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Atopic Dermatitis

Neurodermatitis, atopic dermatitis, atopic eczema or endogenous eczema are synonymous with a chronic inflammatory skin disease associated with severe itching. The central feature of this disease, which occurs in episodes, is a disturbed skin barrier, so that the skin not only becomes drier, but also more cracked and permeable to foreign substances and pathogens. Typical are red inflamed skin areas, which can develop into weeping blisters and eczema.

Neurodermatitis is the most common chronic skin disease in children, but also occurs in adults. The skin changes preferentially occur on different parts of the body depending on age. In young children, it is often the extremities and the head, while in patients of increasing age it is mainly mechanically stressed skin areas such as the neck, back of the knees, wrists and elbows.

Neurodermatitis is not limited to the skin, but is accompanied by a disturbed immune system. In the case of neurodermatitis, the immune system reacts more strongly to foreign substances that penetrate the skin. Both disease factors, a disturbed immune system and dry skin, are favored by a genetic predisposition. Additional external provocation factors such as allergens or stress finally lead to acute neurodermatitis attacks.

How does UV phototherapy work for atopic dermatitis

The soothing power of sunlight is evident in the summer months, when many atopic dermatitis patients experience noticeable symptom relief. The UV component of sunlight initiates various overlapping biological processes in the skin. In addition to calming and suppressing the overactive immune system, the UV spectrum has an anti-inflammatory effect and improves the skin barrier.

Of the various UV spectral ranges, the UV-B 311nm narrow band spectrum and the UV-A1 spectrum have been shown to be equally effective after several weeks of treatment. Individual studies suggest that the UV-A1 spectrum is more rapidly effective. In other studies, however, the UV-B 311nm narrowband spectrum proved more beneficial in chronic atopic dermatitis. The UV-B 311nm narrowband spectrum also has a lower risk profile. In fact, the UV-B 311nm narrow-band spectrum is used more frequently because it is also used for other indications in practices and clinics and is therefore more widespread.

Application and prospects of success for neurodermatitis

The application of UV phototherapy in neurodermatitis can lead to an improvement of the skin appearance and itching as well as to complete freedom from manifestations. The severity of the disease and the therapeutic success is measured by the SCORAD index, which is formed from the affected area, the intensity and from subjective parameters. In two clinical studies, the SCORAD value was improved by an average of 45 and 75%, respectively, after several weeks of treatment with UV-B 311nm narrowband therapy, regardless of age. A further 6 months after the end of therapy, this value was 75% in both studies, so that the success of the therapy can be maintained or even improved in the longer term.

The treatment of neurodermatitis with UV therapy takes place 3 to 5 times a week and usually requires 25 to 30 individual sessions. The initial dosage is based on the skin type and is slowly increased until the erythema threshold is reached.

Therapeutic Alternatives

In addition to UV phototherapy, a variety of other therapeutic options are available for the treatment of atopic dermatitis, which have anti-inflammatory, immunosuppressive, and antipruritic effects in different forms. These include topically applied creams and ointments, systemically acting drugs and subcutaneously injected biologics. Particularly strong-acting therapies can be associated with corresponding side effects and are primarily used to treat active and severe relapses. More tolerable forms of therapy, such as UV phototherapy, are more suitable for the treatment of chronic phases of the disease.