Narrow-band ultraviolet B and broad-band ultraviolet A phototherapy in adult atopic eczema: a randomised controlled trial

doi:10.1016/S0140-6736(00)05114-X

The Lancet

Volume 357, Issue 9273, 23 June 2001, Pages 2012-2016

https://doi.org/10.1016/S0140-6736(00)05114-X Get rights and content

Summary

Background

Narrow-band ultraviolet B (UVB) is an effective treatment for psoriasis, and open studies suggest that this phototherapy might improve atopic eczema. We did a randomised controlled trial to compare narrow-band UVB, UVA, and visible light phototherapy as second-line, adjunctive treatments in adult patients with moderate to severe atopic eczema.

Methods

Phototherapy was administered twice a week for 12 weeks. 26 patients were randomly assigned narrow-band UVB, 24 were assigned UVA, and 23 visible fluorescent light. The primary endpoints were change in total disease activity (sum of scores at six body sites) and change in extent of disease after 24 treatments compared with baseline. Data were analysed by the method of summary measures.

Findings

13 patients withdrew or were excluded from analysis. Mean reductions in total disease activity over 24 treatments in patients who received narrow-band UVB and UVA, respectively, were 9·4 points (95% CI 3·6 to 15·2) and 4·4 points (−1·0 to 9·8) more than in patients who received visible light. Mean reductions in extent of disease after 24 treatments with narrow-band UVB and UVA were 6·7% (1·5 to 11·9) and −1·0% (−5·3 to 3·3) compared with visible light. A small proportion of patients developed erythema after phototherapy or had a flare in their eczema sufficient to withdraw from treatment.

Interpretation

Narrow-band UVB is an effective adjunctive treatment for moderate to severe atopic eczema, and the treatment is well tolerated by most patients.

Introduction

Atopic eczema is a common skin disease that usually arises in childhood, runs a relapsing and remitting course, frequently persists into adult life, and can result in significant morbidity. Emollients and topical steroids form the basis of treatment, but response is often incomplete. Second-line therapies such as ciclosporin and Chinese herbal medicine have been shown through randomised controlled trials to be effective.1, 2 However, there are concerns about safety.3, 4 Patients with atopic eczema often report improvement after sun exposure, and results from a series of studies suggest that ultraviolet B (UVB; wavelength 280-315 nm), ultraviolet A (UVA; 315–400 nm), and combined UVA-UVB are effective treatments.5, 6, 7 However, most of these studies involved patients with mild disease, few studies were randomised, and investigators did not always mask assessors so that they were unaware of treatment assignment.⁵ Furthermore, by contrast with clinical practice, topical therapy was limited to mild steroids and emollients.⁵ Findings of a randomised controlled trial⁸ have shown that high dose UVA1 (340–400 nm) is as effective as moderately potent topical steroids for acute, severe atopic eczema. However, special irradiation devices, which are only available in specialist centres, are needed for this type of treatment.

A narrow-band (311 nm) UVB fluorescent lamp (TL01, Philips, Utrecht, Netherlands) has been developed that is effective in the treatment of psoriasis.9, 10 Results of open, uncontrolled studies11, 12 suggest that narrow-band UVB phototherapy might improve chronic, severe adult atopic eczema. We designed a randomised, controlled, double-blind trial to assess efficacy of narrowband UVB and broad-band UVA (as used, for example, in psoralen photochemotherapy) as second-line, adjunctive treatment in adult patients with moderate to severe atopic eczema. These UV sources are widely available in dermatology practice.

Section snippets

Patients

Between April, 1995, and November, 1997, we enrolled patients, aged 16–65 years, who had been referred to a specialist assessment clinic at the Royal Victoria Infirmary, Newcastle upon Tyne, UK, by family physicians or dermatologists. Diagnosis of atopic eczema was based on the UK modification of Hanifin and Rajka's¹³ diagnostic criteria. We excluded patients if they had received narrow-band UVB or psoralen photochemotherapy, used sunbeds, or received systemic steroids, ciclosporin,

Results

Figure 1 shows the trial profile, and table 1 shows baseline characteristics. 73 patients fulfilled entry criteria and were allocated to a group. We excluded from analysis four patients who withdrew before treatment began. Thus, 69 patients commenced phototherapy. Patients in the narrow-band UVB group and in the broad-band UVA group received median cumulative doses of 24-8 J/cm² (range 2·8–32·2) and 315 J/cm² (15–345), respectively. Median cumulative exposure time to visible fluorescent lamps

Discussion

Our study results indicate that narrow-band UVB phototherapy is an effective adjunctive treatment in moderate-to-severe adult atopic eczema. Narrow-band UVB was better than placebo at reducing total disease activity, extent of disease, physician global assessment, and patient scoring of itch on a visual analogue scale. Furthermore, improvements in physician global assessment and total disease activity seen during treatment were maintained 3 months after phototherapy had been stopped. However,

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ArticlesNarrow-band ultraviolet B and broad-band ultraviolet A phototherapy in adult atopic eczema: a randomised controlled trial

Summary

Background

Methods

Findings

Interpretation

Introduction

Section snippets

Patients

Results

Discussion

Lancet

Lancet

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Investig Dermatol Symp Proc

J Invest Dermatol

J Invest Dermatol

Lancet

Traditional Chinese medicine for eczema: seemingly effective but caution must prevail

BMJ

Renal function after 10 years' treatment with cyclosporin for psoriasis

Br JDermatol

UVB phototherapy of atopic dermatitis

Br J Dermatol

UVA solarium versus UVB phototherapy of atopic dermatitis: a paired-comparison study

Br J Dermatol

A new development in UVB phototherapy of psoriasis

Br J Dermatol

Articles
Narrow-band ultraviolet B and broad-band ultraviolet A phototherapy in adult atopic eczema: a randomised controlled trial