Narrowband UVB phototherapy in skin conditions beyond psoriasis

Abstract

Narrowband (NB) UVB phototherapy has been proven to be clearly more effective than broadband UVB and safer and/or more practicable than psoralen-UVA in the management of psoriasis. However, the role of NB UVB seems to be less clear in the management of skin conditions beyond psoriasis. We sought to give an update on clinical experiences in NB UVB of nonpsoriatic skin conditions, and to establish its current position within the spectrum of competing photo(chemo)therapeutic options. The computerized bibliographic database PubMed, without time limits, and other sources were screened for clinical trials on NB UVB. Included were research articles of randomized controlled trials, open prospective studies, and retrospective observations on NB UVB in skin disorders other than psoriasis. A total of 28 articles met our eligibility criteria including 6 randomized controlled studies, 16 open prospective studies, and 6 retrospective observations. NB UVB is effective in patients with chronic atopic dermatitis (AD) (n = 719) and generalized vitiligo (n = 305) and appears to have some advantages over competing photo(chemo)therapeutic regimens. NB UVB also seems to be effective in patients with polymorphic light eruption (n = 25), early stages of cutaneous T-cell lymphoma (n = 108), chronic urticaria (n = 88), lichen planus (n = 15), pruritus associated with polycythemia vera (n = 10), seborrheic dermatitis (n = 18), actinic prurigo (n = 6), and acquired perforating dermatosis (n = 5). The quality of evidence determined for the aforementioned diagnoses ranged from high to moderate to very low. The best currently available data on NB UVB in nonpsoriatic conditions exist for AD and generalized vitiligo. In view of its efficacy, benefit/risk profile, and costs, NB UVB may be considered the first-line photo(chemo)therapeutic option for moderately severe AD and widespread vitiligo. In the treatment of most other nonpsoriatic conditions, NB UVB appears to be effective, but current data allow no definitive conclusions as to whether NB UVB should be preferred to competing photo(chemo)therapeutic options such as UVA1 and psoralen-UVA regimens. Because NB UVB may have a wider indication spectrum, including AD, vitiligo, and early-stage T-cell lymphoma, and appears to be equally effective or even more effective than broadband UVB, a switch from broadband UVB to NB UVB seems to be justified.