Phototherapy Proven Effective for Asian Pediatric Atopic Dermatitis, Study Shows

This prospective study, led by Shi Yun Chia of the Department of Pediatric Medicine, KK Women's and Children's Hospital, Singapore, gives a different perspective on this modality of treatment. The research indicates clearly that phototherapy is a realizable second-line therapy, especially in comparison with oral systemic immunosuppressants.

This study of patients younger than 18 years who were treated with phototherapy for atopic dermatitis at KK Women's and Children's Hospital from January 2017 to December 2020. Subjects were identified by the hospital's phototherapy database, and clinical photographs before and after treatment were captured. Disease severity was independently rated by pediatric dermatologists using either a 5-point IGA or EASI. Data regarding demographic information, duration of disease, and associated medical conditions were also recorded. Duration of treatment, phototherapy modalities, number of sessions, maximum dose, response to therapy and complications if any were accurately noted and recorded.

The study used narrowband ultraviolet B (NBUVB) in a phototherapy cabinet, with initial doses ranging from 250 to 400 mJ/cm² based on Fitzpatrick skin types II–VI. Dose increases of 10%–20% were applied based on erythema responses. Some patients received a combination of UVA and NBUVB, starting with 1 J/cm² UVA and 100 mJ/cm² NBUVB, regardless of skin type. Photochemotherapy (psoralen + UVA, or PUVA) was employed for severe hand and foot dermatitis, with initial UVA doses of 1 J/cm² and increments of 0.5–1 J/cm².

• The study included 62 children aged 4–16 years, with 60% male and 40% female participants. Most had moderate to severe atopic dermatitis.

•60.3% had initial body surface area (BSA) involvement of 31%–60%, and 13.8% had BSA involvement of 61%–90%.

• Mean reductions in EASI scores were 11.4 for NBUVB and 7.9 for combined UVA and NBUVB phototherapy.

• Common side effects included pruritus, xerosis, erythema, and pain. Two patients receiving PUVA developed post-UVA burns and subsequently withdrew.

• Treatment outcomes were successful in 56.9% of patients, and significant improvements in IGA and EASI scores were noted.

• In 86.2%, compliance was good; in 12%, fair; and in 3.4%, lost to follow-up.

Phototherapy offers a lot of advantages in the management of moderate-to-severe atopic dermatitis in children within the Asian population. Researchers highly recommend it as a second-line treatment, proving its efficacy with easily manageable side effects in comparison with oral systemic immunosuppressants.

Reference:

Chia SY, Chee EEC, Wee LWY, Koh MJA. Phototherapy for the treatment of atopic dermatitis in Singaporean children and adolescents. Photodermatol Photoimmunol Photomed. 2024; 40:e12986. doi:10.1111/phpp.12986.