The Cochrane database of systematic reviewsOct 28, 2021

Light Treatment for Atopic Eczema

Longevity & Aging Weekly Brief ↗PubMed ↗DOI ↗

Updated Apr 3, 2026

Abstract

A total of 1219 participants across 32 trials were analyzed to evaluate the effects of phototherapy on atopic eczema.

Narrowband ultraviolet B (NB-UVB) may lead to a greater reduction in physician-assessed signs of atopic eczema compared to placebo after 12 weeks of treatment.
There may be an increase in the number of participants reporting reduced itch after 12 weeks of NB-UVB treatment compared to placebo.
The number of participants with moderate to greater global improvement may be higher with NB-UVB than with placebo after 12 weeks.
Evidence comparing NB-UVB to other treatments such as UVA1 and PUVA is assessed as very low certainty, showing no significant differences in outcomes.
Reported adverse events from phototherapy include low rates of phototoxic reactions and severe irritation, indicating potential safety concerns.

Simplified

BACKGROUND: Atopic eczema (AE), also known as atopic dermatitis, is a chronic inflammatory skin condition that causes significant burden. Phototherapy is sometimes used to treat AE when topical treatments, such as corticosteroids, are insufficient or poorly tolerated.

OBJECTIVES: To assess the effects of phototherapy for treating AE.

SEARCH METHODS: We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and ClinicalTrials.gov to January 2021.

SELECTION CRITERIA: We included randomised controlled trials in adults or children with any subtype or severity of clinically diagnosed AE. Eligible comparisons were any type of phototherapy versus other forms of phototherapy or any other treatment, including placebo or no treatment.

DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology. For key findings, we used RoB 2.0 to assess bias, and GRADE to assess certainty of the evidence. Primary outcomes were physician-assessed signs and patient-reported symptoms. Secondary outcomes were Investigator Global Assessment (IGA), health-related quality of life (HRQoL), safety (measured as withdrawals due to adverse events), and long-term control.

MAIN RESULTS: We included 32 trials with 1219 randomised participants, aged 5 to 83 years (mean: 28 years), with an equal number of males and females. Participants were recruited mainly from secondary care dermatology clinics, and study duration was, on average, 13 weeks (range: 10 days to one year). We assessed risk of bias for all key outcomes as having some concerns or high risk, due to missing data, inappropriate analysis, or insufficient information to assess selective reporting. Assessed interventions included: narrowband ultraviolet B (NB-UVB; 13 trials), ultraviolet A1 (UVA1; 6 trials), broadband ultraviolet B (BB-UVB; 5 trials), ultraviolet AB (UVAB; 2 trials), psoralen plus ultraviolet A (PUVA; 2 trials), ultraviolet A (UVA; 1 trial), unspecified ultraviolet B (UVB; 1 trial), full spectrum light (1 trial), Saalmann selective ultraviolet phototherapy (SUP) cabin (1 trial), saltwater bath plus UVB (balneophototherapy; 1 trial), and excimer laser (1 trial). Comparators included placebo, no treatment, another phototherapy, topical treatment, or alternative doses of the same treatment. Results for key comparisons are summarised (for scales, lower scores are better): NB-UVB versus placebo/no treatment There may be a larger reduction in physician-assessed signs with NB-UVB compared to placebo after 12 weeks of treatment (mean difference (MD) -9.4, 95% confidence interval (CI) -3.62 to -15.18; 1 trial, 41 participants; scale: 0 to 90). Two trials reported little difference between NB-UVB and no treatment (37 participants, four to six weeks of treatment); another reported improved signs with NB-UVB versus no treatment (11 participants, nine weeks of treatment). NB-UVB may increase the number of people reporting reduced itch after 12 weeks of treatment compared to placebo (risk ratio (RR) 1.72, 95% CI 1.10 to 2.69; 1 trial, 40 participants). Another trial reported very little difference in itch severity with NB-UVB (25 participants, four weeks of treatment). The number of participants with moderate to greater global improvement may be higher with NB-UVB than placebo after 12 weeks of treatment (RR 2.81, 95% CI 1.10 to 7.17; 1 trial, 41 participants). NB-UVB may not affect rates of withdrawal due to adverse events. No withdrawals were reported in one trial of NB-UVB versus placebo (18 participants, nine weeks of treatment). In two trials of NB-UVB versus no treatment, each reported one withdrawal per group (71 participants, 8 to 12 weeks of treatment). We judged that all reported outcomes were supported with low-certainty evidence, due to risk of bias and imprecision. No trials reported HRQoL. NB-UVB versus UVA1 We judged the evidence for NB-UVB compared to UVA1 to be very low certainty for all outcomes, due to risk of bias and imprecision. There was no evidence of a difference in physician-assessed signs after six weeks (MD -2.00, 95% CI -8.41 to 4.41; 1 trial, 46 participants; scale: 0 to 108), or patient-reported itch after six weeks (MD 0.3, 95% CI -1.07 to 1.67; 1 trial, 46 participants; scale: 0 to 10). Two split-body trials (20 participants, 40 sides) also measured these outcomes, using different scales at seven to eight weeks; they reported lower scores with NB-UVB. One trial reported HRQoL at six weeks (MD 2.9, 95% CI -9.57 to 15.37; 1 trial, 46 participants; scale: 30 to 150). One split-body trial reported no withdrawals due to adverse events over 12 weeks (13 participants). No trials reported IGA. NB-UVB versus PUVA We judged the evidence for NB-UVB compared to PUVA (8-methoxypsoralen in bath plus UVA) to be very low certainty for all reported outcomes, due to risk of bias and imprecision. There was no evidence of a difference in physician-assessed signs after six weeks (64.1% reduction with NB-UVB versus 65.7% reduction with PUVA; 1 trial, 10 participants, 20 sides). There was no evidence of a difference in marked improvement or complete remission after six weeks (odds ratio (OR) 1.00, 95% CI 0.13 to 7.89; 1 trial, 9/10 participants with both treatments). One split-body trial reported no withdrawals due to adverse events in 10 participants over six weeks. The trials did not report patient-reported symptoms or HRQoL. UVA1 versus PUVA There was very low-certainty evidence, due to serious risk of bias and imprecision, that PUVA (oral 5-methoxypsoralen plus UVA) reduced physician-assessed signs more than UVA1 after three weeks (MD 11.3, 95% CI -0.21 to 22.81; 1 trial, 40 participants; scale: 0 to 103). The trial did not report patient-reported symptoms, IGA, HRQoL, or withdrawals due to adverse events. There were no eligible trials for the key comparisons of UVA1 or PUVA compared with no treatment. Adverse events Reported adverse events included low rates of phototoxic reaction, severe irritation, UV burn, bacterial superinfection, disease exacerbation, and eczema herpeticum.

AUTHORS' CONCLUSIONS: Compared to placebo or no treatment, NB-UVB may improve physician-rated signs, patient-reported symptoms, and IGA after 12 weeks, without a difference in withdrawal due to adverse events. Evidence for UVA1 compared to NB-UVB or PUVA, and NB-UVB compared to PUVA was very low certainty. More information is needed on the safety and effectiveness of all aspects of phototherapy for treating AE.

Funding

Competing interests

Emma Axon : has declared that they have no conflict of interest. Robert J Boyle : reports receiving personal income from several private paediatric allergy practice clinics that include eczema management. Marijke Brouwer : has declared that they have no conflict of interest. Robert S Dawe: is a member of the steering group for the Scottish National Managed Clinical Network for Phototherapy (Photonet). Aaron Drucker : reports receiving compensation from the British Journal of Dermatology (Section Editor and Reviewer; honorarium paid to institution) and the American Academy of Dermatology (guidelines writer; paid to institution). AD reports being interviewed for the Eczema Society of Canada’s educational resource ‘Ask the doctor about...Phototherapy’ (eczemahelp.ca/wp-content/uploads/hcp-resources/ESC_Ask-the-Doctor_Phototherapy_2020.pdf) (no payment received), and he has been a grant reviewer for the National Eczema Association (no payment received). John Ferguson: reports paid consultancy (personal payment) with Genesis Care, a personal healthcare company with an interest in providing radiotherapy for benign skin disease. This could include the treatment of eczema, particularly in its more chronic forms. The relevance of this work with respect to this Cochrane Review is limited, but Dr Ferguson wishes readers to be aware of the potential conflict. Dr Ferguson reports that a charitable trust in the UK (Photobiology Trust) has given money to Guy's and St Thomas' Hospital Trust (GSTT) towards the purchase of an excimer lamp for people with GSTT. Excimer lamp technology can be used for treating eczema, particularly chronic forms. Dr Ferguson wishes readers to be aware of this potential conflict. JF is a member of the British Photo‐dermatology Group. Carsten Flohr : has declared that they have no conflict of interest. Floor Garritsen : reports payment from AbbVie for a presentation about treatment of atopic dermatitis (personal payment); payment from AbbVie for participation on an atopic dermatitis advisory board (personal payment); and payment from the Dutch Society of Dermatology (NVDV) for an atopic dermatitis guideline panel (personal payment). Louise Gerbens : has declared that they have no conflict of interest. Jane Harvey : has declared that they have no conflict of interest. Sally Ibbotson: reports payment from La Roche‐Posay as an invited speaker at a masterclass November 2019 (paid to institution). SI reports personal payment from UCB Pharma for registration fees for the British Association of Dermatologists annual meeting September 2020 (invited speaker), the American Academy of Dermatology VMX virtual meeting April 2021 (invited speaker), and the British Association of Dermatologists annual meeting July 2021. SI reports personal payment from Galderma (UK) for registration, accommodation, and travel expenses to support attendance at the World Congress of Dermatology June 2019 (invited speaker), and registration fees for the European Academy of Dermatology and Venereology virtual congress in October 2020 (invited speaker). Stephanie J Lax : has declared that they have no conflict of interest. Jacqueline Limpens : has declared that they have no conflict of interest. Soudeh Mashayekhi : has declared that they have no conflict of interest. Annelie H Musters : has declared that they have no conflict of interest. Laura E Prescott : has declared that they have no conflict of interest. Phyllis I Spuls : reports consultancies in the past for Sanofi (2017) and AbbVie (2017) (unpaid). PIS received a departmental independent research grant (paid to institution) for her role as Chief Investigator of the systemic and phototherapy atopic eczema registry (TREAT NL) for adults and children; this grant was from a governmental grant office (ZonMW in 2017), LEO Pharma (in 2019), and Novartis (in 2020); other companies have already agreed to sponsor in order to have multi‐sponsoring. PIS reports involvement in performing clinical trials with many pharmaceutical industries that manufacture drugs used for the treatment of psoriasis and atopic dermatitis. Financial compensation for this work is paid to the department or hospital. PIS is one of the main investigators of the SECURE‐AD registry. PIS is currently trying to get funding for a study that could be included in a future update of this review. The funding resource is ZonMW, governmental funding body, Netherlands. Our cohort study TREAT NL registry is not a randomised controlled trial, thus, not eligible. Clinical referee, Sara Brown: Wellcome Trust Senior Fellow and Professor of Dermatology, University of Edinburgh and NHS Lothian: I trained in dermatology with Nick Reynolds and colleagues from 2000 to 2008. My research is focussed on genetic mechanisms in atopic eczema; I receive grant funding from the Wellcome Trust, British Skin Foundation, EU‐IMI (including multiple pharmaceutical partners), and philanthropic donors. I received a grant from Pfizer for an investigator‐initiated research study 3 years ago. I am a consultant for Sosei Heptares and AbbVie (reimbursement paid to the University of Edinburgh – no personal financial reward). I have received honoraria for speaking about my research at academic conferences and symposia, including the British Association of Dermatologists, British Society for Paediatric Dermatology, Harvard Grand Rounds, and Wellcome Trust Advanced Course.

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Light Treatment for Atopic Eczema

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