UVB, psoralen plus UVA, UVA1) for people with atopic eczema?

Bottom line

This review included 4 studies (89 participants) that compared NB‐UVB with no treatment or placebo. The certainty of evidence for outcomes from these studies was low.

Physician‐assessed changes in clinical signs (assessed using a total disease activity score) may improve more with NB‐UVB than with placebo after 12 weeks of treatment. For patient‐reported changes in symptoms, itching may be reduced more with NB‐UVB compared with placebo after 12 weeks of treatment. NB‐UVB may also provide moderate or greater improvement, as measured by the Investigator Global Assessment scale, than placebo after 12 weeks of treatment. However, after only 4 weeks of treatment, there seems to be very little treatment effect.

The remaining studies compared different types of phototherapy regimens, but there was insufficient evidence available to determine their effectiveness.

Caveat

Although atopic eczema is common in children, the mean age of study participants was 28 years (range: 5–83 years; 5 studies did not report the mean age). Most studies included only Fitzpatrick skin types II to III (light to medium skin colours), limiting their generalisability.

UVB was the most prevalent intervention assessed in the included studies – approximately 40% of studies assessed NB‐UVB, which reflects its status as the most recognised and widespread form of phototherapy treatment for atopic eczema. The comparison of NB‐UVB versus placebo provided low-certainty evidence as there were small sample sizes and some concerns about the conduct of some studies, which led them to be judged as having high risk of bias.

Context

Atopic eczema is a common chronic inflammatory skin condition with several treatment options available. Therapeutic options for moderate to severe atopic eczema include phototherapy and photochemotherapy.

Cochrane Systematic Review

Musters AH, et al. Phototherapy for atopic eczema. Cochrane Database Syst Rev 2021;10:CD013870. This review contains 32 trials with a total of 1219 participants.

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