Atopic dermatitis (eczema)

5-methoxypsoralen plus UVA is superior to medium-dose UVA1 in the treatment of severe atopic dermatitis. A randomized crossover trial.

Br J Dermatol. 2009 Sep 21;

Authors: Tzaneva S, Kittler H, Holzer G, Reljic D, Weber M, Hönigsmann H, Tanew A

Background: UVA1 and PUVA are effective treatment options for severe atopic dermatitis, however, their relative efficacy has not been determined yet in a head-to-head study. Objectives: To compare UVA1 and oral 5-methoxypsoralen (5-MOP) plus UVA with respect to efficacy, tolerability and duration of response in patients with severe generalized atopic dermatitis. Methods: 40 patients were included in this randomized observer-blinded crossover trial. The patients either received 15 exposures to medium-dose UVA1 as the first treatment and, in case of relapse, another 15 exposures to 5-MOP plus UVA as the second treatment or vice versa. All patients were followed until 12 months after discontinuation of the last treatment. The SCORAD score was determined by a blinded investigator at baseline, after 10 and 15 treatments each and during the follow-up period. In addition, all adverse events were recorded during the whole study period. Results: 23 patients completed the crossover treatment. Both phototherapies resulted in clinical improvement, however, PUVA reduced the baseline SCORAD score to a significantly greater extent than UVA1 (54.3 +/- 25.7% vs. 37.7 +/- 22.8%; p=0.041). The median length of remission was 4 weeks (interquartile range: 4-11) after discontinuation of UVA1 and 12 weeks (interquartile range: 6-26) after PUVA therapy (p=0.012). Conclusions: PUVA provides a better short- and long-term response than medium-dose UVA1 in patients with severe atopic dermatitis.

PMID: 19769631 [PubMed - as supplied by publisher]