Narrow-band (NB)-UVB vs. Bath-PUVA and NB-UVB Plus Salt Water Baths in Atopic Dermatitis

• Clinical improvement after treatments using a validated SASSAD index [ Time Frame: Evaluation at baseline and after 4-week treatment, 3 months follow-up ] [ Designated as safety issue: No ]
  Clinical improvement after treatments using a validated SASSAD index
  
  

• Evaluation of pruritus and sleeplessness visual analogue scales [ Time Frame: Evaluation at baseline and after 4-week treatment, 3 months follow-up ] [ Designated as safety issue: Yes ]
  Evaluation of pruritus and sleeplessness using visual analogue scales with 0 being no complaints and 10 being the worst complaints imaginable
  
  
• Measuring quality of life using the Skindex-29 [ Time Frame: Evaluation at baseline and after 4-week treatment, 3 months follow-up ] [ Designated as safety issue: No ]
  Measuring patient's satisfaction / safety and quality of life using a qualified questionnaire: the Skindex-29.
  
  
• Immunohistochemical, RT-PCR and serological parameters [ Time Frame: Evaluation at baseline and after 4-week treatment ] [ Designated as safety issue: No ]
  Measuring several immunohistochemical, RT-PCR and serological parameters in skin and blood, respectively.
  
  

Atopic dermatitis (AD) is a very common skin disorder that is characterized by pruritic inflammatory skin lesions, with patients usually having an individual or family history of atopic diseases in their background (e.g., allergic asthma and rhinitis). Defective skin barrier, immunological dysfunctions (type I and IV allergy), genetic disorders, and psychological factors contribute to the pathogenesis of AD. However, among these factors, CD4+ Th cells are reported to play a particularly crucial role in the pathogenesis of AD. Phototherapy is among the first-line approaches in the management of AD. In this context, a variety of studies have shown a beneficial effect of natural or artificial UV radiation in AD. Different broadband (BB) UV spectra (BB-UVA, BB-UVB, BB-UVA/BB-UVB) and combined treatment modalities such as balneophototherapy and PUVA have previously been proven to be effective in AD. A small controlled study has previously demonstrated that the combination of UVB/UVA and saltwater baths is superior to phototherapy alone. Previous data from uncontrolled studies also speak for the effectiveness of systemic psoralen plus UVA (PUVA) therapy. A controlled crossover study has shown that systemic PUVA therapy is clearly superior to UVA1 phototherapy both in terms of clinical score (SCORAD) and reduction of response time. Systemic PUVA has in relation to bath PUVA significantly greater adverse effects (eg, nausea, liver enzyme elevation, photocarcinogenesis). A direct comparison between NB-UVB and bath PUVA has only been studied by a half-side comparison in a small number of patients. Both therapies were proved equally effective. In a recent study, it has been shown a clear advantage of NB-UVB plus salt water baths in comparison to NB-UVB alone. Tolerability was comparable; both treatments showed to be safe.

A randomized observer-blinded controlled crossover trial is conducted in which patients with AD receive a 4-week course of both NB-UVB and bath-PUVA or NB-UVB plus salt water baths. Clinical efficacy is assessed using the Six Area, Six Sign, Atopic Dermatitis (SASSAD) score and a visual analogue scale for pruritus. Assessment of health-related quality of life was performed using the Skindex-29. Moreover, immunohistochemical, RT-PCR and serological studies are planned.