High-dose versus medium-dose UVA1 phototherapy for patients with severe generalized atopic dermatitis

Background. Several studies have demonstrated the efficacy of UVA1 (340-400 nm) phototherapy for patients with severe atopic dermatitis. However, the optimum treatment dose has yet to be determined. Although in seminal invest igations high UVA1 doses were used, comparable results were reported in rec ent studies with a medium-dose regimen. Objective: Our purpose was to compare the efficacy of high-dose with medium -dose UVA1 phototherapy for patients with severe generalized atopic dermati tis. Methods. Ten adult patients with a median baseline SCORAD score of 67 -were enrolled in an investigatorblinded, bilateral comparison study. Treatment was given 5 times weekly over a period of 3 weeks on an outpatient basis, I rradiation was performed by exposing one half of the patient's body to high -dose UVA1 (less than or equal to 130 J/cm(2)), and the contralateral body side received only half that dose. The clinical response was assessed after 5, 10, and 15 treatments. After completion of the study, patients were fol lowed up for 6 months to evaluate the duration of clinical improvement. Results. All but one patient responded favorably to treatment. High-dose UV A1 led to a decrease of the median SCORAD score by 33.4% after 1 week, 38.4 % after 2 weeks, and 34.7% after 3 weeks. The respective values for the med ium-dose regimen were 29.7%, 36.4%, and 28.2%. The difference in efficacy b etween the two dosages remained below the level of significance at all time points. Relapses occurred after a median of 4 weeks. Time of onset and sev erity of relapse were the same for both doses. Conclusion: Our data support previous uncontrolled observations that medium -dose UVA1 is comparably as effective as high-dose treatment for patients w ith severe generalized atopic dermatitis. Irrespective of the dose regimen, follow-up examinations revealed early relapse in the majority of patients.