Phototherapy in Dermatology: Modern Methods of Treating Skin Diseases

Introduction: Light as a Method of Skin Treatment

Phototherapy, or light therapy, is one of the key methods in the arsenal of modern dermatology, offering an effective solution for patients with various chronic skin diseases. This approach uses controlled exposure to ultraviolet light to reduce inflammation and improve skin condition. Phototherapy is especially relevant for those who do not respond to standard topical treatments, such as corticosteroids [4, 5].

What is Phototherapy and How Does it Work?

Phototherapy is based on the use of different spectrums of ultraviolet (UV) light that penetrate the skin and exert immunomodulatory and anti-inflammatory effects. The goal is to slow down excessive skin cell growth and suppress inflammatory processes. This makes it a valuable tool for treating conditions such as atopic dermatitis (eczema) and psoriasis.

Main Methods of Phototherapy in Dermatology

Several types of phototherapy are used in dermatological practice, each with its own characteristics and indications:

• Narrowband Ultraviolet B (NB-UVB) Therapy: Considered one of the most effective methods for treating chronic atopic dermatitis [5]. It uses a narrow spectrum of UV-B radiation (around 311 nm), which minimizes side effects associated with the broader UV-B spectrum.
• Ultraviolet A1 (UVA1) Therapy: Recognized as effective for treating acute atopic dermatitis [5]. UVA1 penetrates deeper into the skin, affecting immune cells in the dermis and reducing inflammation.
• Photochemotherapy (PUVA): This method combines exposure to UV-A light with the administration of the photosensitizing drug psoralen. Psoralen increases the skin's sensitivity to UV-A radiation, enhancing the therapeutic effect. PUVA is used for more severe forms of skin diseases, but requires closer monitoring due to potential side effects.

Phototherapy in the Treatment of Skin Diseases: Focus on Eczema

Atopic dermatitis (AD), also known as atopic eczema, is a chronic inflammatory skin disease that significantly impairs patients' quality of life [4, 5, 6]. When topical treatments such as corticosteroids or calcineurin inhibitors prove insufficient or are poorly tolerated, phototherapy becomes an effective second-line therapy [4, 5].

Phototherapy can be used either alone or in combination with systemic medications, such as corticosteroids, in the most severe cases [5]. It helps reduce itching, inflammation, and improve overall skin condition. Chronic hand and foot eczema is also a common and difficult-to-treat condition, and phototherapy can be part of a comprehensive management approach [1].

Integration and Combined Approaches

The effectiveness of phototherapy can be enhanced when combined with other treatments:

• Balneophototherapy: This is a combination of balneotherapy (treatment with thermal waters) and phototherapy. Thermal waters with anti-inflammatory properties, combined with UV light, significantly enhance the therapeutic effect, especially in psoriasis and atopic dermatitis [3]. Well-known balneophototherapy centers include the Dead Sea, the La Roche-Posay Thermal Center in France, and the Blue Lagoon in Iceland [3].
• Combination with Topical and Systemic Medications: In cases of moderate-to-severe atopic dermatitis, phototherapy can be integrated into a treatment regimen that includes newer topical agents (e.g., Janus kinase inhibitors or PDE4 inhibitors) or systemic medications [6]. Importantly, each new treatment should be viewed as supplementing or overlapping the previous therapy [1].

The Future of Phototherapy and Conclusion

Phototherapy remains an important and effective treatment method for many dermatological diseases, especially chronic inflammatory conditions such as eczema. Despite its proven efficacy, there are still no unified international guidelines on the optimal use of various forms of phototherapy for atopic dermatitis, indicating the need for further research and protocol development [5]. A comprehensive approach that includes not only pharmacological and physical treatment, but also addressing causative factors, lifestyle modifications, and social support, is the key to successfully managing chronic skin diseases [1].

Sources

1. Management of chronic hand and foot eczema. Australian/New Zealand Clinical Consensus. https://pubmed.ncbi.nlm.nih.gov/32776537/
2. Effect of Terminalia fagifolia mart. extract combined with photobiomodulation on diabetic foot ulcers: protocol for a randomized, blinded clinical trial. https://pubmed.ncbi.nlm.nih.gov/42501111/
3. The use of balneotherapy in dermatology. https://pubmed.ncbi.nlm.nih.gov/29908578/
4. Phototherapy in atopic eczema. https://pubmed.ncbi.nlm.nih.gov/34709669/
5. Safety and efficacy of phototherapy in the treatment of eczema. https://pubmed.ncbi.nlm.nih.gov/29124712/
6. Expert consensus on the management of moderate-to-severe atopic dermatitis in Qatar. https://pubmed.ncbi.nlm.nih.gov/37700510/
7. What's new in the treatment of eczema. https://pubmed.ncbi.nlm.nih.gov/29050445/
8. Paradoxical eruptions to targeted therapy in dermatology: a systematic review and analysis. https://pubmed.ncbi.nlm.nih.gov/33307146/

The information provided in the article is for reference purposes only and cannot replace an in-person consultation with a qualified medical specialist. Always consult a physician for diagnosis and treatment.