Br J Dermatol 2014 Jan 13;170(1)150-156, S Darné, SN Leech, AE Taylor
Research · January 21, 2014
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- While narrow-band UVB (NBUVB) therapy is sometimes used to treat children with atopic dermatitis, its use is based on limited retrospective data. This prospective cohort study examined NBUVB therapy in patients with moderate to severe atopic dermatitis. The use of NBUVB compared with no treatment led to significant improvement in both objective and subjective measures of severity, including affected surface area at the end of 12 weeks of treatment. Objective measures were still improved at 3 and 6 months post treatment.
- Use of NBUVB is effective in patients with moderate to severe atopic dermatitis and produces durable improvement.
Commentary By: Sharmela Darné MD
When one is seeing a child with moderate to severe eczema in clinic, it is useful to be able to give him or her an expected outcome with phototherapy. In this study, NBUVB resulted in an improvement in objective SASSAD score of 61% in children treated with NBUVB compared with a worsening of 6% in the control cohort. Overall, 40% of children were clear at the end of a 12-week course, and 29% remained clear at 6 months after treatment. These are useful figures to tell parents.
All the children managed the practical aspects of the treatment very well as exposure times are short for this modality; parents could keep talking to them and could see them through a transparent window in the cabinet. The youngest child was just under 4 years of age and had severe eczema. He was able to undertake therapy as he was accompanied by his parent (who was fully clothed and wore a face visor) in the cabinet, with his parent turning him around at half time so that both sides of his body received UV.
Anecdotally, we found that the eczema would improve toward the end of the course of treatment; so, it is worth getting children to complete the full course (24 exposures given twice weekly in this study). In fact, more were clear at the 3-month follow-up; so, maximal improvement is probably seen after the course. Skin cancer risk is a pertinent question when exposing young skin to phototherapy (discussed in the paper). However, it is safer than the alternatives (systemic immunosuppression) in this therapeutically challenging group.