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 resp ond well to conventional therapy. In the present prospective randomized tri al, 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-UV B 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 wi th combined UVA-UVB discontinued therapy course before finishing treatment protocol because skin status did not improve or even deteriorated.In the ot her patients treated over a period of th ree weeks, skin status improved si gnificantly 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 o f the SCORAD-Score (UVA1 group from 68,6+/-SD 10,9 to 29,8+/-SD 7,1 and UVA 1 cold light group from 72,5+/-SD 13,4 to 23,8+/-SD 11,6; p<0,05 each).In t he 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 sh owed a prolonged therapy benefit as compared to UVA-UVB treated patients. P lasma levels of eosinophil cationic protein and soluble interleukin-2 recep tor significantly decreased under UVA1 phototherapy but not under UVA-UVB t herapy. Compared to conventional UVA1 phototherapy, UVA1 cold light phototh erapy showed advantages due to the absence of potentially proinflammatory e ffects based on temperature-induced increase of skin blood flow (quantified by Laser doppler scanning) and increased sweat production (determined by t he patient using a visual analog scale).