The Efficacy and Safety of Combining Phototherapy and Topicals in the Treatment of Atopic Eczema: A Systematic Review of the Current Evidence

IF 3.4 4区医学 Q1 DERMATOLOGY

Dermatologic Therapy Pub Date : 2025-03-04 DOI:10.1155/dth/9993910

Eva Knöps, Marlide R. Jukema, Phyllis I. Spuls, Louise A. A. Gerbens

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引用次数: 0

Abstract

Background: In patients with atopic eczema (AE), phototherapy is often combined with topical therapy in order to achieve better disease control. While commonly used guidelines do recommend concomitant use of ointments, creams and ultraviolet (UV) radiation, details on how to apply a topical regimen in combination with phototherapy in an effective, safe and tolerable manner are currently not provided. This systematic review assesses the available evidence on whether and how the several types of topical therapies can be effectively and safely used in combination with phototherapy in the treatment of AE.

Methods: An update of a 2021 Cochrane review’s search was conducted. Randomised controlled trials (RCTs) were included that studied the treatment of AE with phototherapy in one or more study arms, to ensure no RCTs that allowed for the concomitant use of topicals would be missed. Two authors performed study selection and extraction of topical therapy data.

Results: A total of 33 studies were included. Twenty-nine studies reported on combining topical therapy with phototherapy. Of these studies, all allowed for the concomitant use of emollients, 13 allowed topical corticosteroids and 1 allowed a topical calcineurin inhibitor. One study investigated the efficacy of combining phototherapy and a topical agent. None of the remaining studies commented on the efficacy of combination therapy. Nine studies included details on the frequency of the use of topicals. Three studies reported on timing of emollients with regard to phototherapy. Six studies reported a topical base type (cream, ointment, jelly). No studies reported on safety. Risk of bias was assessed as ‘high’or as ‘some concerns’.

Conclusions: Very limited data from RCTs exist on the efficacy, safety and methods of combining topical therapy with phototherapy in the treatment of AE. This results in a lack of detailed guidance on how to perform combination therapy, which is striking as the combination of topicals and UV is widely applied in daily practice.

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光疗与外敷联合治疗特应性湿疹的疗效和安全性：对现有证据的系统回顾

背景：在特应性湿疹（AE）患者中，光疗通常与局部治疗相结合，以达到更好的疾病控制。虽然常用的指南确实建议同时使用软膏、面霜和紫外线（UV）辐射，但目前没有提供有关如何以有效、安全和耐受的方式将局部方案与光疗结合使用的详细信息。本系统综述评估了几种类型的局部治疗是否以及如何有效和安全地与光疗联合用于AE治疗的现有证据。方法：对2021年Cochrane综述的检索进行更新。随机对照试验（RCTs）纳入了研究光疗治疗AE的一个或多个研究组，以确保没有允许同时使用外用药物的随机对照试验被遗漏。两位作者进行了研究选择和提取局部治疗数据。结果：共纳入33项研究。报道了29项局部治疗与光疗结合的研究。在这些研究中，所有研究都允许同时使用润肤剂，13个允许局部使用皮质类固醇，1个允许局部使用钙调磷酸酶抑制剂。一项研究调查了光疗和局部药物联合使用的疗效。其余的研究都没有评论联合治疗的疗效。九项研究包括了局部药物使用频率的细节。三个研究报告了润肤剂在光疗中的使用时间。六项研究报告了外用基础类型（乳膏、软膏、果冻）。没有关于安全性的研究报道。偏倚风险被评估为“高”或“有一些担忧”。结论：关于局部治疗与光疗联合治疗AE的疗效、安全性及方法的随机对照试验资料非常有限。这导致缺乏关于如何进行联合治疗的详细指导，这是引人注目的，因为局部药物和紫外线的组合在日常实践中广泛应用。

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来源期刊

Dermatologic Therapy 医学-皮肤病学

CiteScore

7.00

自引率

8.30%

发文量

711

审稿时长

3 months

期刊介绍： Dermatologic Therapy has been created to fill an important void in the dermatologic literature: the lack of a readily available source of up-to-date information on the treatment of specific cutaneous diseases and the practical application of specific treatment modalities. Each issue of the journal consists of a series of scholarly review articles written by leaders in dermatology in which they describe, in very specific terms, how they treat particular cutaneous diseases and how they use specific therapeutic agents. The information contained in each issue is so practical and detailed that the reader should be able to directly apply various treatment approaches to daily clinical situations. Because of the specific and practical nature of this publication, Dermatologic Therapy not only serves as a readily available resource for the day-to-day treatment of patients, but also as an evolving therapeutic textbook for the treatment of dermatologic diseases.