Dogra Sunil, Mahajan Rahul
Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Dermatol Venereol Leprol. 2015 Jan-Feb;81(1):10-5. doi: 10.4103/0378-6323.148557.
The aim of these guidelines is to review the available published literature regarding the effectiveness of phototherapy and photochemotherapy in atopic dermatitis and put forward recommendations regarding their use in atopic dermatitis.
A literature search was performed to collect data from PubMed, EMBASE, and the Cochrane Library published till March 2014. Keywords used were "phototherapy", "photochemotherapy", "NB-UVB", "BBUVB", "PUVA", "UVA1", "atopic dermatitis", and "atopic eczema". Systematic reviews, meta-analysis, national guidelines, randomized controlled trials, prospective open label studies, and retrospective case series in English literature mentioning use of above-mentioned keywords were reviewed.
Six hundred and eighty eight studies were evaluated, 38 of which fulfilled the criteria for inclusion in the guidelines.
Both UV1 and narrow-band UVB are effective in significantly decreasing the eczema severity although UV1 may be preferred in acute flares and narrow-band UVB in chronic eczema, especially in adults (Level of evidence 1+, Grade of recommendation A). Among various doses of UVA1, medium dose UVA1 may be preferred over others as its efficacy is similar to high dose and better than low dose UVA1 phototherapy. Narrow-band UVB is preferred to broad-band UVB (Level of evidence 1+, Grade of recommendation A). Medium-dose UVA1 is similar in efficacy to narrow-band UVB (Level of evidence 1+, Grade of recommendation A). In children, despite its efficacy, narrow-band UVB phototherapy should be used only as a second line therapy due to its potential for long-term adverse effects (Level of evidence 2+, Grade of recommendation B).
本指南旨在回顾已发表的关于光疗和光化学疗法治疗特应性皮炎有效性的文献，并就其在特应性皮炎中的应用提出建议。
进行文献检索，以收集截至2014年3月发表于PubMed、EMBASE和Cochrane图书馆的数据。使用的关键词为“光疗”“光化学疗法”“窄谱中波紫外线（NB - UVB）”“宽谱中波紫外线（BBUVB）”“补骨脂素紫外线A疗法（PUVA）”“长波紫外线1（UVA1）”“特应性皮炎”和“特应性湿疹”。对英文文献中提及使用上述关键词的系统评价、荟萃分析、国家指南、随机对照试验、前瞻性开放标签研究和回顾性病例系列进行了综述。
共评估了688项研究，其中38项符合纳入本指南的标准。
紫外线1（UV1）和窄谱中波紫外线（NB - UVB）均能有效显著降低湿疹严重程度，尽管在急性发作期UV1可能更受青睐，而在慢性湿疹中NB - UVB更受青睐，尤其是在成人中（证据级别1 +，推荐等级A）。在各种剂量的UVA1中，中等剂量UVA1可能比其他剂量更受青睐，因为其疗效与高剂量相似且优于低剂量UVA1光疗。窄谱中波紫外线（NB - UVB）优于宽谱中波紫外线（BBUVB）（证据级别1 +推荐等级A）。中等剂量UVA1的疗效与窄谱中波紫外线（NB - UVB）相似（证据级别1 +，推荐等级A）。在儿童中，尽管窄谱中波紫外线（NB - UVB）光疗有效，但由于其潜在的长期不良反应，应仅作为二线治疗使用（证据级别2 +，推荐等级B）。
