Phototherapy for atopic dermatitis. 2016

Dorothy L Rodenbeck, and Jonathan I Silverberg, and Nanette B Silverberg
Departments of Dermatology, Preventive Medicine, and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL.

Phototherapy is a second-line treatment for moderate to severe atopic dermatitis (AD) that effectively decreases cutaneous inflammation with minimal or no systemic side effects. Children in grade school, adolescents, and adults may benefit from phototherapy, when they have chronic AD refractory to first-line topical treatments. This review focuses on six approaches for phototherapy in AD: (1) broadband ultraviolet B (UVB), (2) Goeckerman regimen (coal tar + broadband UVB), (3) narrowband UVB, (4) excimer lasers for targeted areas, (5) combination UVA/UVB, and (6) UVA-1. Phototherapy can be very effective in some individuals, but it is limited by inconvenience and adverse effects, including limited access to in-office treatment, difficulty adhering to thrice-weekly schedule, flaring from excessive heat, and increased risk of skin cancer. Dosing regimen and treatment concerns are reviewed.

UI MeSH Term Description Entries
D007641 Keratolytic Agents Agents that soften, separate, and cause desquamation of the cornified epithelium or horny layer of skin. They are used to expose mycelia of infecting fungi or to treat corns, warts, and certain other skin diseases. Desquamating Agents,Skin-Peeling Agents,Agents, Desquamating,Agents, Keratolytic,Agents, Skin-Peeling,Skin Peeling Agents
D010778 Photochemotherapy Therapy using oral or topical photosensitizing agents with subsequent exposure to light. Blue Light Photodynamic Therapy,Photodynamic Therapy,Red Light PDT,Red Light Photodynamic Therapy,Therapy, Photodynamic,Light PDT, Red,PDT, Red Light,Photochemotherapies,Photodynamic Therapies,Therapies, Photodynamic
D003033 Coal Tar A by-product of the destructive distillation of coal used as a topical antieczematic. It is an antipruritic and keratoplastic agent used also in the treatment of psoriasis and other skin conditions. Occupational exposure to soots, tars, and certain mineral oils is known to be carcinogenic according to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985) (Merck Index, 11th ed). Clinitar,Estar,Tar, Coal
D003876 Dermatitis, Atopic A chronic inflammatory genetically determined disease of the skin marked by increased ability to form reagin (IgE), with increased susceptibility to allergic rhinitis and asthma, and hereditary disposition to a lowered threshold for pruritus. It is manifested by lichenification, excoriation, and crusting, mainly on the flexural surfaces of the elbow and knee. In infants it is known as infantile eczema. Eczema, Atopic,Eczema, Infantile,Neurodermatitis, Atopic,Neurodermatitis, Disseminated,Atopic Dermatitis,Atopic Eczema,Atopic Neurodermatitis,Disseminated Neurodermatitis,Infantile Eczema
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014467 Ultraviolet Therapy The use of ultraviolet electromagnetic radiation in the treatment of disease, usually of the skin. This is the part of the sun's spectrum that causes sunburn and tanning. Ultraviolet A, used in PUVA, is closer to visible light and less damaging than Ultraviolet B, which is ionizing. Actinotherapy,Therapy, Ultraviolet,Actinotherapies,Therapies, Ultraviolet,Ultraviolet Therapies
D017410 Practice Guidelines as Topic Works about directions or principles presenting current or future rules of policy for assisting health care practitioners in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. Clinical Guidelines as Topic,Best Practices,Best Practice
D054018 Lasers, Excimer Gas lasers with excited dimers (i.e., excimers) as the active medium. The most commonly used are rare gas monohalides (e.g., argon fluoride, xenon chloride). Their principal emission wavelengths are in the ultraviolet range and depend on the monohalide used (e.g., 193 nm for ArF, 308 nm for Xe Cl). These lasers are operated in pulsed and Q-switched modes and used in photoablative decomposition involving actual removal of tissue. (UMDNS, 2005) Argon Fluoride Excimer Lasers,Excimer Lasers,Krypton Chloride Excimer Lasers,Xenon Chloride Excimer Lasers,ArF Excimer Lasers,ArF Lasers,Argon Fluoride Lasers,Excimer Laser,Excimer Lasers, ArF,Excimer Lasers, Argon Fluoride,Excimer Lasers, KrCl,Excimer Lasers, Krypton Chloride,Excimer Lasers, XeCl,Excimer Lasers, Xenon Chloride,KrCl Excimer Lasers,Krypton Chloride Lasers,Lasers, ArF Excimer,Lasers, Argon Fluoride Excimer,Lasers, KrCl,Lasers, Krypton Chloride,Lasers, Krypton Chloride Excimer,Lasers, XeCl Excimer,Lasers, Xenon Chloride,Lasers, Xenon Chloride Excimer,XeCl Lasers,Xenon Chloride Lasers,ArF Excimer Laser,ArF Laser,Argon Fluoride Laser,Chloride Laser, Krypton,Chloride Laser, Xenon,Chloride Lasers, Krypton,Chloride Lasers, Xenon,Excimer Laser, ArF,Excimer Laser, KrCl,Excimer Laser, XeCl,Fluoride Laser, Argon,Fluoride Lasers, Argon,KrCl Excimer Laser,KrCl Laser,KrCl Lasers,Krypton Chloride Laser,Laser, ArF,Laser, ArF Excimer,Laser, Argon Fluoride,Laser, Excimer,Laser, KrCl,Laser, KrCl Excimer,Laser, Krypton Chloride,Laser, XeCl,Laser, XeCl Excimer,Laser, Xenon Chloride,Lasers, ArF,Lasers, Argon Fluoride,Lasers, KrCl Excimer,Lasers, XeCl,XeCl Excimer Laser,XeCl Excimer Lasers,XeCl Laser,Xenon Chloride Laser

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