title: Phototherapy in the management of atopic dermatitis: a systematic review.
abstract: OBJECTIVE
  Atopic dermatitis (AD) is a common and extremely burdensome skin disorder with limited therapeutic options. Ultraviolet (UV) phototherapy is a well tolerated, efficacious treatment for AD, but its use is limited by a lack of guidelines in the optimal choice of modality and dosing. Given this deficit, we aim to develop suggestions for the treatment of AD with phototherapy by systematically reviewing the current medical literature.
  
  
  METHODS
  
  
  
  METHODS
  All data sources were identified through searches of MEDLINE via the Ovid interface, the Cochrane Central Register of Controlled Trials, and a complementary manual literature search.
  
  
  METHODS
  Studies selected for review met these inclusion criteria, as applied by multiple reviewers: controlled clinical trials of UV phototherapy in the management of AD in human subjects as reported in the English-language literature. Studies limited to hand dermatitis and studies in which subjects were allowed unmonitored use of topical corticosteroids or immunomodulators were excluded.
  
  
  METHODS
  Included studies were assessed by multiple independent observers who extracted and compiled the following data: number of patients, duration of treatment, cumulative doses of UV radiation, adverse effects, and study results. Data quality was assessed by comparing data sets and rechecking source materials if a discrepancy occurred.
  
  
  RESULTS
  Nine trials that met the inclusion criteria were identified. Three studies demonstrated that UVA1 is both faster and more efficacious than combined UVAB for treating acute AD. Two trials disclosed the advantages of medium dose (50 J/cm(2)) UVA1 for treating acute AD. Two trials revealed the superiority of combined UVAB in the management of chronic AD. Two additional studies demonstrated that narrow-band UVB is more effective than either broad-band UVA or UVA1 for managing chronic AD.
  
  
  CONCLUSIONS
  On the basis of available evidence, the following suggestions can be made: phototherapy with medium-dose (50 J/cm(2)) UVA1, if available, should be used to control acute flares of AD while UVB modalities, specifically narrow-band UVB, should be used for the management of chronic AD.
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center and Dermatology Section (Medical Service), Dallas Veterans Affairs Medical Center, and Private Practice, Dallas, TX 75390, USA.
authors.forename: N Bhavani
authors.initials: NB
authors.lastname: Meduri
authors.forename: Travis
authors.initials: T
authors.lastname: Vandergriff
authors.forename: Heather
authors.initials: H
authors.lastname: Rasmussen
authors.forename: Heidi
authors.initials: H
authors.lastname: Jacobe
mesh_terms: D002908:Chronic Disease; D018849:Controlled Clinical Trials as Topic; D003876:Dermatitis, Atopic / Q000532:radiotherapy*; D006801:Humans; D011879:Radiotherapy Dosage; D012720:Severity of Illness Index; D014467:Ultraviolet Therapy / Q000009:adverse effects / Q000379:methods*