UVA-1 phototherapy for the management of atopic dermatitis:
a large retrospective study conducted in a low-middle income
ıa F. Ord
, Claudia M. Arenas
, and Juan G. Chalela
Department of Dermatology, Hospital
Militar Central, Universidad Militar Nueva
Granada, Bogota, Colombia, and
on Santa Fe, Bogot
ıa F. Ord
nez Rubiano, MD
Department of Dermatology
Hospital Militar Central
Universidad Militar Nueva Granada
Transversal 3 # 49 – 02
Background Medium-dose ultraviolet light A – 1 (UVA-1) phototherapy, given in short
courses, has shown efﬁcacy in atopic dermatitis ﬂares; little is known about its use,
efﬁcacy, and side effects in prolonged exposure used in the chronic disease despite its
Methods A descriptive retrospective study was conducted; convenience sampling of
patients with atopic dermatitis treated with UVA-1 phototherapy was made; evaluation of
clinical response by SCORAD, adverse effects, and protocols used in each patient were
Results Patients exposed to UVA-1 phototherapy showed a decrease in the SCORAD (30.1
points) – total cumulative dose-dependent (P < 0.0001) – regardless of multiple variables
studied. There were low rates of relapse and adverse effects. The most frequent doses were
30 and 60 J/cm
, three times per week; patients had similar clinical responses and adverse
effects in these groups independent of the other variables studied (P = 0.057).
Conclusion UVA-1 phototherapy can be an alternative for patients with severe atopic
dermatitis even at lower doses than those described in other series (30 J/cm
) and not
only for acute ﬂares. Cumulative total dose is a variable that affects the clinical response
directly. Large prospective studies are needed.
Atopic dermatitis (AD) affects almost 25% of children and 2–3%
of adults in the world.
Multiple therapies have been used in the
disease including topical (emollients, steroids, calcineurin inhibi-
tors) and systemic (cyclosporine A, methotrexate, mycopheno-
late mofetil, azathioprine, and phototherapy).
Phototherapy with ultraviolet light B or A (UVB or UVA) has
been used in the disease.
UVA-1 phototherapy (UVA-1) con-
sists of light in the spectrum of 240–400 nm, and its mechanism
of action is thought to be related with T and B lymphocyte apop-
tosis, less production of interleukins (IL): IL-5, IL-13, and IL-31,
inhibition of calcineurin phosphatase, and decrease on antigen
presentation by Langerhans cells.
It has been used since
1992 when it was ﬁrst described for acute exacerbations of
UVA-1 has been studied mainly in acute ﬂares, and little
is known about its role in chronic and prolonged therapy.
Studies of phototherapy for AD have been summarized in three
systematic reviews. Brieﬂy, UVA-1 has been studied in moderate
and severe disease. Scarce data are known about its use in
infancy and pregnancy; the response is faster with UVA-1 than
with UVA-UVB in ﬂares; UVA-1 is more effective for ﬂares com-
pared with broad band-UVB, UVA-UVB, and topical steroids;
UVA-1 and narrow band-UVB are equally effective for ﬂares; and
ﬁnally, high (130 J/cm
), medium (50 J/cm
), and low (10 J/cm
doses have been studied, the former equally effective as medium
and the last less than the medium-dose regimen.
A retrospective observational study was conducted including
patients treated between January 2005 and December 2015 at a
tertiary care hospital and a phototherapy center in Bogot
Colombia. Three authors, throughout 2016, carried out data col-
lection. The ethics committee of the hospital approved this study.
All medical records (MR) of patients diagnosed with atopic
dermatitis (Eichenﬁeld et al., 2003 criteria were used
received treatment with UVA-1 were susceptible for eligibility;
incomplete MR were excluded.
Variables studied included gender, age, previous treatment
(topical and systemic), initial condition (SCORAD), concomitant
treatment (topical and systemic), per day dose (J/cm
quency (days in the week), treatment time (weeks), cumulative
), initial and ﬁnal clinical condition (SCORAD),
response to treatment (difference between initial and ﬁnal
SCORAD), adverse effects (AE), and relapse (3 months). With
ª 2018 The International Society of Dermatology International Journal of Dermatology 2018, 57, 799–803