Where Does Phototherapy Still Fit In?

Christopher Bunick, MD, FAAD (00:07):

When I first finished residency over a decade ago, phototherapy, particularly narrowband UVB, was still prominently used for treating moderate to severe atopic dermatitis. We now have six FDA-approved advanced systemic therapies that are all highly recommended by the American Academy of Dermatology.

(00:27):

Where does phototherapy still fit in? Well, in my particular practice, the answer is I'm not using a lot of phototherapy for moderate to severe atopic dermatitis, because we have such good advanced systemic medicines. And let's be honest, we have at least one agent currently approved down to six months of age: dupilumab from six months all the way up to adults. But in particular, that six-month to eleven-year-old age group, we only have one FDA-approved therapy.

(00:54):

But what's that therapy doing? That therapy has actually shown that it can improve growth, height, weight, and growth kinetics, as well as bone mineralization of patients. We don't think about that all the time, but the systemic inflammatory effects of atopic dermatitis in children can stunt their growth and stunt their bone mineralization. And treatment with advanced systemic therapies like to dupilumab in that age group is changing the game for how the pediatric growth curve in moderate to severe atopic dermatitis patients is occurring.

(01:30):

That said, there really, in my opinion, there are small areas where you may still want to use phototherapy for a certain patient where a biologic or a JAK inhibitor is not indicated, a patient that you don't want to use steroids, a patient that may have a preference for narrowband UVB.

(01:48):

So I think there's a very small place for phototherapy in treatment of atopic dermatitis. But as a whole, I'm reaching for the advanced systemic therapies because they give more than just skin relief. They give skin, they give quality of life, itch reduction, and they're affecting that systemic inflammation that's occurring in atopic dermatitis that probably phototherapy is having less effect on.