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. 2021 Oct 28;10(10):CD013870.
doi: 10.1002/14651858.CD013870.pub2.

Phototherapy for atopic eczema

Annelie H Musters  1 , Soudeh Mashayekhi  2 , Jane Harvey  3 , Emma Axon  4 , Stephanie J Lax  3 , Carsten Flohr  2 , Aaron M Drucker  5   6 , Louise Gerbens  1 , John Ferguson  2 , Sally Ibbotson  7 , Robert S Dawe  7 , Floor Garritsen  8 , Marijke Brouwer  9 , Jacqueline Limpens  10 , Laura E Prescott  4 , Robert J Boyle  4   11 , Phyllis I Spuls  1
Affiliations

Phototherapy for atopic eczema

Annelie H Musters et al. Cochrane Database Syst Rev. .

Abstract

Background: Atopic eczema (AE), also known as atopic dermatitis, is a chronic inflammatory skin condition that causes significant burden. Phototherapy is sometimes used to treat AE when topical treatments, such as corticosteroids, are insufficient or poorly tolerated.

Objectives: To assess the effects of phototherapy for treating AE.

Search methods: We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and ClinicalTrials.gov to January 2021.

Selection criteria: We included randomised controlled trials in adults or children with any subtype or severity of clinically diagnosed AE. Eligible comparisons were any type of phototherapy versus other forms of phototherapy or any other treatment, including placebo or no treatment.

Data collection and analysis: We used standard Cochrane methodology. For key findings, we used RoB 2.0 to assess bias, and GRADE to assess certainty of the evidence. Primary outcomes were physician-assessed signs and patient-reported symptoms. Secondary outcomes were Investigator Global Assessment (IGA), health-related quality of life (HRQoL), safety (measured as withdrawals due to adverse events), and long-term control.

Main results: We included 32 trials with 1219 randomised participants, aged 5 to 83 years (mean: 28 years), with an equal number of males and females. Participants were recruited mainly from secondary care dermatology clinics, and study duration was, on average, 13 weeks (range: 10 days to one year). We assessed risk of bias for all key outcomes as having some concerns or high risk, due to missing data, inappropriate analysis, or insufficient information to assess selective reporting. Assessed interventions included: narrowband ultraviolet B (NB-UVB; 13 trials), ultraviolet A1 (UVA1; 6 trials), broadband ultraviolet B (BB-UVB; 5 trials), ultraviolet AB (UVAB; 2 trials), psoralen plus ultraviolet A (PUVA; 2 trials), ultraviolet A (UVA; 1 trial), unspecified ultraviolet B (UVB; 1 trial), full spectrum light (1 trial), Saalmann selective ultraviolet phototherapy (SUP) cabin (1 trial), saltwater bath plus UVB (balneophototherapy; 1 trial), and excimer laser (1 trial). Comparators included placebo, no treatment, another phototherapy, topical treatment, or alternative doses of the same treatment. Results for key comparisons are summarised (for scales, lower scores are better): NB-UVB versus placebo/no treatment There may be a larger reduction in physician-assessed signs with NB-UVB compared to placebo after 12 weeks of treatment (mean difference (MD) -9.4, 95% confidence interval (CI) -3.62 to -15.18; 1 trial, 41 participants; scale: 0 to 90). Two trials reported little difference between NB-UVB and no treatment (37 participants, four to six weeks of treatment); another reported improved signs with NB-UVB versus no treatment (11 participants, nine weeks of treatment). NB-UVB may increase the number of people reporting reduced itch after 12 weeks of treatment compared to placebo (risk ratio (RR) 1.72, 95% CI 1.10 to 2.69; 1 trial, 40 participants). Another trial reported very little difference in itch severity with NB-UVB (25 participants, four weeks of treatment). The number of participants with moderate to greater global improvement may be higher with NB-UVB than placebo after 12 weeks of treatment (RR 2.81, 95% CI 1.10 to 7.17; 1 trial, 41 participants). NB-UVB may not affect rates of withdrawal due to adverse events. No withdrawals were reported in one trial of NB-UVB versus placebo (18 participants, nine weeks of treatment). In two trials of NB-UVB versus no treatment, each reported one withdrawal per group (71 participants, 8 to 12 weeks of treatment). We judged that all reported outcomes were supported with low-certainty evidence, due to risk of bias and imprecision. No trials reported HRQoL. NB-UVB versus UVA1 We judged the evidence for NB-UVB compared to UVA1 to be very low certainty for all outcomes, due to risk of bias and imprecision. There was no evidence of a difference in physician-assessed signs after six weeks (MD -2.00, 95% CI -8.41 to 4.41; 1 trial, 46 participants; scale: 0 to 108), or patient-reported itch after six weeks (MD 0.3, 95% CI -1.07 to 1.67; 1 trial, 46 participants; scale: 0 to 10). Two split-body trials (20 participants, 40 sides) also measured these outcomes, using different scales at seven to eight weeks; they reported lower scores with NB-UVB. One trial reported HRQoL at six weeks (MD 2.9, 95% CI -9.57 to 15.37; 1 trial, 46 participants; scale: 30 to 150). One split-body trial reported no withdrawals due to adverse events over 12 weeks (13 participants). No trials reported IGA. NB-UVB versus PUVA We judged the evidence for NB-UVB compared to PUVA (8-methoxypsoralen in bath plus UVA) to be very low certainty for all reported outcomes, due to risk of bias and imprecision. There was no evidence of a difference in physician-assessed signs after six weeks (64.1% reduction with NB-UVB versus 65.7% reduction with PUVA; 1 trial, 10 participants, 20 sides). There was no evidence of a difference in marked improvement or complete remission after six weeks (odds ratio (OR) 1.00, 95% CI 0.13 to 7.89; 1 trial, 9/10 participants with both treatments). One split-body trial reported no withdrawals due to adverse events in 10 participants over six weeks. The trials did not report patient-reported symptoms or HRQoL. UVA1 versus PUVA There was very low-certainty evidence, due to serious risk of bias and imprecision, that PUVA (oral 5-methoxypsoralen plus UVA) reduced physician-assessed signs more than UVA1 after three weeks (MD 11.3, 95% CI -0.21 to 22.81; 1 trial, 40 participants; scale: 0 to 103). The trial did not report patient-reported symptoms, IGA, HRQoL, or withdrawals due to adverse events. There were no eligible trials for the key comparisons of UVA1 or PUVA compared with no treatment. Adverse events Reported adverse events included low rates of phototoxic reaction, severe irritation, UV burn, bacterial superinfection, disease exacerbation, and eczema herpeticum.

Authors' conclusions: Compared to placebo or no treatment, NB-UVB may improve physician-rated signs, patient-reported symptoms, and IGA after 12 weeks, without a difference in withdrawal due to adverse events. Evidence for UVA1 compared to NB-UVB or PUVA, and NB-UVB compared to PUVA was very low certainty. More information is needed on the safety and effectiveness of all aspects of phototherapy for treating AE.

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Conflict of interest statement

Emma Axon: has declared that they have no conflict of interest.

Robert J Boyle: reports receiving personal income from several private paediatric allergy practice clinics that include eczema management.

Marijke Brouwer: has declared that they have no conflict of interest.

Robert S Dawe: is a member of the steering group for the Scottish National Managed Clinical Network for Phototherapy (Photonet).

Aaron Drucker: reports receiving compensation from the British Journal of Dermatology (Section Editor and Reviewer; honorarium paid to institution) and the American Academy of Dermatology (guidelines writer; paid to institution). AD reports being interviewed for the Eczema Society of Canada’s educational resource ‘Ask the doctor about...Phototherapy’ (eczemahelp.ca/wp-content/uploads/hcp-resources/ESC_Ask-the-Doctor_Phototherapy_2020.pdf) (no payment received), and he has been a grant reviewer for the National Eczema Association (no payment received).

John Ferguson: reports paid consultancy (personal payment) with Genesis Care, a personal healthcare company with an interest in providing radiotherapy for benign skin disease. This could include the treatment of eczema, particularly in its more chronic forms. The relevance of this work with respect to this Cochrane Review is limited, but Dr Ferguson wishes readers to be aware of the potential conflict. Dr Ferguson reports that a charitable trust in the UK (Photobiology Trust) has given money to Guy's and St Thomas' Hospital Trust (GSTT) towards the purchase of an excimer lamp for people with GSTT. Excimer lamp technology can be used for treating eczema, particularly chronic forms. Dr Ferguson wishes readers to be aware of this potential conflict. JF is a member of the British Photo‐dermatology Group.

Carsten Flohr: has declared that they have no conflict of interest.

Floor Garritsen: reports payment from AbbVie for a presentation about treatment of atopic dermatitis (personal payment); payment from AbbVie for participation on an atopic dermatitis advisory board (personal payment); and payment from the Dutch Society of Dermatology (NVDV) for an atopic dermatitis guideline panel (personal payment).

Louise Gerbens: has declared that they have no conflict of interest.

Jane Harvey: has declared that they have no conflict of interest.

Sally Ibbotson: reports payment from La Roche‐Posay as an invited speaker at a masterclass November 2019 (paid to institution). SI reports personal payment from UCB Pharma for registration fees for the British Association of Dermatologists annual meeting September 2020 (invited speaker), the American Academy of Dermatology VMX virtual meeting April 2021 (invited speaker), and the British Association of Dermatologists annual meeting July 2021. SI reports personal payment from Galderma (UK) for registration, accommodation, and travel expenses to support attendance at the World Congress of Dermatology June 2019 (invited speaker), and registration fees for the European Academy of Dermatology and Venereology virtual congress in October 2020 (invited speaker).

Stephanie J Lax: has declared that they have no conflict of interest.

Jacqueline Limpens: has declared that they have no conflict of interest.

Soudeh Mashayekhi: has declared that they have no conflict of interest.

Annelie H Musters: has declared that they have no conflict of interest.

Laura E Prescott: has declared that they have no conflict of interest.

Phyllis I Spuls: reports consultancies in the past for Sanofi (2017) and AbbVie (2017) (unpaid). PIS received a departmental independent research grant (paid to institution) for her role as Chief Investigator of the systemic and phototherapy atopic eczema registry (TREAT NL) for adults and children; this grant was from a governmental grant office (ZonMW in 2017), LEO Pharma (in 2019), and Novartis (in 2020); other companies have already agreed to sponsor in order to have multi‐sponsoring. PIS reports involvement in performing clinical trials with many pharmaceutical industries that manufacture drugs used for the treatment of psoriasis and atopic dermatitis. Financial compensation for this work is paid to the department or hospital. PIS is one of the main investigators of the SECURE‐AD registry. PIS is currently trying to get funding for a study that could be included in a future update of this review. The funding resource is ZonMW, governmental funding body, Netherlands. Our cohort study TREAT NL registry is not a randomised controlled trial, thus, not eligible.

Clinical referee, Sara Brown: Wellcome Trust Senior Fellow and Professor of Dermatology, University of Edinburgh and NHS Lothian: I trained in dermatology with Nick Reynolds and colleagues from 2000 to 2008. My research is focussed on genetic mechanisms in atopic eczema; I receive grant funding from the Wellcome Trust, British Skin Foundation, EU‐IMI (including multiple pharmaceutical partners), and philanthropic donors. I received a grant from Pfizer for an investigator‐initiated research study 3 years ago. I am a consultant for Sosei Heptares and AbbVie (reimbursement paid to the University of Edinburgh – no personal financial reward). I have received honoraria for speaking about my research at academic conferences and symposia, including the British Association of Dermatologists, British Society for Paediatric Dermatology, Harvard Grand Rounds, and Wellcome Trust Advanced Course.

Figures

1
1
2
2
RoB 2 summary ‐ Physician‐assessed changes in clinical signs
3
3
RoB 2 summary ‐ patient‐reported symptoms
4
4
RoB 2 summary ‐ Investigator Global Assessment (IGA)
5
5
RoB 2 summary ‐ HR QoL
6
6
RoB 2 summary ‐ withdrawals due to adverse events
1.1
1.1. Analysis
Comparison 1: NB‐UVB versus placebo/no treatment, Outcome 1: Physician‐assessed changes in clinical signs (mean reduction in total disease activity score)
1.3
1.3. Analysis
Comparison 1: NB‐UVB versus placebo/no treatment, Outcome 3: Patient‐reported changes in symptoms (number of participants reporting a reduction in VAS for itch; short‐term)
1.5
1.5. Analysis
Comparison 1: NB‐UVB versus placebo/no treatment, Outcome 5: Investigator Global Assessment (number of participants with moderate or greater improvement)
1.7
1.7. Analysis
Comparison 1: NB‐UVB versus placebo/no treatment, Outcome 7: Long‐term control
2.1
2.1. Analysis
Comparison 2: NB‐UVB versus UVA1, Outcome 1: Physician‐assessed changes in clinical signs (SASSAD; short‐term)
2.3
2.3. Analysis
Comparison 2: NB‐UVB versus UVA1, Outcome 3: Patient‐reported changes in symptoms ( VAS for pruritus; short‐term)
2.5
2.5. Analysis
Comparison 2: NB‐UVB versus UVA1, Outcome 5: Health‐related quality of life (German Skindex‐29)
3.2
3.2. Analysis
Comparison 3: NB‐UVB versus PUVA, Outcome 2: Investigator Global Assessment (number of participants with marked improvement or complete remission; short‐term)
4.1
4.1. Analysis
Comparison 4: UVA1 versus PUVA, Outcome 1: Physician‐assessed changes in clinical signs (SCORAD)
5.1
5.1. Analysis
Comparison 5: NB‐UVB versus UVA, Outcome 1: Physician‐assessed changes in the clinical signs (mean reduction in total disease activity score)
5.2
5.2. Analysis
Comparison 5: NB‐UVB versus UVA, Outcome 2: Patient‐reported changes in symptoms (number of participants reporting a reduction in VAS for itch (short‐term)
5.3
5.3. Analysis
Comparison 5: NB‐UVB versus UVA, Outcome 3: Investigator Global Assessments (number of participants with moderate or greater improvement)
5.5
5.5. Analysis
Comparison 5: NB‐UVB versus UVA, Outcome 5: Long‐term control
10.3
10.3. Analysis
Comparison 10: UVB 0.8 MED versus UVB 0.4 MED , Outcome 3: Investigator Global Assessment (short‐term)
11.1
11.1. Analysis
Comparison 11: UVB versus UVA, Outcome 1: Physician‐assessed changes in clinical signs (SCORAD; short‐term)
11.2
11.2. Analysis
Comparison 11: UVB versus UVA, Outcome 2: Investigator Global Assessment (number of participants with excellent improvement; short‐term)
12.3
12.3. Analysis
Comparison 12: BB‐UVB versus placebo, Outcome 3: Investigator Global Assessment (number of participants healed or considerably improved; short‐term)
13.3
13.3. Analysis
Comparison 13: BB‐UVB versus UVA, Outcome 3: Investigator Global Assessment (number of participants considerably improved or healed; short‐term)
14.3
14.3. Analysis
Comparison 14: BB‐UVB versus UVAB, Outcome 3: Investigator Global Assessment (number of participants healed or considerably improved; short‐term)
15.1
15.1. Analysis
Comparison 15: UVA1 versus UVAB, Outcome 1: Physician‐assessed changes in clinical signs (short‐term)
15.4
15.4. Analysis
Comparison 15: UVA1 versus UVAB, Outcome 4: Investigator Global Assessment (IGA) ‐ number of participants who healed or considerably improved (short term)
16.1
16.1. Analysis
Comparison 16: High dose UVA1 versus medium dose UVA1, Outcome 1: Physician‐assessed changes in the clinical signs (short term) ‐ SCORAD
16.3
16.3. Analysis
Comparison 16: High dose UVA1 versus medium dose UVA1, Outcome 3: Subgroup analysis (Skin type): Physician‐assessed changes in the clinical signs (short term) ‐ SCORAD
17.1
17.1. Analysis
Comparison 17: High dose UVA1 versus low dose UVA1, Outcome 1: Physician‐assessed changes in the clinical signs (short term) ‐ SCORAD
18.1
18.1. Analysis
Comparison 18: Medium dose UVA1 versus low dose UVA1, Outcome 1: Physician‐assessed changes in the clinical signs (short term) ‐ SCORAD
19.1
19.1. Analysis
Comparison 19: UVA1 medium dose versus UVA1 medium dose cold‐light, Outcome 1: Physician‐assessed changes in the clinical signs (short term) ‐ SCORAD
20.1
20.1. Analysis
Comparison 20: UVA1 versus topical steroids, Outcome 1: Physician‐assessed changes in the clinical signs (short term) ‐ Costa
21.1
21.1. Analysis
Comparison 21: UVA versus placebo, Outcome 1:  Physician‐assessed changes in the clinical signs ‐ mean reduction in total disease activity score
21.2
21.2. Analysis
Comparison 21: UVA versus placebo, Outcome 2: Patient‐reported changes in symptoms ‐ number of participants reporting a reduction in itch VAS (short term)
21.3
21.3. Analysis
Comparison 21: UVA versus placebo, Outcome 3: Investigator Global Assessment (IGA) ‐ number of participants with moderate or greater improvement
21.5
21.5. Analysis
Comparison 21: UVA versus placebo, Outcome 5: Long‐term control
22.1
22.1. Analysis
Comparison 22: UVAB versus topical steroid, Outcome 1: Physician‐assessed changes in the clinical signs (short term) ‐ Costa
23.1
23.1. Analysis
Comparison 23: UVAB versus cyclosporin, Outcome 1: Physician‐assessed changes in the clinical signs ‐ mean change SCORAD from baseline (short term)
23.2
23.2. Analysis
Comparison 23: UVAB versus cyclosporin, Outcome 2: Patient‐reported changes in symptoms ‐ number of participants reporting very good or good efficacy (short term)
23.3
23.3. Analysis
Comparison 23: UVAB versus cyclosporin, Outcome 3: Health‐related quality of life ‐ Eczema disability index score
23.4
23.4. Analysis
Comparison 23: UVAB versus cyclosporin, Outcome 4: Long‐term control
24.1
24.1. Analysis
Comparison 24: Excimer laser versus topical steroid, Outcome 1: Physician‐assessed changes in the clinical signs ‐ unnamed scale: number of nodules, excoriation, erythema, induration and pruritus (VAS) (short term)
24.3
24.3. Analysis
Comparison 24: Excimer laser versus topical steroid, Outcome 3:  Investigator Global Assessment (IGA) ‐ number of participants cleared or almost clear
24.5
24.5. Analysis
Comparison 24: Excimer laser versus topical steroid, Outcome 5: Long‐term control ‐ physician‐assessed changes in clinical signs
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Jekler 1988b {published data only}
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Jekler 1990 {published data only}
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Jekler 1991b Study 2 {published data only}
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Krutmann 1998 {published data only}
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Legat 2003 {published data only}
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Leone 1998 {published data only}
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Majoie 2009 {published data only}
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Maul 2017 {published data only}
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Pacifico 2019 {published data only}
    1. Pacifico A, Iacovelli P, Damiani G, Ferraro C, Cazzaniga S, Conic RZ, et al. 'High dose' vs. 'medium dose' UVA1 phototherapy in Italian patients with severe atopic dermatitis. Journal of the European Academy of Dermatology and Venereology 2019;33(4):718‐24. - PMC - PubMed
Qayyum 2016 {published data only}
    1. Qayyum S, Asad F, Agrawal R, Khurshid K, Rani Z, Pal SS. Comparison of efficacy and safety of ultraviolet A radiation versus ultraviolet B radiation in atopic dermatitis. Journal of Pakistan Association of Dermatologists 2016;26(3):223‐8.
Reynolds 2001 {published data only}
    1. ISRCTN10725589. Ultraviolet light (UV) therapy for atopic dermatitis: double blind, randomised trial of narrow band (TLO1) versus UVA versus placebo. www.who.int/trialsearch/Trial2.aspx?TrialID=ISRCTN10725589 (accessed before 13 July 2021).
    1. Reynolds N, Franklin V, Gray J, Diffey B, Farr P. Effectiveness of narrow-band UVB (TL01) compared to UVA in adult atopic eczema: a randomized controlled trial. British Journal of Dermatology 1999;141(Suppl 55):20-1.
    1. Reynolds N, Franklin V, Gray J, Diffey B, Farr P. Randomized, controlled trial of narrow-band UVB (TL01) and UVA in adult atopic dermatitis. Journal of Investigative Dermatology 1999;112(4):655. [ABSTRACT NUMBER: 794]
    1. Reynolds NJ, Franklin V, Gray JC, Diffey BL, Farr PM. Narrow-band ultraviolet B and broad-band ultraviolet A phototherapy in adult atopic eczema: a randomised controlled trial. Lancet 2001;357(9273):2012‐6. - PubMed
Selvaag 2005 {published data only}
    1. Selvaag E, Caspersen L, Bech-Thomsen N, Wulf HC. Optimized UVB treatment of atopic dermatitis. A controlled, left-right comparison trial. Annales de Dermatologie et de Venereologie 2002;129(Suppl 1 Pt 2):1S734.
    1. Selvaag E, Caspersen L, Bech-Thomsen N, Wulf HC. Optimized UVB treatment of atopic dermatitis using skin reflectance measurements. A controlled, left-right comparison trial. Acta Dermato-Venereologica 2005;85(2):144‐6. - PubMed
Tzaneva 2001 {published data only}
    1. Tzaneva S, Seeber A, Schwaiger M, Hönigsmann H, Tanew A. High-dose versus medium-dose UVA1 phototherapy for patients with severe generalized atopic dermatitis. Journal of the American Academy of Dermatology 2001;45(4):503‐7. - PubMed
Tzaneva 2010 {published data only}
    1. EUCTR2006-006982-17-AT. UVA 1 therapy versus 5-MOP UVA photochemotherapy for patients with severe generalized atopic dermatitis. www.clinicaltrialsregister.eu/ctr-search/trial/2006-006982-17/AT (first received 14 March 2007).
    1. NCT00533195. Comparison of UVA1 phototherapy versus photochemotherapy for patients with severe generalized atopic dermatitis. clinicaltrials.gov/show/NCT00533195 (first received 21 September 2007).
    1. Tzaneva S, Kittler H, Holzer G, Reljic D, Weber M, Hönigsmann H, et al. 5-methoxypsoralen plus ultraviolet (UV) A is superior to medium-dose UVA1 in the treatment of severe atopic dermatitis: a randomized crossover trial. British Journal of Dermatology 2010;162(3):655‐60. - PubMed
Tzung 2006 {published data only}
    1. Tzung TY, Lin CB, Chen YH, Yang CY. Pimecrolimus and narrowband UVB as monotherapy or combination therapy in children and adolescents with atopic dermatitis. Acta Dermato-Venereologica 2006;86(1):34‐8. - PubMed
Von Kobyletzki 1999a {published data only}
    1. Frietag M, Von Kobyletzki G, Pieck F, Breuckmann F, Hoffmann K, Altmeyer P. Medium-dose UVA1 cold light phototherapy in the treatment of severe atopic dermatitis. Journal of the European Academy of Dermatology and Venereology 1999;12(Suppl 2):S122. - PubMed
    1. Von Kobyletzki G, Freitag M, Herde M, Höxtermann S, Stücker M, Hoffmann K, et al. Phototherapy in severe atopic dermatitis. Comparison between current UVA1 therapy, UVA1 cold light and combined UVA-UVB therapy. Der Hautarzt 1999;50(1):27-33. - PubMed
    1. Von Kobyletzki G, Freitag M, Herde M, Stücker M, Reuther T, Hoffmann K, et al. Comparison between conventional UVA1 phototherapy, UVA1 cold light phototherapy and combined UVA-UVB phototherapy in atopic dermatitis. Journal of the European Academy of Dermatology and Venereology 1998;11(Suppl 2):S318.
    1. Von Kobyletzki G, Pieck C, Hoffmann K, Freitag M, Altmeyer P. Medium dose UVA1 cold light phototherapy in the treatment of severe atopic dermatitis. Dermatology 1999;199(1):83. - PubMed
    1. Von Kobyletzki G, Pieck C, Hoffmann K, Freitag M, Altmeyer P. Medium-dose UVA1 cold-light phototherapy in the treatment of severe atopic dermatitis. Journal of the American Academy of Dermatology 1999;41(6):931‐7. - PubMed
Youssef 2020 {published data only}
    1. PACTR201810815694251. A randomised controlled trial comparing topical glycerol versus narrowband ultraviolet light B in atopic dermatitis: a clinical and bacteriological evaluation. www.who.int/trialsearch/Trial2.aspx?TrialID=PACTR201810815694251 (accessed before 13 July 2021).
    1. Youssef R, Hafez V, Elkholy Y, Mourad A. Glycerol 85% efficacy on atopic skin and its microbiome: a randomized controlled trial with clinical and bacteriological evaluation. Journal of Dermatological Treatment 2020 Jan 6 [Epub ahead of print]. [DOI: 10.1080/09546634.2019.1708246] - DOI - PubMed
Zimmerman 1994 {published data only}
    1. Zimmermann J, Utermann S. Photo-brine therapy in patients with psoriasis and neurodermatitis atopica. Der Hautarzt 1994;45(12):849-53. - PubMed

References to studies excluded from this review

Anonymous 2016 {published data only}
    1. Anonymous. Erratum: Prospective, randomized study on the efficacy and safety of local UV-free blue light treatment of eczema (Dermatology (2016) 232 (496-502) DOI: 10.1159/000448000). Dermatology 2016;232(4):522. - PubMed
Biella 1993 {published data only}
    1. Biella U, Biella B, Huse C. Visible light and infrared versus low-dose UVA in the treatment of atopic eczema in childhood. Aktuelle Dermatologie 1993;19(7):185‐6.
Breuckmann 2003 {published data only}
    1. Breuckmann F, Kobyletzki G, Avermaete A, Kreuter A, Altmeyer P, Gambichler T. Mast cells in atopic dermatitis: resistance against medium-dose UVA1 phototherapy? Dermatology 2003;207(3):334-6. - PubMed
Collins 1995 {published data only}
    1. Collins P, Ferguson J. Narrowband (TL-01) UVB air-conditioned phototherapy for atopic eczema in children . British Journal of Dermatology 1995;133(4):653-67. - PubMed
Dittmar 1999 {published data only}
    1. Dittmar HC, Pflieger D, Schempp CM, Schöpf E, Simon JC. Comparison of balneophototherapy and UVA/B mono-phototherapy in patients with subacute atopic dermatitis. Der Hautarzt 1999;50(9):649‐53. - PubMed
Edstrom 2010 {published data only}
    1. Edstrom DW, Linder J, Wennersten G, Brismar K, Ros AM. Phototherapy with ultraviolet radiation: a study of hormone parameters and psychological effects. Journal of the European Academy of Dermatology and Venereology 2010;24(4):403-9. - PubMed
Falk 1985 {published data only}
    1. Falk ES. UV-light therapies in atopic dermatitis. Photo-Dermatology 1985;2(4):241‐6. - PubMed
Gambichler 2000 {published data only}
    1. Gambichler T, Kuster W, Kreuter A, Altmeyer P, Hoffmann K. Balneophototherapy — combined treatment of psoriasis vulgaris and atopic dermatitis with salt water baths and artificial ultraviolet radiation . Journal of the European Academy of Dermatology and Venereology 2000;14(5):425-8. - PubMed
Grabbe 1996 {published data only}
    1. Grabbe J, Welker P, Humke S, Grewe M, Schopf E, Henz BM, et al. High-dose ultraviolet A1 (UVA1), but not UVA/UVB therapy, decreases IgE-binding cells in lesional skin of patients with atopic eczema. Journal of Investigative Dermatology 1996;107(3):419-22. - PubMed
Hjerppe 2001 {published data only}
    1. Hjerppe M, Hasan T, Saksala I, Reunala T. Narrow-band UVB treatment in atopic dermatitis. Acta Dermato-Venereologica 2001;81(6):439‐40. - PubMed
Jekler 1990 {published data only}
    1. Jekler J, Diffey B, Larkö O. Ultraviolet radiation dosimetry in phototherapy for atopic dermatitis. Journal of the American Academy of Dermatology 1990;23(1):49‐51. - PubMed
Jekler 1990a {published data only}
    1. Jekler J, Larko O. The effect of ultraviolet radiation with peaks at 300 nm and 350 nm in the treatment of atopic dermatitis. Photodermatology, Photoimmunology & Photomedicine 1990;7(4):169‐72. - PubMed
JPRN‐UMIN000018462 {published data only}
    1. JPRN-UMIN000018462. Efficacy study of long-wave ultraviolet light therapy with LED for the skin disease. www.who.int/trialsearch/Trial2.aspx?TrialID=JPRN-UMIN000018462 (accessed before 13 July 2021).
Keemss 2016 {published data only}
    1. Keemss K, Pfaff SC, Born M, Liebmann J, Merk HF, Felbert V. Prospective, randomized study on the efficacy and safety of local UV-free blue light treatment of eczema. Dermatology 2016;232(4):496‐502. - PubMed
    1. NCT02002871. Blue light for treating eczema. clinicaltrials.gov/show/NCT02002871 (first received 6 December 2013).
Kowalzick 1994 {published data only}
    1. Kowalzick L, Kleinheinz A, Weichenthal M, Neuber K, Kohler I, Grosch J, et al. Effects of medium-dose UV-A1 on clinical course and serum levels of sICAM-1,sELAM-1 and ECP in severe atopic eczema. Journal of Investigative Dermatology 1994;103(3):410. [ABSTRACT NUMBER: 82]
Kowalzick 1995 {published data only}
    1. Kowalzick L, Kleinheinz A, Weichenthal M, Neuber K, Kohler I, Grosch J, et al. Low dose versus medium dose UV-A1 treatment in severe atopic eczema. Acta Dermato-Venereologica 1995;75(1):43‐5. - PubMed
Krutmann 1991 {published data only}
    1. Krutmann J, Czech W, Diepgen T, Niedner R, Kapp A, Schopf E. High dose UVA1 therapy in the treatment of patients with atopic dermatitis. Journal of Investigative Dermatology 1991;96(4):568. [ABSTRACT NUMBER: 223] - PubMed
Lajevardl 2015 {published data only}
    1. Lajevardl V, Ghiasl M, Hejazl P, Ansarl M, Akbarl Z, Shakibl H, et al. The effect of narrow band UVB on serum levels of folate: trial on patients with dermatologic disorders. Iranian Journal of Dermatology 2015;18(71):36-7.
Legat 2017 {published data only}
    1. Legat FJ, Hofer A, Gruber-Wackernagel A, Quehenberger F, Waltner K, Wolf P. Both narrowband-UVB and broadband UVB are equally effective in reducing itch in chronic pruritus patients. Acta Dermato-Venereologica 2017;97(8):1056‐7.
Midelfart 1985 {published data only}
    1. Midelfart K, Stenvold SE, Volden G. Combined UVB and UVA phototherapy of atopic eczema. Dermatologica 1985;171(2):95‐8. - PubMed
Morison 1978 {published data only}
    1. Morison WL, Parrish J, Fitzpatrick TB. Oral psoralen photochemotherapy of atopic eczema. British Journal of Dermatology 1978;98(1):25‐30. - PubMed
NCT00129415 {published data only}
    1. NCT00129415. Ultraviolet (UVA and UVB) light therapy in the treatment of inflammatory skin conditions. ClinicalTrials.gov/show/NCT00129415 (first received 11 August 2005).
NCT01402414 {published data only}
    1. NCT01402414. Narrow-band (NB)-UVB vs. Bath-PUVA and NB-UVB plus salt water baths in atopic dermatitis. ClinicalTrials.gov/show/NCT01402414 (first received 26 July 2011).
NCT03083730 {published data only}
    1. NCT03083730. Impact of narrowband UVB phototherapy on systemic inflammation in patients with atopic dermatitis. ClinicalTrials.gov/show/NCT03083730 (first received 20 March 2017).
NCT03402412 {published data only}
    1. NCT03402412. Atopic dermatitis: early gene expression changes as predictors of therapeutic response to narrow-band UVB treatment. ClinicalTrials.gov/show/NCT03402412 (first received 18 January 2018).
NCT04444726 {published data only}
    1. NCT04444726. Phototherpy versus tapwater iontophoresis for management of atopic dermatitis in children, randomized clinical trial. clinicaltrials.gov/show/NCT04444726 (first received 23 June 2020).
Pasic 1996 {published data only}
    1. Pasic A, Lipozencic J, Milavec-Puretic V, Murat-Susic S. Ultraviolet light in the treatment of atopic dermatitis. Acta Dermatovenerologica Croatica 1996;4(2):59-64.
Salo 1983 {published data only}
    1. Salo O, Lassus A, Juvakoski T, Kanerva L, Lauharanta J. Treatment of atopic dermatitis and seborrheic dermatitis with selective UV-phototherapy and PUVA. A comparative study. Dermatologische Monatsschrift 1983;169(6):371‐5. - PubMed
Schiffner 2002 {published data only}
    1. Schiffner R, Schiffner-Rohe J, Landthaler M, Stolz W. How large is the loss of effectiveness of a treatment procedure between "theory" and "practice"? Evaluating health economics basic data within the scope of a trial model of ambulatory synchronous balenophototherapy of atopic eczema. Der Hautarzt 2002;53(1):22-9. - PubMed
Shephard 1996 {published data only}
    1. Shephard SE, Schregenberger N, Dummer R, Panizzon R. Comparison of two forms of local PUVA therapy: bath-PUVA versus topical meladinine lotion. Dermatology 1996;193(2):162. - PubMed
Snellman 2000 {published data only}
    1. Snellman E, Rantanen T, Sundell J. Cumulative UV radiation dose and outcome in clinical practice: effectiveness of trioxsalen bath PUVA with minimal UVA exposure. Photodermatology Photoimmunology & Photomedicine 2000;16(5):207-10. - PubMed
Valkova 2004 {published data only}
    1. Valkova S, Velkova A. UVA/UVB phototherapy for atopic dermatitis revisited. Journal of Dermatological Treatment 2004;15(4):239‐44. - PubMed

References to studies awaiting assessment

Hannuksela 1985 {published data only}
    1. Hannuksela M, Karvonen J, Husa M, Jokela R, Katajamäki L, Leppisaari M. Ultraviolet light therapy in atopic dermatitis. Acta Dermato-Venereologica 1985;114:137-9. - PubMed
Kim 2012 {published data only}
    1. Kim HK, Park MK, Park KY, Kim MN, Oh G, Seo SH. Clinical Study of StoneTouch® far-infrared device on atopic dermatitis. Korean Journal of Dermatology 2012;50(10):874‐9.
Potapenko 2000 {published data only}
    1. Potapenko A, Butov Y, Levinzon E, Mamedov I, Kyagova A, Nikonenko B, et al. Treatment of eczema with photooxidized psoralen. British Journal of Dermatology 2000;143(Suppl 57):35.
Pullman 1985 {published data only}
    1. Pullmann H, Möres E, Reinbach S. Infrared and UVA rays on human skin and their effectiveness in treating endogenous eczema [Infrarot- und UVA-Strahlen auf die menschliche Haut und ihre Wirksamkeit bei der Behandlung des endogenen Ekzems]. Zeitschrift fur Hautkrankheiten 1985;60:171-7. - PubMed

References to ongoing studies

ACTRN12620000546954 {published data only}
    1. ACTRN12620000546954. Comparing the effect of narrowband ultraviolet B (UVB) therapy to therapy with natural sunlight and an amino acid lecithin cream on dermatologic symptoms. www.who.int/trialsearch/Trial2.aspx?TrialID=ACTRN12620000546954 (accessed before 13 July 2021).
Droitcourt 2019 {published data only}
    1. Droitcourt C, Barbarot S, Maruani A, Darrieux L, Misery L, Brenaut E, et al, Groupe de Recherche sur l'Eczema Atopique de la Societe Francaise de Dermatologie. A new phototherapy regimen during winter as an add-on therapy, coupled with oral vitamin D supplementation, for the long-term control of atopic dermatitis: study protocol for a multicentre, randomized, crossover, pragmatic trial — the PRADA trial. Trials 2019;20(1):184. - PMC - PubMed
    1. EUCTR2015-000881-73-FR. PRAgmatic trial, Multicentre, cross-over, evaluating in patients with atopic dermatitis the long-term control effectiveness of new phototherapy regimen during winter, in supplement of standard topical treatments, with oral vitamin D supplementation or not. www.clinicaltrialsregister.eu/ctr-search/trial/2015-000881-73/FR (first received 29 July 2015).
    1. NCT02537509. PRAgmatic Trial in atopic dermatitis testing long-term control effectiveness of new phototherapy regimen during winter coupled with oral vitamin D supplementation vs. placebo. ClinicalTrials.gov/show/NCT02537509 (first received 1 September 2015).
Kromer 2019 {published data only}
    1. Kromer C, Nuhnen VP, Pfutzner W, Pfeiffer S, Laubach HJ, Boehncke WH, et al. Treatment of atopic dermatitis using a full-body blue light device (AD-Blue): protocol of a randomized controlled trial. JMIR Research Protocols 2019;8(1):e11911. - PMC - PubMed
    1. NCT03085303. Treatment of atopic dermatitis by a full-body blue light device (AD-Blue). ClinicalTrials.gov/show/NCT03085303 (first received 21 March 2017).
NCT02915146 {published data only}
    1. NCT02915146. Narrowband ultraviolet B versus narrowband ultraviolet B plus ultraviolet A1 for atopic eczema. ClinicalTrials.gov/show/NCT02915146 (first received 26 September 2016).

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