nach oben

Archives of Dermatological Research

Erschienen in:

01.03.2009 | Review Article

Management of atopic dermatitis using photo(chemo)therapy

verfasst von: Thilo Gambichler

Erschienen in: Archives of Dermatological Research | Ausgabe 3/2009

Einloggen, um Zugang zu erhalten

Abstract

The conclusions that may be drawn by interpreting the current literature on the efficacy of photo(chemo)therapy in the treatment of atopic dermatitis (AD) are limited by several factors including publication bias, small sample sizes, high variability of parameters used in different studies, and in particular the lack of randomized controlled trials comparing different photo(chemo)therapeutic modalities. The newer ultraviolet (UV) modalities, such as medium-dose UVA1 and narrowband (NB) UVB, with a high output and a narrow emission spectrum may be considered the probably most efficacious regimens for treating acute and chronic AD, respectively, in particular when compared to conventional broadband UV regimens. There are no prospective trials on AD patients comparing NB UVB and UVA1 with more complex regimens such as heliotherapy, balneophototherapy, psoralen plus UVA (PUVA), and extracorporeal photophoresis. Support for the role of the aforementioned regimens in the treatment of AD is generally weaker than for the newer modalities including medium-dose UVA1 and NB UVB. When photo(chemo)therapy is considered for AD patients, its use is very much dedicated by the cost-effectiveness, availability, and the practicality of attending the clinic several times a week.

Abeck D, Schmidt T, Fesq H, Strom K, Mempel M, Brockow K, Ring J (2000) Long-term efficacy of medium-dose UVA1 phototherapy in atopic dermatitis. J Am Acad Dermatol 42:254–257. doi:10.1016/S0190-9622(00)90134-8 PubMedCrossRef

Atherton DJ, Carabott F, Glover MT, Hawk JL (1988) The role of psoralen photochemotherapy (PUVA) in the treatment of severe atopic eczema in adolescents. Br J Dermatol 118:791–795. doi:10.1111/j.1365-2133.1988.tb02597.x PubMedCrossRef

Autio P, Komulainen P, Larni HM (2002) Heliotherapy in atopic dermatitis: a prospective study on climatotherapy using the SCORAD index. Acta Derm Venereol 82:436–440. doi:10.1080/000155502762064575 PubMedCrossRef

Collins P, Ferguson J (1995) Narrowband (TL-01) UVB air-conditioned phototherapy for atopic eczema in children. Br J Dermatol 133:653–667. doi:10.1111/j.1365-2133.1995.tb02725.x PubMedCrossRef

Dawe RS (2003) Ultraviolet A1 phototherapy. Br J Dermatol 148:626–637. doi:10.1046/j.1365-2133.2003.05261.x PubMedCrossRef

De Kort WJ, van Weelden H (2000) Bath psoralen-ultraviolet A therapy in atopic eczema. J Eur Acad Dermatol Venereol 14:172–174. doi:10.1046/j.1468-3083.2000.00067.x PubMedCrossRef

Der-Petrossian M, Seeber A, Hönigsmann H, Tanew A (2000) Half-side comparison study on the efficacy of 8-methoxypsoralen bath-PUVA versus narrow-band ultraviolet B phototherapy in patients with severe chronic atopic dermatitis. Br J Dermatol 142:39–43. doi:10.1046/j.1365-2133.2000.03239.x PubMedCrossRef

Dittmar HC, Pflieger D, Schempp CM, Schöpf E (1999) Comparison of balneophototherapy and UVA/B mono-phototherapy in patients with subacute atopic dermatitis. Hautarzt 50:649–653. doi:10.1007/s001050050975 PubMedCrossRef

Gambichler T (2007) Balneophototherapy for psoriasis using saltwater baths and UV-B irradiation, revisited. Arch Dermatol 143:647–649. doi:10.1001/archderm.143.5.647 PubMedCrossRef

10.

Gambichler T, Küster W, Kreuter A, Altmeyer P, Hoffmann K (2000) Balneophototherapy—combined treatment of psoriasis vulgaris and atopic dermatitis with salt water baths and artificial ultraviolet radiation. J Eur Acad Dermatol Venereol 14:425–428. doi:10.1046/j.1468-3083.2000.00102-4.x PubMedCrossRef

11.

Gambichler T, Breuckmann F, Boms S, Altmeyer P, Kreuter A (2005) Narrowband UVB phototherapy in skin conditions beyond psoriasis. J Am Acad Dermatol 52:660–670. doi:10.1016/j.jaad.2004.08.047 PubMedCrossRef

12.

Gambichler T, Othlinghaus N, Tomi NS, Holland-Letz T, Boms S, Skrygan M, Altmeyer P, Kreuter A (2008) Medium-dose ultraviolet (UV) A1 versus narrowband UVB phototherapy in atopic eczema: a randomised crossover study. Br J Dermatol. doi:10.1111/j.1365-2133.2008.08984.x

13.

George SA, Bilsland DJ, Johnson BE, Ferguson J (1993) Narrow-band (TL-01) UVB air-conditioned phototherapy for chronic severe adult atopic dermatitis. Br J Dermatol 128:49–56. doi:10.1111/j.1365-2133.1993.tb00147.x PubMedCrossRef

14.

Hannuksela M, Karvonen J, Husa M, Jokela R, Katajamäki L, Leppisaari M (1985) Ultraviolet light therapy in atopic dermatitis. Acta Derm Venereol Suppl (Stockh) 114:137–139

15.

Harari M, Shani J, Seidl V, Hristakieva E (2000) Climatotherapy of atopic dermatitis at the Dead Sea: demographic evaluation and cost-effectiveness. Int J Dermatol 39:59–69. doi:10.1046/j.1365-4362.2000.00840.x PubMedCrossRef

16.

Hjierpe M, Hasan T, Salsala I, Reunala T (2001) Narrow-band UVB treatment in atopic dermatitis. Acta Derm Venereol 81:439–440. doi:10.1080/000155501317208462 CrossRef

17.

Horio T (1998) Skin disorders that improve by exposure to sunlight. Clin Dermatol 16:59–65. doi:10.1016/S0738-081X(97)00170-3 PubMedCrossRef

18.

Hudson-Peacock MJ, Diffey BL, Farr PM (1996) Narrow-band UVB phototherapy for severe atopic dermatitis. Br J Dermatol 135:332. doi:10.1111/j.1365-2133.1996.tb01179.x PubMedCrossRef

19.

Jekler J, Larkö O (1990) The effect of ultraviolet radiation with peaks at 300 nm and 350 nm in the treatment of atopic dermatitis. Photodermatol Photoimmunol Photomed 7:169–172PubMed

20.

Jekler J, Larkö O (1990) Combined UVA-UVB versus UVB phototherapy for atopic dermatitis: a paired-comparison study. J Am Acad Dermatol 22:49–53. doi:10.1016/0190-9622(90)70006-4 PubMedCrossRef

21.

Jekler J, Larkö O (1991) Phototherapy for atopic dermatitis with ultraviolet A (UVA), low-dose UVB and combined UVA and UVB: two paired-comparison studies. Photodermatol Photoimmunol Photomed 8:151–156PubMed

22.

Katagiri K, Arakawa S, Hatano Y, Fujiwara S (2008) Tolerogenic antigen-presenting cells successfully inhibit atopic dermatitis-like skin lesion induced by repeated epicutaneous exposure to ovalbumin. Arch Dermatol Res 300:583–593PubMedCrossRef

23.

Kowalzick L, Kleinheinz A, Weichenthal M, Neuber K, Köhler I, Grosch J, Lungwitz G, Seegeberg C, Ring J (1995) Low dose versus medium dose UV-A1 treatment in severe atopic eczema. Acta Derm Venereol 75:43–45PubMed

24.

Krutmann J (2000) Phototherapy for atopic dermatitis. Clin Exp Dermatol 25:552–558. doi:10.1046/j.1365-2230.2000.00700.x PubMedCrossRef

25.

Krutmann J, Czech W, Diepgen T, Niedner R, Kapp A, Schöpf E (1992) High-dose UVA1 therapy in the treatment of patients with atopic dermatitis. J Am Acad Dermatol 26:225–230. doi:10.1016/0190-9622(92)70031-A PubMedCrossRef

26.

Krutmann J, Diepgen TL, Luger TA, Grabbe S, Meffert H, Sönnichsen N, Czech W, Kapp A, Stege H, Grewe M, Schöpf E (1998) High-dose UVA1 therapy for atopic dermatitis: results of a multicenter trial. J Am Acad Dermatol 38:589–593. doi:10.1016/S0190-9622(98)70123-9 PubMedCrossRef

27.

Larkö O (1996) Phototherapy of eczema. Photodermatol Photoimmunol Photomed 12:91–94PubMed

28.

Lee E, Koo J, Berger T (2005) UVB phototherapy and skin cancer risk: a review of the literature. Int J Dermatol 44:355–360. doi:10.1111/j.1365-4632.2004.02186.x PubMedCrossRef

29.

Legat FJ, Hofer A, Brabek E, Quehenberger F, Kerl H, Wolf P (2003) Narrowband UV-B vs medium-dose UV-A1 phototherapy in chronic atopic dermatitis. Arch Dermatol 139:223–224. doi:10.1001/archderm.139.2.223 PubMedCrossRef

30.

Majoie IM, Oldhoff JM, van Weelden H, Laaper-Ertmann M, Bousema MT, Sigurdsson V, Knol EF, Bruijnzeel-Koomen CA, de Bruin-Weller MS (2009) Narrowband ultraviolet B and medium-dose ultraviolet A1 are equally effective in the treatment of moderate to severe atopic dermatitis. J Am Acad Dermatol 60:77–84PubMedCrossRef

31.

Meduri NB, Vandergriff T, Rasmussen H, Jacobe H (2007) Phototherapy in the management of atopic dermatitis: a systematic review. Photodermatol Photoimmunol Photomed 23:106–112. doi:10.1111/j.1600-0781.2007.00291.x PubMedCrossRef

32.

Midelfart K, Stenvold SE, Volden G (1985) Combined UVB and UVA phototherapy of atopic eczema. Dermatologica 171:95–98PubMedCrossRef

33.

Mori H, Yamanaka K, Matsuo K, Kurokawa I, Yasutomi Y, Mizutani H (2008) Administration of Ag85B showed therapeutic effects to Th2-type cytokine-mediated acute phase atopic dermatitis by inducing regulatory T cells. Arch Dermatol Res (Epub ahead of print)

34.

Polderman MCA, Wintzen M, le Cessie S, Pavel S (2005) UVA-1 cold light therapy in the treatment of atopic dermatitis: 61 patients treated in the Leiden University Medical Center. Photodermatol Photoimmunol Photomed 21:93–96. doi:10.1111/j.1600-0781.2005.00150.x PubMedCrossRef

35.

Prinz B, Michelsen S, Pfeiffer C, Plewig G (1999) Long-term application of extracorporeal photochemotherapy in severe atopic dermatitis. J Am Acad Dermatol 40:577–582. doi:10.1016/S0190-9622(99)70440-8 PubMedCrossRef

36.

Radenhausen M, Michelsen S, Plewig G, Bechara FG, Altmeyer P, Hoffmann K (2004) Bicentre experience in the treatment of severe generalised atopic dermatitis with extracorporeal photochemotherapy. J Dermatol 31:961–9670PubMed

37.

Reynolds NJ, Franklin V, Gray JC, Diffey BL, Farr PM (2001) Narrow-band ultraviolet B and broad-band ultraviolet A phototherapy in adult atopic eczema: a randomised controlled trial. Lancet 357:2012–2016. doi:10.1016/S0140-6736(00)05114-X PubMedCrossRef

38.

Richter HI, Billmann-Eberwein C, Grewe M, Stege H, Berneburg M, Ruzicka T, Krutmann J (1998) Successful monotherapy of severe and intractable atopic dermatitis by photopheresis. J Am Acad Dermatol 38:585–588. doi:10.1016/S0190-9622(98)70122-7 PubMedCrossRef

39.

Sand M, Bechara FG, Sand D, Radenhausen M, Tomi NS, Altmeyer P, Hoffmann K (2007) Extracorporeal photopheresis as a treatment for patients with severe, refractory atopic dermatitis. Dermatology 215:134–138. doi:10.1159/000104265 PubMedCrossRef

40.

Scheinfeld NS, Tutrone WD, Weinberg JM, DeLeo VA (2003) Phototherapy of atopic dermatitis. Clin Dermatol 21:241–248. doi:10.1016/S0738-081X(02)00364-4 PubMedCrossRef

41.

Schiffner R, Schiffner-Rohe J, Gerstenhauer M, Landthaler M, Hofständer F, Stolz W (2002) Dead Sea treatment—principle for outpatient use in atopic dermatitis: safety and efficacy of synchronous balneophototherapy using narrowband UVB and bathing in Dead Sea salt solution. Eur J Dermatol 12:543–548PubMed

42.

Sheehan MP, Atherton DJ, Norris P, Hawk J (1993) Oral psoralen photochemotherapy in severe childhood atopic eczema: an update. Br J Dermatol 129:431–436. doi:10.1111/j.1365-2133.1993.tb03171.x PubMedCrossRef

43.

Stern RS, PUVA Follow up Study (2001) The risk of melanoma in association with long-term exposure to PUVA. J Am Acad Dermatol 44:755–761. doi:10.1067/mjd.2001.114576 PubMedCrossRef

44.

Tzaneva S, Seeber A, Schwaiger M, Hönigsmann H, Tanew A (2001) High-dose versus medium-dose UVA1 phototherapy for patients with severe generalized atopic dermatitis. J Am Acad Dermatol 45:503–507. doi:10.1067/mjd.2001.114743 PubMedCrossRef

45.

Uetsu N, Horio T (2003) Treatment of persistent severe atopic dermatitis in 113 Japanese patients with oral psoralen photo-chemotherapy. J Dermatol 30:450–457PubMed

46.

Valkova S, Velkova A (2004) UVA/UVB phototherapy for atopic dermatitis revisited. J Dermatolog Treat 15:239–244. doi:10.1080/09546630410035338 PubMedCrossRef

47.

von Kobyletzki G, Pieck C, Hoffmann K, Freitag M, Altmeyer P (1999) Medium-dose UVA1 cold-light phototherapy in the treatment of severe atopic dermatitis. J Am Acad Dermatol 41:931–937. doi:10.1016/S0190-9622(99)70249-5 CrossRef

48.

Weischer M, Blum A, Eberhard F, Röcken M, Berneburg M (2004) No evidence for increased skin cancer risk in psoriasis patients treated with broadband or narrowband UVB phototherapy: a first retrospective study. Acta Derm Venereol 84:370–374. doi:10.1080/00015550410026948 PubMedCrossRef

49.

Yoshiike T, Aikawa Y, Sindhvananda J, Ogawa H (1993) A proposed guideline for psoralen photochemotherapy (PUVA) with atopic dermatitis: successful therapeutic effect on severe and intractable cases. J Dermatol Sci 5:50–53. doi:10.1016/0923-1811(93)90105-X PubMedCrossRef

50.

Zimmermann J, Utermann S (1994) Photosoletherapie bei Patienten mit Psoriasis und Neurodermitis atopica. Hautarzt 45:849–853. doi:10.1007/s001050050184 PubMedCrossRef

Titel: Management of atopic dermatitis using photo(chemo)therapy
verfasst von: Thilo Gambichler
Publikationsdatum: 01.03.2009
Verlag: Springer-Verlag
Erschienen in: Archives of Dermatological Research / Ausgabe 3/2009
Print ISSN: 0340-3696
Elektronische ISSN: 1432-069X
DOI: https://doi.org/10.1007/s00403-008-0923-5

Leitlinien kompakt für die Dermatologie

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Dermatologie

Riesenzellarteriitis: 15% der Patienten sind von okkulter Form betroffen

16.05.2024 Riesenzellarteriitis Nachrichten

In einer retrospektiven Untersuchung haben Forschende aus Belgien und den Niederlanden die okkulte Form der Riesenzellarteriitis genauer unter die Lupe genommen. In puncto Therapie und Rezidivraten stellten sie keinen sehr großen Unterschied zu Erkrankten mit kranialen Symptomen fest.

Betalaktam-Allergie: praxisnahes Vorgehen beim Delabeling

16.05.2024 Pädiatrische Allergologie Nachrichten

Die große Mehrheit der vermeintlichen Penicillinallergien sind keine. Da das „Etikett“ Betalaktam-Allergie oft schon in der Kindheit erworben wird, kann ein frühzeitiges Delabeling lebenslange Vorteile bringen. Ein Team von Pädiaterinnen und Pädiatern aus Kanada stellt vor, wie sie dabei vorgehen.

Isotretinoin: Risiko für schwere Laboranomalien „marginal erhöht“

08.05.2024 Akne Nachrichten

Die Aknetherapie mit Isotretinoin kann einen Anstieg von Leberenzymen und Blutfetten verursachen. Das Risiko für schwere Störungen ist laut einer Forschungsgruppe der Universität Lübeck aber nur marginal erhöht und auf einen engen Zeitraum konzentriert.

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Update Dermatologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2009

Density and proportions of the epidermal T cell population in human sun-exposed skin differ from those in sun-protected skin: preliminary immunohistochemical study

Transgenic expression of S100A2 in hairless mouse skin enhances Cxcl13 mRNA in response to solar-simulated radiation

6-Benzylaminopurine stimulates melanogenesis via cAMP-independent activation of protein kinase A

Ultraviolet A irradiation of the eye induces immunomodulation of skin and intestine in mice via hypothalomo–pituitary–adrenal pathways

The expression of differentiation markers in aquaporin-3 deficient epidermis