Phototherapy of atopic dermatitis:: comparison between conventional UVA1 phototherapy, UVA1 cold light phototherapy and combined UVA-UVB phototherapy

Severe atopic dermatitis, especially when involving the face, does not respond well to conventional therapy. In the present prospective randomized trial, we compared therapeutic efficiency of medium-dose UVA1,medium-dose cold light UVA1 (15 treatment courses with 50 J/cm(2) each) and combined UVA-UVB phototherapy. Four (13,3%) of 30 UVA1 treated patients, one (3,4%) of 30 UVA1 cold light treated patients and th ree (30%) of 10 patients treated with combined UVA-UVB discontinued therapy course before finishing treatment protocol because skin status did not improve or even deteriorated.In the other patients treated over a period of th ree weeks, skin status improved significantly or even cleared completely in 80,8% of UVA1 treated and in 89,7% of UVA1 cold light treated patients resulting in a significant decrease of the SCORAD-Score (UVA1 group from 68,6+/-SD 10,9 to 29,8+/-SD 7,1 and UVA1 cold light group from 72,5+/-SD 13,4 to 23,8+/-SD 11,6; p<0,05 each).In the UVB-UVB treated group,the SCORAD-Score also decreased (from 71,0+/-SD 9,4 to 41,6+/-10,5), but significantly less than in both UVA1 treated groups (p<0,05 each). Four weeks after completing therapy UVA1 treated patients showed a prolonged therapy benefit as compared to UVA-UVB treated patients. Plasma levels of eosinophil cationic protein and soluble interleukin-2 receptor significantly decreased under UVA1 phototherapy but not under UVA-UVB therapy. Compared to conventional UVA1 phototherapy, UVA1 cold light phototherapy showed advantages due to the absence of potentially proinflammatory effects based on temperature-induced increase of skin blood flow (quantified by Laser doppler scanning) and increased sweat production (determined by the patient using a visual analog scale).