Management of atopic dermatitis: safety and efficacy of phototherapy

Figures & data

Table 1 Features of the main forms of phototherapy

Phototherapy in AD (all forms): strength of recommendation B, level of evidence II	Use, features, and efficacy	Limitations and side effects
Broadband UVB (280–315 nm)	One of the first radiations used in phototherapy, recently substituted by NB-UVB	UVB causes sunburn, erythema, xerosis, tenderness, and other forms of epidermal photodamage Carcinogenic risk has not been excluded
Narrowband UVB (311–313 nm)	Short-acting, less erythemogenic, and more effective than BB-UVB First choice for chronic cases of moderate to severe AD Satisfying results also in children	The same as UVB, but milder or less frequent
UVAB (280–400 nm)	Combination of UVA and UVB radiation: in combined, simultaneous, or subsequent emission	Side effects of both UVA and UVB radiation
UVA (315–400 nm) and UVA1 (340–400 nm)	Cause less sunburn and erythema than NB-UVB, due to their deep dermal action	Need longer exposures than UVB (10 minutes to 1 hour per session)
Including: HD-UVA1 (80–130 J/cm^2) MD-UVA1 (40–80 J/cm^2) LD-UVA1 (>40 J/cm^2)	Administration of MD-UVA1 shows best results in terms of efficacy and tolerability Optimal for flares in AD	HD-UVA1 is usually not well tolerated UVA radiation can cause lentigines, folliculitis, hypertrichosis, pruritus, herpes simplex virus reactivation, hyperpigmentation, redness, cataract, polymorphous skin eruption, and other acute dermal side effects Carcinogenic risk has not been excluded
Photochemotherapy (PUVA, balneophototherapy)	Combines UVA (or also UVB, concerning balneophototherapy) radiation with administration of psoralens Good clinical outcomes were reported, but only few studies are available	PUVA can cause systemic toxicity, folliculitis, photo-onycholysis. Long-term PUVA should be avoided since it is likely related to a carcinogenic effect Balneophototherapy often causes mild adverse effects but is better tolerated than PUVA

Abbreviations: UVA, ultraviolet A; AD, atopic dermatitis; UVB, ultra violet B; UVAB, ultra violet AB; UVA1, ultra violet A1; LD, low dose; MD, medium dose; HD, high dose; PUVA, psoralen + UVA; BB, broad band; NB, narrow band.