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

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.