• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
FSL for atopic dermatitis

FSL for atopic dermatitis



Full-Spectrum light for atopic dermatitis issued by " internaional Journal of Dermatology 2010"

Full-Spectrum light for atopic dermatitis issued by " internaional Journal of Dermatology 2010"



Total Views
Views on SlideShare
Embed Views



2 Embeds 12

http://www.linkedin.com 10
https://www.linkedin.com 2


Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
Post Comment
Edit your comment

    FSL for atopic dermatitis FSL for atopic dermatitis Document Transcript

    • doi: 10.1111/j.1365-4632.2010.04663.xReportFull-spectrum light phototherapy for atopic dermatitisHee Jin Byun1, MD, Hye In Lee2, MD, Beomjoon Kim2, MD, PhD, Myeung Nam Kim2, 3 3 3 1MD, PhD, Hyuckki Hong , Yeonshik Choi , Youngchang Jo , Kwang Hyun Cho , MD, PhD 4and Seog-Kyun Mun , MD, PhD1 Department of Dermatology, College of SummaryMedicine, Seoul National University, Background Atopic dermatitis (AD) is a chronic skin disease resulting in a profound deteri-Seoul, 2Department of Dermatology, oration in quality of life. The FSLÒ is a newly developed phototherapy device generatingCollege of Medicine, Chung-Ang full-spectrum light (FSL) with a continuous wavelength (320–5000 nm). This study aimed toUniversity, Seoul, 3Medical IT ResearchCenter, Korea Electronics Technology evaluate the efficacy and safety of FSLÒ phototherapy in AD.Institute, Gyeonggi-do, South Korea, Methods We enrolled 38 patients with moderate to severe AD in this open, randomized,and 4Department of controlled, prospective study. In the FSL-irradiated group (20 patients), irradiation wasOtorhinolaryngology - Head and Neck conducted twice per week for 4 consecutive weeks. In the control group (18 patients), onlySurgery, College of Medicine, Chung- emollient application was allowed. SCORing Atopic Dermatis (SCORAD) values wereAng University, Seoul,Korea obtained at baseline, week 4 and 8. Patients were asked to give subjective assessments ofCorrespondence improvement and laboratory tests including serum eosinophil counts, ECP levels, IgE levelsSeog-Kyun Mun, MD, PHD. and 22 cytokine levels were performed.Department of Otorhinolaryngology- Results In the FSL-irradiated group, the mean SCORAD value decreased significantly afterHead and Neck Surgery 4 weeks of phototherapy and remained reduced for a further 4 weeks after the cessation ofChung-Ang UniversityYongsan Hospital treatment. In the control group, the mean SCORAD value did not change significantly over65-207, Hangangro 3-ka the study period. Patients’ subjective assessments indicated good to excellent responsesYongsan-gu in 75% of the FSL-irradiated group, by contrast with 50% of the control group. The meanSeoul 140-757 values for serum eosinophil counts, IL-4 and IL-5 levels decreased significantly after FLSSouth Korea phototherapy. No serious adverse effects were reported.E-mail: entdoctor@cau.ac.kr Conclusions In this study, we showed that FSLÒ phototherapy can be an effective andFunding: This study was supported by a safe treatment option in AD.research grant from Chung-AngUniversity awarded in 2010.Conflicts of interest: None. At present, mainly 311-nm narrowband UVB (NBUVB),Introduction UVA1 and psoralen with UVA (PUVA) are used.3 In theAtopic dermatitis (AD) is a chronically relapsing skin dis- management of AD, PUVA is thought to be the mostease, characterized by age-related distribution and severe effective and to induce the longest remission periodpruritus, and resulting in a profound deterioration in (£12 weeks4). After PUVA, high- and medium-dose (sin-quality of life. Multiple treatment modalities, including gle-exposure doses of 80–130 J/cm2 and 50–70 J/cm2,topical and systemic immunosuppressants, and photother- respectively) UVA1 and NBUVB are thought to beapy at various wavelengths, have been used in the treat- equally effective.4–9 Combined UVA/UVB has been shownment of AD. However, current therapies are often to be less effective than medium-dose UVA1, and low-unsatisfactory and cannot be used continuously because dose (single-exposure doses of 10 J/cm2) UVA1 has rarelythey carry a risk for adverse effects.1 Therefore, efforts to been effective in AD.4,10 However, conventional photo-develop novel treatment modalities with high levels of therapies have limitations and cannot be used in allefficacy and safety are ongoing. patients. Despite its excellent efficacy, the use of PUVA In 1948, Nexman2 reported that ultraviolet (UV) light has decreased continuously as a result of longterm haz-emitted by a carbon arc lamp significantly improved AD. ards, such as the development of skin cancers, and theSince then, numerous reports have shown that photother- difficulties involved in taking oral medication on a timelyapies are potent modalities for moderate to severe AD. basis and shielding the skin from sunlight for several 1ª 2010 The International Society of Dermatology International Journal of Dermatology 2010
    • 2 Report Full-spectrum light phototherapy for atopic dermatitis Byun et al. days.3,5,10 UVA1 has a rapid onset of action, but fewer Table 1 Demographic patient data than 50% of affected individuals respond to UVA1 treat- ment and the response is usually short-lived.3,10 FSL-irradiated group Control group Natural sunlight itself has also been used for photother- Patients, n 20 18 apy under the designations of ‘‘heliotherapy’’ (after Age, years (mean ± SD) 25.68 ± 7.69 25.63 ± 8.41 Helios, the personification of the sun in Greek mythology) Sex, n (male/female) 8/12 9/9 or climatotherapy. Heliotherapy has been demonstrated to SCORAD (mean ± SD) 47.87 ± 15.45 39.79 ± 9.76 be highly effective in AD. Two-week heliotherapy in the Mean duration of AD, years 11.09 10.95 Canary Islands reduced mean SCORing Atopic Dermatis (SCORAD) values by 70–74% in previous reports, indi- FSL, full-spectrum light; SD, standard deviation; AD, atopic cating a level of efficacy higher than that of PUVA, which dermatitis. has been reported to reduce baseline SCORAD by 54% after 15 exposures.4,11,12 However, heliotherapy can be ranged from 25 to 48 years. The mean SCORAD index at the performed only in specific regions with strong sunlight, beginning of the study was 47.87 points in the FSL-irradiated such as the Canary Islands and the area around the Dead group and 39.79 points in the control group. There was no Sea, and is usually conducted in the form of a ‘‘heliothera- statistically significant difference in baseline SCORAD values py trip’’ organized as a 2- or 3-week tour. Therefore, between the two groups (P = 0.167, Mann–Whitney U-test). All despite its high efficacy, the application of heliotherapy is patients were Korean and had skin of phototypes III or IV. limited as a result of the interruption it causes to daily life Demographic data for the patients are shown in Table 1. and the cost of travel expenses.11,12 Informed consent was obtained from each patient prior to To overcome the limitations of heliotherapy, we used enrollment. the FSLÒ (BMC Co. Ltd, Anyang-si, South Korea) for The FSLÒ phototherapy device generates light on a treatment of AD. The FSLÒ is a newly developed photo- continuous wavelength of 320–5000 nm, from an electrical arc therapy device which generates full-spectrum light (FSL) between two carbon rods (Ark RodsÒ; BMC Co. Ltd) at a on a continuous wavelength spectrum of 320–5000 nm. temperature of >3000 °C. An Ark RodÒ is made of carbon The light profile emitted by the FSLÒ is nearly identical compounds including 16 confidential chemical elements. to that of sunlight except that it omits UVB; it includes A calibrated quartz tungsten halogen lamp (model 63355; UVA, visible light and infrared light. Given the high effi- Newport Corp., Stratford, CT, USA), a monochromator cacy of heliotherapy in AD treatment, we expected that (Cornerstone 260Ô; Newport Corp.) and a digital lock-in FSL phototherapy would also be effective. Phototherapy radiometry system (MerlineÔ; Newport Corp.) were used to devices emitting FSL, like the FSLÒ, have been used make light with a continuous wavelength. A two-color mainly in neuropsychiatric diseases, such as depression photodetector (IGA030-TE2-H; Electro Optical Systems, Inc., and sleep disturbance.13–15 So far, there have been no Phoenixville, PA, USA), a TE-cooler (PS/TC-1; Newport Corp.) reports on the application of FSL devices in AD. and a TE-cooled HgCdZnTe detector (MIR8025Ô; Newport In this study, we aimed to evaluate the efficacy and Corp.) were used as a detection system. safety of FSLÒ phototherapy in patients with moderate to In the FSL-irradiated group, irradiation was performed with severe AD. the FSLÒ phototherapy device twice per week for 4 consecutive weeks, resulting in a total of eight applications of irradiation. We performed a pilot study to determine the appropriate exposure Materials and methods time. From the pilot study results, we concluded that exposures This was an open, randomized, controlled, prospective study. of 20 min are most effective and safe (data not shown). We recruited 38 patients diagnosed with extrinsic AD according Therefore, in each phototherapy session, the anterior side of to previously published definitions,8,9 from August 2007 to July the body was irradiated for 20 min and the posterior side was 2008. Only patients with moderate to severe AD with SCORAD subsequently irradiated for 20 min. The fluence of each index values of >25 were included. The following subjects were irradiation was 530 J/cm2, including 121 J/cm2 of UVA and excluded: patients aged <18 years; patients who had been 409 J/cm2 of visible and infrared light. During the entire study treated with systemic corticosteroid, any type of phototherapy or period, the use of any topical or systemic agents other than the photosensitizing drugs in the 3 months prior to enrollment; designated emollient cream (PhysiogelÒ; Stiefel-Korea Ltd, pregnant or lactating women, and patients with a history of Seoul, South Korea) was disallowed. In the control group, the neoplasm or photosensitive dermatosis. Patients were screened emollient, PhysiogelÒ, was applied twice per day without any to ensure they fulfilled inclusion and exclusion criteria and other treatment. randomly assigned to either the FSL-irradiated group (20 The SCORAD index was used to assess disease severity.10 patients) or to the control group (18 patients). Patient ages SCORAD values in each patient were assessed three times International Journal of Dermatology 2010 ª 2010 The International Society of Dermatology
    • Byun et al. Full-spectrum light phototherapy for atopic dermatitis Reportduring the study period: (i) prior to the beginning of treatment (a)(at baseline); (ii) after 4 weeks of FSL phototherapy (at week4), and (iii) 4 weeks after the cessation of phototherapy (atweek 8). All assessments were performed by the samedermatologist. Patients’ subjective assessments of clinicalimprovement were obtained at week 8, using a 4-point scalewith the following descriptors: ‘‘poor response’’ (0–25%improvement); ‘‘fair response’’ (26–50% improvement); ‘‘goodresponse’’ (51–75% improvement), and ‘‘excellent response’’(76–100% improvement). Laboratory tests were carried out in those patients whoagreed to them. The tests were performed twice, at baselineand at week 8, and included serum eosinophil counts,eosinophil cationic protein (ECP) levels, immunoglobulin E (IgE)levels and levels of 22 human cytokines. Serum cytokine levelswere determined using the Luminex 200 SystemÒ (LuminexCorp., Austin, TX, USA), which uses xMAP technology tocombine sandwich immunoassay and fluorescent bead-basedtechnology, and the Beadlyte Human 22-plex Multi-cytokine (b)Detection SystemÒ (Millipore Corp., Billerica, MA, USA). The 22human cytokines were: interleukin-1a (IL-1a); IL-1b; IL-2; IL-3;IL-4; IL-5; IL-6; IL-7; IL-8; IL-10; p40 subunit of IL-12; p70subunit of IL-12; IL-13; IL-15; GM-CSF (granulocyte-macrophage colony-stimulating factor); interferon-c (IFN-c);tumor necrosis factor-a (TNF-a); eotaxin; monocyte chemotacticprotein-1 (MCP-1); RANTES (regulated upon activation, normalT cell expressed and secreted); macrophage inflammatoryprotein-1a (MIP-1a), and interferon-inducible protein-10 (IP-10). The Wilcoxon signed rank test was used to compare clinicaland laboratory values at baseline and at weeks 4 or 8. P-valuesof < 0.05 were considered statistically significant.ResultsClinical evaluationIn the FSL-irradiated group, the mean SCORAD valuewas 47.87 at baseline and decreased significantly to 36.81at week 4 (reduced by 23.1%; P < 0.01). It reduced fur- Figure 1 (a) Before treatment, several eczematous patchesther to 30.76 at week 8 (reduced by 35.7% from base- with some erosive lesions could be seen on the face. (b) Afterline), 4 weeks after the cessation of treatment (Figs 1 and 2). 4 weeks of full-spectrum light phototherapy, facial lesionsIn the control group, mean SCORAD values did not were significantly improved, leaving only slight erythema andchange significantly during the entire study period (39.79 hyperpigmentationat baseline, 35.39 at week 4, 33.85 at week 8; P = 0.236)(Fig. 2). the control group. Serum ECP and IgE levels were Patients’ subjective assessments are summarized in checked in 18 patients in the FSL-irradiated group and 16Table 2. Good to excellent responses (51–100% improve- patients in the control group. Serum cytokine levels werement) were found in 75% of the FSL-irradiated group, by checked in 13 patients in the FSL-irradiated group and 11contrast with 50% of the control group. patients in the control group. In the FSL-irradiated group, the mean values of serumLaboratory tests eosinophil counts showed a significant decrease at week 8Laboratory tests were performed in patients who con- compared with baseline values, although both weresented to them. Serum eosinophil counts were checked in within normal limits. Mean IL-4 and IL-5 levels also19 patients in the FSL-irradiated group and 17 patients in showed a significant decrease at week 8 compared withª 2010 The International Society of Dermatology International Journal of Dermatology 2010
    • 4 Report Full-spectrum light phototherapy for atopic dermatitis Byun et al. Figure 2 SCORAD index values (mean ± SD) at baseline, at week 4 of phototherapy, and at week 8 (4 weeks after the cessation of phototherapy). Scores in the full-spectrum light (FSL)- irradiated group at weeks 4 and 8, but not in the control group, show a signifi- cant decrease from baseline. *P < 0.01;   P < 0.001 ous reports which used the SCORAD index for evaluating Table 2 Patients’ subjective assessments of clinical improve- ment the efficacy of phototherapy are as follows. Tzaneva et al.4 reported mean reductions in SCORAD values of FSL-irradiated Control 54% (from 62.5 to 28.8) after 15 administrations of group, n (%) group, n (%) PUVA treatment and of 37% (from 63.7 to 40.1) after medium-dose UVA1 treatment. The same group of Excellent (76–100% improvement) 6 (30.0) 2 (11.1) authors also reported that baseline SCORAD was reduced Good (51–75% improvement) 9 (45.0) 7 (38.9) by 35% by high-dose UVA1 and by 28% by medium- Fair (26–50% improvement) 4 (20.0) 8 (44.4) Poor (0–25% improvement) 1 (5.0) 1 (5.6) dose UVA1 after five treatments per week for 3 weeks, in Total 20 (100) 18 (100) 10 patients with severe AD with a median baseline SCO- RAD value of 67.9 In other reports, medium-dose UVA1 FSL, full-spectrum light. and low-dose UVA1 reduced SCORAD values from 64 at baseline to 47 (reduced by 27%) and 60 (reduced by baseline values (P < 0.001 for all) (Fig. 3). Serum ECP, 6%), respectively.16,17 Narrowband UVB therapy was IgE and other cytokine levels did not show significant reported to reduce SCORAD values from 71.2 to 48.8 changes over the entire study period. (reduced by 33%) after 4.3 accumulated joules of therapy None of the laboratory values in the control group in 10 patients with severe AD.18 Der-Petrossian et al.19 showed significant changes over the entire study period reported more promising results with NBUVB, which (Fig. 3). showed SCORAD reductions of 24% after 2 weeks and 45% after 4 weeks of therapy, in 10 patients with severe Safety and adverse effects AD with a mean baseline SCORAD value of 67.9. The FSL irradiation was generally well tolerated by all Vähävihu et al.11 reported that a 2-week course of helio- patients. Among the 20 patients in the FSL-irradiated therapy in the Canary Islands reduced SCORAD values group, erythema was reported in six patients (30%), dry- from 34 to 9 (reduced by 74%) in January and from 30 ness in six patients (30%), pruritus in four patients to 9 (reduced by 70%) in March in 23 AD patients. Au- (20%), and burning sensation in two patients (10%). tio et al.12 reported a mean reduction of 70% in SCO- Transient exacerbation of AD was observed in six RAD values after 2 weeks of heliotherapy and noted that patients (30%) during the first 2 weeks of FSL photother- mean SCORAD values remained at 45% of baseline val- apy. Dryness and pruritus were controllable with the ues at 3 months after therapy. In summary, the reduction emollient, and the erythema and burning sensation sub- from baseline SCORAD values after 2–4 weeks of treat- sided within 1 week of the cessation of phototherapy. No ment was about 70–74% in heliotherapy, 54% in PUVA, serious adverse effects were reported during the study. 35% in high-dose UVA1, 27–37% in medium-dose UVA1, 24–45% in NBUVB, and 6% in low-dose UVA1. In this study, mean SCORAD values dropped from Discussion 47.87 at baseline to 36.81 (reduced by 23.1%) after The SCORAD index is a viable parameter which can be 4 weeks of FSL phototherapy with a total of eight irradia- used for comparing the results of different studies. Previ- tion treatments, and fell further to 30.76 (reduced by International Journal of Dermatology 2010 ª 2010 The International Society of Dermatology
    • Byun et al. Full-spectrum light phototherapy for atopic dermatitis Report(a) 35.7% from baseline) at 4 weeks after the cessation of treatment. From these results, FSL phototherapy would appear to be less effective than heliotherapy, contrary to our expectations. This discrepancy in efficacy between FSL phototherapy and heliotherapy may result from dif- ferences in light doses or light profiles. However, the total energy of the irradiated light does not seem to represent the cause of the difference in efficacy because total light energy irradiated over 2 weeks of heliotherapy was reported to about 60–109 standard erythema dose corre- sponding to 0.60–1.09 J/cm2, whereas the energy irradi- ated during even a single exposure to FSL phototherapy was 530 J/cm2 and included 121 J/cm2 of UVA and 409 J/cm2 of visible and infrared light.11 Instead, the lack(b) of UVB in FSL may represent a cause of decreased effi- cacy. Furthermore, the therapeutic effects of heliotherapy do not derive solely from light. Air, temperature, humid- ity and barometric pressure also contribute to the thera- peutic effects. Although there are no standardized programs of heliotherapy, most programs commonly include relaxation activities such as yoga, lectures on skin care, time for the exchange of personal experiences, and, in some cases, psychological consultation, as well as sun- bathing time.11,12,20 The various relaxation activities included may also contribute to the therapeutic effects of the treatment, and the fact that patients are removed from the stress of daily life may also play a positive role. Compared with the known efficacies of other photothera- py modalities, the efficacy of FSL phototherapy, with SCORAD reductions of 23.1% at week 4 and 35.7% at week 8, was lower than that of PUVA and comparable(c) with those of NBUVB, high-dose and medium-dose UVA1. However, in terms of the number of treatment sessions required, FSL proved superior to the other phototherapy modalities. In previous reports, PUVA and UVA1 were usually irradiated five times per week for 4 weeks resulting in a total of 20 irradiation treatments, and NBUVB was delivered three times per week for 2–6 weeks for a total of six to 18 irradiation treatments.3–10,16–19 Full-spectrum light was administered twice per week for 4 weeks and therefore only eight irradiation treatments were delivered to achieve the results reported herein. However, it may not be appropri- ate to directly compare the results of previous reports with those of our study because the mean SCORAD index at baseline in patients in most of the previousFigure 3 At week 8, 4 weeks after the cessation of photo- studies was > 60–70, much higher than that of 47.87 intherapy, significant decreases from baseline levels are seen our patients.3–10,16–19 The discrepancy in the severity ofin mean values of (a) eosinophil count, (b) IL-4 and (c) IL-5 disease in enrolled patients may result in apparent differ-in the full-spectrum light (FSL)-irradiated group, but not ences in efficacy. Further, in many of the previousin the control group. Data are shown as mean ± SD. reports,3–10,16–19 use of topical steroids was allowed,*P < 0.01 whereas only emollient application was permitted in our study. Further well-designed comparative studies areª 2010 The International Society of Dermatology International Journal of Dermatology 2010
    • 6 Report Full-spectrum light phototherapy for atopic dermatitis Byun et al. needed to precisely compare the efficacy of FSL photo- number and function of Langerhans cells, and the induc- therapy with those of conventional phototherapies. tion of immunomodulatory cytokines such as IL-10.24–27 Remission periods have been reported to extend to 4 UVA has also been known to inhibit histamine release and 12 weeks after medium-dose UVA1 and PUVA, from human basophils and mast cells.28 In addition, both respectively, although not many reports have included UVA and UVB light have been shown to have antimicro- this.4 In this study, patients were followed until 4 weeks bial effects.29–32 Because acute exacerbation of AD is after FSL phototherapy and therefore the exact length of often associated with bacterial super-infection, UV photo- remission could not be evaluated. However, the reduced therapy, especially high-dose UVA1, is effective in this SCORAD was maintained to 4 weeks after the cessation context in AD.32 Visible and infrared light have mostly of treatment and therefore we can assume that FSL been used for the treatment of chronic and acute wounds phototherapy is at least comparable with medium-dose and for the acceleration of skin regeneration after chemi- UVA1 in terms of remission length. Further longterm cal or laser peeling.33–36 This spectrum of light is studies are needed to evaluate the length of the remission absorbed by cellular photosensitizers, such as cyto- period after FSL phototherapy more precisely. chromes, flavins/riboflavins and NADP (nicotinamide There are few reports on changes in cytokine levels adenine dinucleotide phosphate), and then induces the after phototherapy in AD patients. Skin biopsy specimens production of low levels of reactive oxygen species. Low used to evaluate mRNA expression showed significant levels of reactive oxygen species play important roles in reductions in expression of IL-5, IL-13 and IL-31 after redox signaling, leading to the acceleration of cell growth UVA1 phototherapy and a reduction in IFN-c in patients and regeneration, which can be helpful for the regenera- who underwent various treatments, including UVA1.21–23 tion of damaged skin in AD.33,34,36,37 Infrared light also By contrast, we used patients’ serum to evaluate cytokine induces heating of the irradiated skin, leading to vessel levels, a process that is thought to reflect systemic cyto- dilatation and an increase in blood circulation, which can kine levels more than skin specimens. Changes in serum result in the wash-up of inflammatory molecules and the cytokine levels after phototherapy in AD patients have acceleration of tissue regeneration.38 Thus, visible and not previously been reported. In our results, the mean val- infrared light can play positive roles in the treatment of ues of eosinophil counts, IL-4 and IL-5 levels showed sig- AD, although they may not be very effective in isolation. nificant decreases after FSL phototherapy. Eosinophil is Combined irradiation with several types of light may lead known to play an important role in the chronic mainte- to complex interactions in the irradiated skin that extend nance of AD, contributing to allergic inflammation by the beyond simple synergism. However, this complex interac- secretion of cytokines and mediators and inducing tissue tion has not been studied very much. Everett et al.35 injury through the production of reactive oxygen interme- reported that prior heating of the skin increased the UV diates and the release of toxic granule proteins. IL-4 and threshold erythema dose. Similarly, heating of the skin by IL-5 are the most important cytokines produced by Th 2 the infrared light included in FSL may modulate the cells, which play dominant roles in the pathogenesis of effects of UV light irradiated at the same time. Further AD. IL-4 is especially important in acute AD, mediating studies are needed to elucidate the precise interactions of immunoglobulin isotype switching to IgE synthesis and various types of light in irradiated skin. upregulating expression of adhesion molecules on endo- The common adverse effects of conventional photother- thelial cells. By contrast, IL-5 predominates in chronic apy are dryness and first-degree burn presenting as ery- AD and is involved in eosinophil development.1 There- thema.10 The adverse effects observed in this study were fore, we can conclude that FSL phototherapy improves similar to those of conventional phototherapy and not only the clinical symptoms, but also the laboratory included erythema, dryness, pruritus and a burning profiles that are important in both the acute and chronic sensation. Dryness and pruritus were controllable with phases of AD. the emollient, and the erythema and burning sensation The therapeutic effects of the FSL used in this study subsided within 1 week of the cessation of phototherapy. (320–5000 nm) are thought to derive from the combined No serious adverse effects were reported during the study. effects of UVA, visible light and infrared light. This is the We suggest that more intensive use of emollients and deli- advantage of FSL therapy, which can offer benefits from cate dose adjustment (a fixed dose was adopted in this the various types of light simultaneously. UV light has study) may minimize these reactions. Phototherapy can been most widely used as phototherapy for various also result in serious complications such as skin cancers. inflammatory skin diseases, including AD. The major Skin carcinogenesis is induced by UV light in photothera- therapeutic mechanisms of UV phototherapy in AD py.3 Therefore, FSL with a lower proportion of UV can involve immunosuppression and include the induction of be safer than conventional UV phototherapies such as apoptosis in skin-infiltrating T cells, a reduction in the PUVA, UVA1 and NBUVB. However, FSL phototherapy International Journal of Dermatology 2010 ª 2010 The International Society of Dermatology
    • Byun et al. Full-spectrum light phototherapy for atopic dermatitis Reportshould also be used cautiously, especially if it is used over 13 Praschak-Rieder N, Willeit M, Neumeister A, et al.a long period, and should be avoided in patients at high Therapeutic sleep deprivation and phototherapy. Wienrisk for developing skin cancers. Med Wochenschr 1999; 149: 520–524. In this study, we showed that FSL phototherapy can be 14 Neumeister A, Kapitany T, Rieder N, et al. Fall/winter depression and its therapy. Wien Klin Wochenschr 1994;an effective and safe treatment option for moderate to 106: 665–670.severe AD. Further large-scale studies are needed to 15 Lingjaerde O, Reichborn-Kjennerud T, Haggag A, et al.confirm the efficacy and safety of FSL phototherapy and Treatment of winter depression in Norway. I. Short- andto conclude the optimal therapeutic schedule. long-term effects of 1500-lux white light for 6 days. Acta Psychiatr Scand 1993; 88: 292–299. 16 Krutmann J, Czech W, Diepgen T, et al. High-doseReferences UVA1 therapy in the treatment of patients with atopic 1 Leung DYM, Eichenfield LF, Boguniewicz M. Atopic dermatitis. J Am Acad Dermatol 1992; 26: 225–230. dermatitis. In: Wolff K, Goldsmith LA, Kats SI, et al., 17 Krutmann J, Diepgen TL, Luger TA, et al. High-dose eds. Fitzpatrick’s Dermatitis in General Medicine, 7th UVA1 therapy for atopic dermatitis: results of a edn. New York, NY: McGraw-Hill, 2008: 146–158. multicenter trial. J Am Acad Dermatol 1998; 38: 589– 2 Nexman PH. Clinical Studies of Besnier’s Prurigo, 593. Dissertation. Copenhagen: Rosenkilde & Bagger 18 Silva SH, Guedes AC, Gontijo B, et al. Influence of Publishers, 1948. narrowband UVB phototherapy on cutaneous microbiota 3 Gambichler T. Management of atopic dermatitis using of children with atopic dermatitis. J Eur Acad Dermatol photo(chemo)therapy. Arch Dermatol Res 2009; 301: Venereol 2006; 20: 1114–1120. 197–203. 19 Der-Petrossian M, Seeber A, Hönigsmann H, et al. Half- 4 Tzaneva S, Kittler H, Holzer G, et al. 5-Methoxypsoralen side comparison study on the efficacy of 8- plus ultraviolet (UV) A is superior to medium-dose UVA1 methoxypsoralen bath-PUVA versus narrowband in the treatment of severe atopic dermatitis: a randomized ultraviolet B phototherapy in patients with severe chronic crossover trial. Br J Dermatol 2010; 162: 655–660. atopic dermatitis. Br J Dermatol 2000; 142: 39–43. 5 von Kobyletzki G, Pieck C, Hoffmann K, et al. Medium- 20 Harari M, Shani J, Seidl V, et al. Climatotherapy of dose UVA1 cold-light phototherapy in the treatment of atopic dermatitis at the Dead Sea: demographic severe atopic dermatitis. J Am Acad Dermatol 1999; 41: evaluation and cost-effectiveness. Int J Dermatol 2000; 931–937. 39: 59–69. 6 Legat FJ, Hofer A, Brabek E, et al. Narrowband UV-B 21 Gambichler T, Kreuter A, Tomi NS, et al. Gene vs. medium-dose UV-A1 phototherapy in chronic atopic expression of cytokines in atopic eczema before and after dermatitis. Arch Dermatol 2003; 139: 223–224. ultraviolet A1 phototherapy. Br J Dermatol 2008; 158: 7 Gambichler T, Othlinghaus N, Tomi NS, et al. Medium- 1117–1120. dose ultraviolet (UV) A1 vs. narrowband UVB 22 Grewe M, Gyufko K, Schöpf E, et al. Lesional expression phototherapy in atopic eczema: a randomized crossover of interferon-r in atopic eczema. Lancet 1994; 343: 25– study. Br J Dermatol 2009; 160: 652–658. 26. 8 Majoie I, Oldhoff J, van Weelden H, et al. Narrowband 23 Krutmann J. Ultraviolet A-1 irradiation as a tool to study ultraviolet B and medium-dose ultraviolet A1 are equally the pathogenesis of atopic dermatitis. Methods Enzymol effective in the treatment of moderate to severe atopic 2000; 319: 296–302. dermatitis. J Am Acad Dermatol 2009; 60: 77–84. 24 Vermeer BJ, Hurks M. The clinical relevance of 9 Tzaneva S, Seeber A, Schwaiger M, et al. High-dose immunosuppression by UV irradiation. J Photochem versus medium-dose UVA1 phototherapy for patients Photobiol 1994; 24: 149–154. with severe generalized atopic dermatitis. J Am Acad 25 Kalimo K, Koulu L, Jansen CT. Effect of a single UVB or Dermatol 2001; 45: 503–507. PUVA exposure on immediate and delayed skin10 Meduri NB, Vandergriff T, Rasmussen H, et al. hypersensitivity reactions in humans: correlation to Phototherapy in the management of atopic dermatitis: a erythemal response and Langerhans cell depletion. Arch systematic review. Photodermatol Photoimmunol Dermatol Res 1983; 275: 374–378. Photomed 2007; 23: 106–112. 26 Garssen J, Vandebriel RJ, De Gruijl FR, et al. UVB11 Vähävihu K, Ylianttila L, Salmelin R, et al. Heliotherapy exposure-induced systemic modulation of Th1- and Th2- improves vitamin D balance and atopic dermatitis. Br J mediated immune responses. Immunology 1999; 97: Dermatol 2008; 158: 1323–1328. 506–514.12 Autio P, Komulainen P, Larni HM. Heliotherapy in 27 Nghiem DX, Kazimi N, Mitchell DL, et al. Mechanisms atopic dermatitis: a prospective study on climatotherapy underlying the suppression of established immune using the SCORAD index. Acta Derm Venereol 2002; responses by ultraviolet radiation. J Invest Dermatol 82: 436–440. 2002; 119: 600–608.ª 2010 The International Society of Dermatology International Journal of Dermatology 2010
    • 8 Report Full-spectrum light phototherapy for atopic dermatitis Byun et al. 28 Kronauer C, Eberlein-Konig B, Ring J, et al. Influence of acute exacerbation of atopic eczema. Acta Derm UVB, UVA and UVA1 irradiation on histamine release Venereol (Suppl) 1992; 176: 120–122. from human basophils and mast cells in vitro in the 33 Conlan MJ, Rapley JW, Cobb CM. Biostimulation of presence and absence of antioxidants. Photochem wound healing by low-energy laser irradiation. J Clin Photobiol 2003; 77: 531–534. Periodontol 1996; 23: 492–496. 29 Yoshimura-Mishima M, Akamatsu H, Namura S, et al. 34 Grossman N, Schneid N, Reuveni H, et al. 780-nm low Suppressive effect of ultraviolet (UVB and PUVA) power diode laser irradiation stimulates proliferation of radiation on superantigen production by keratinocyte cultures: involvement of reactive oxygen Staphylococcus aureus. J Dermatol Sci 1999; 19: 31– species. Lasers Surg Med 1998; 22: 212–218. 36. 35 Everett MA, Doran CK, Everett HD, et al. Modification 30 Atherton DJ, Carabott F, Glover MT, et al. The role of of sunburn by infrared ray. JAMA 1963; 23: 778–779. psoralen photochemotherapy (PUVA) in the treatment of 36 Lipovsky A, Nitzan Y, Lubart R. A possible mechanism severe atopic eczema in adolescents. Br J Dermatol 1988; for visible light-induced wound healing. Lasers Surg Med 118: 791–795. 2008; 40: 509–514. 31 Jekler J, Larkö O. UVB phototherapy of atopic 37 Rhee SG. Redox signaling: hydrogen peroxide as dermatitis. Br J Dermatol 1988; 119: 697–705. intracellular messenger. Exp Mol Med 1999; 31: 53–59. 32 Krutmann J, Schöpf E. High-dose-UVA 1 phototherapy: a 38 Schriber WJ. A Manual of Electrotherapy, 4th edn. novel and highly effective approach for the treatment of Philadelphia, PA: Lea & Febiger: 1975, 128–129. International Journal of Dermatology 2010 ª 2010 The International Society of Dermatology