From the Guidelines
Ultraviolet (UV) light therapy is considered a confirmed and established line of management for eczema, particularly for moderate to severe cases that don't respond adequately to topical treatments. This therapy, also called phototherapy, typically involves narrowband UVB (NB-UVB) radiation, which is the most commonly used form due to its effectiveness and relatively low risk profile, as supported by a recent study 1. Treatment regimens generally involve 2-3 sessions per week for 6-12 weeks, with each session lasting seconds to minutes depending on skin type and response. The duration increases gradually to avoid burns. For implementation, patients need to attend specialized dermatology clinics equipped with phototherapy units, wear protective goggles during treatment, and shield sensitive areas not affected by eczema.
UV therapy works by suppressing the overactive immune response in the skin, reducing inflammation, and decreasing the proliferation of skin cells involved in eczema flares. It also has antimicrobial effects that can help manage secondary infections. While effective, UV therapy requires commitment to regular sessions, may cause side effects like redness or burning, and carries a small long-term risk of skin aging and skin cancer, making it important to discuss the risk-benefit ratio with a dermatologist before starting treatment, as noted in a study from the Journal of the American Academy of Dermatology 1.
Some key points to consider when using UV therapy for eczema management include:
- Accessibility, as most regimens require treatments 2 to 3 times per week for 10-14 weeks, which can be a substantial time commitment for patients 1
- Insurance coverage, which can be variable and may require substantial co-pays per phototherapy session, making the cost prohibitive for many patients 1
- The potential for home UVB phototherapy units to increase accessibility, although studies on the efficacy and safety of home phototherapy units for people with atopic dermatitis are limited 1
- The importance of patient training and clinician supervision when using home phototherapy units to ensure safe and effective treatment.
Overall, UV therapy is a valuable treatment option for patients with moderate to severe eczema, and its benefits and risks should be carefully considered and discussed with a dermatologist before starting treatment, as recommended by recent guidelines 1.
From the Research
Role of UV Rays in Eczema Management
- UV rays are considered a treatment option for eczema, with narrow-band ultraviolet B (NB-UVB) phototherapy being an effective adjunctive treatment for moderate to severe atopic eczema 2.
- A study comparing NB-UVB, UVA, and visible light phototherapy found that NB-UVB was effective in reducing total disease activity and extent of disease in patients with moderate to severe atopic eczema 2.
- Another study found that NB-UVB may improve physician-rated signs, patient-reported symptoms, and Investigator Global Assessment (IGA) after 12 weeks, without a difference in withdrawal due to adverse events 3.
Comparison of UV-Based Phototherapies
- NB-UVB phototherapy is usually the primary choice for treating eczema, while psoralen-UVA (PUVA) photochemotherapy is often used when NB-UVB fails or in specific indications 4.
- A study comparing local narrowband UVB phototherapy with paint-PUVA in patients with chronic hand eczema found that both treatments were effective, with no significant difference in clinical response between the two treatment modalities 5.
- The evidence for UVA1 compared to NB-UVB or PUVA, and NB-UVB compared to PUVA was very low certainty, highlighting the need for more research in this area 3.
Mechanisms of Action and Emerging Molecular Targets
- UV-based phototherapy works by regulating the inflammatory component and inducing apoptosis of pathogenic cells, resulting in a complex network of simultaneous events that transform the microenvironment of UV-exposed skin 6.
- The key effects of phototherapy, including proapoptotic, immunomodulatory, antipruritic, antifibrotic, propigmentary, and pro-prebiotic, promote clinical improvement in various skin diseases, including psoriasis, atopic dermatitis, and vitiligo 6.