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Abstract
Atopic dermatitis is a common chronic inflammatory skin disease often preceding the development of asthma and allergic disorders, such as food allergy or allergic rhinoconjunctivitis. The pathophysiology of AD is the product of a complex interaction between various susceptibility genes, host environments, infectious agents, defects in skin barrier function, and immunologic responses Narrow-band UVB is a useful, effective and well-tolerated treatment for the management of severe inflammatory dermatoses as psoriasis, vitiligo, and mycosis fungoides and proved to have effect on AD.
This study was designed to evaluate the efficacy and safety of NB- UVB phototherapy in treatment of AD in Egyptian patients. Twenty-one patients with AD were included in this work. Diagnosis was based on the diagnostic criteria developed by Hanifin and Rajka in 1980. They were 11 females (52.4%) and 10 males (47.6%) with their ages ranging between 8-30 years with a mean of 13.52±7.79 years. Their skin types were 16 patients (76%) of skin type IV and 5 patients (24%) of skin type V. All patients selected stopped treatment at least 2 weeks prior to enrolment in this study.
All patients were subjected to NB-UVB therapy twice weekly for up to 24 sessions using the phototherapy unit GH-8ST (Cosmedico Medizintechnik, Schwenningen, Germany). It contains 8 mercury low pressure lamps (Philips TL 100W/01) with a spectrum of 305-315nm and a maximum wavelength of 311nm providing an irradiance of 6-8 mW/cm2. The starting dose was chosen according to skin phototype; 0.574 J/cm2 for patients with skin type IV, and 0.707 J/cm2 for patients with skin type V .The genital area was shielded in all cases and eyes were protected with UVB-blocking goggles. No other concomitant treatment for AD was allowed except emollient.
Evaluation of the treatment was done using SCORAD in all before 1st NB-UVB session, and after 6, 12, 18, and 24 sessions. Photographic documentation was taken before1st NB-UVB session, after 12, and 24 sessions. The clinical response was based on the percentage of the decrease of the SCORAD index as follow: excellent response (≥75%), good response (≥50%.-<75%) and fair response(≥25-<50%). A histopathological examination was done for some patients before treatment, after 12 and after 24 sessions.
Follow up was done for 6-9 months after completion of treatment for detection of any recurrence.
In this study, evaluation of the clinical response of patients to NB-UVB therapy showed that 5 (24%) patients showed excellent response, 14 (66%) patients had good response and 2 (10%) patients had fair response. Improvement of subjective symptoms was detected after 6 to 12 sessions.
Regarding SCORAD score, this work showed that pretreatment SCORAD score decreased by about 4%, 19.7%, 46.6%, and 57% after 6, 12, 18, and 24 sessions of treatment with NB-UVB respectively.
No significant associations were detected between age and sex of patients, family history of atopy, skin phototype, severity of disease and clinical response to therapy. Follow up of the cases for 6 months after therapy showed no recurrence or flare up of disease. Only 5 patients complete follow up period for 9 months. Two of these 5 patients showed recurrence of disease at the end of follow up period.
Histopathological examination of skin biopsy from a patient showed excellent response after 24 sessions of NB-UVB revealed : nearly normal epidermis, with scanty inflammatory infiltrate, mainly small lymphocytes, in the dermis by H&E stain. While Geimsa stain revealed few number of granulated mast cells.