الفهرس 
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Abstract
Atopic dermatitis is a chronic pruritic skin disease that can be classified into three phases : infantile phase, childhood phase and adulthood phase. Treatment of AD is usually symptomatic, and the standard treatment consisting of topical corticosteroids is sometimes disappointing and it is afflicted with well known side effects.(136)
Several alternative modes of therapy including phototherapy have emerged. The phototherapeutic approach which gained the greatest attention has been photochemotherapy, its results were impressive but it is a treatment with potential long-term side effects.(241, 242)
The aim of the present study was directed to compare the effects of other phototherapeutic modalities.
This study was carried out on 36 adult AD patients divided into 3 main groups:
Group A : Ten patients were treated using BB-UVA with an initial dose of 7-11 J/cm2 on one side of the body, and visible light as a placebo on the other side.
Group B : it was further subdivided into 2 subgroups :
group B1 : Ten patients were treated using BB-UVB with an initial dose of 0.4 M.E.D. on one side of the body, and visible light on the other side.
group B2 : Six patients were treated using NB-UVB with an initial dose of 0.7 M.E.D. on one side of the body, and visible light on the other side.
Group AB : Ten patients were treated using both BB-UVA and BB-UVB on one side of the body, and visible light on the other side.
Treatment for each group was given three times weekly for a maximum of 8 weeks. Bacterial culture samples were collected from lesional and non lesional skin of the UV-treated side to compare bacterial counts before, after 4 weeks and at the end of the treatment course. No other treatment affecting the results of the study was allowed at least 2 weeks prior to the start of phototherapy and during the study period.
The results showed improvement at the UV-treated side in the four groups with statistically significant differences compared with the pre-study assessment and with change percentages at the placebo sides whether in pruritus score or objective SCORAD score and its 2 components: dermatitis extent and intensity score.
After interpretation of the results, the following conclusions were obtained:
- Patients treated with NB-UVB achieved best results and greatest improvement, followed by patients treated with UVAB, although the difference in pruritus score changes was the only statistically significant difference between the 2 groups.
- They are followed by patients treated with BB-UVA then patients treated with BB-UVB although the difference in dermatitis extent changes was the only statistically significant difference between the last 2 groups.
- Patients treated with NBUVB or UVAB showed statistically significant differences versus those who were treated with BB-UVA or BB-UVB.
- The side effects encountered were xerosis with no statistically significant differences between the 4 groups, and first degree burn which affected 40% of the patients treated with BB-UVB compared with non of patients treated with NB-UVB, and percentage of developing first degree burn was higher in the patients treated with UVAB than patients treated with UVA alone.
- BB-UVB and NB-UVB achieved significant reduction of total bacterial counts on lesional skin after 4 weeks, but no type of UVR could achieve it on non lesional skin till the end of the study. The effect on S. aureus was more pronounced and BB-UVB and NB-UVB achieved significant reduction of its counts after 8 weeks on non lesional skin, and on leisonal skin they achieved it after 4 weeks with further significant reduction under the effect of NB-UVB at the end of the study.
- UVA alone could not achieve any significant reduction of bacterial counts, and the differences between the effects of UVAB and that of BB-UVB alone were not statistically significant.
- NB-UVB appears to be a promising treatment for chronic AD as regard its effectiveness and low side effects. It is ideal for mild to moderate cases and can also be used effectively in severe cases especially as an adjunct treatment with other therapies such as topical steroids to reduce their potency or cumulative doses.
- UVAB can be an effective alternative therapy, and if UVA is used alone it is recommended to use antimicrobial treatment in conjunction with it.
- BB-UVB devices which are the most available phototherapeutic devices can be used, especially for localized mild-moderate AD lesions, but the dose must be adapted for each patient, and the initial dose is recommended to be 0.4 MED.
- Phototherapy is recommended to be done in an air conditioned cubicle or room to reduce the risk of sweating and exacerbation of pruritus.
- A maintenance treatment schedule must be considered to avoid relapse of dermatitis.
- It is recommended to study the effect of combination of NB-UVB and UVA irradiation to treat patients with severe AD.
- Further studies are needed to evaluated the long term side effects of the different modalities of phototherapy.