Phototherapy in Atopic Dermatitis: A Systematic Review of the Literature

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Pérez-Ferriols, B. Aranegui, J.A. Pujol-Montcusí, A. Martín-Gorgojo, M. Campos-Domínguez, R.A. Feltes, Y. Gilaberte, B. Echeverría-García, A. Alvarez-Pérez, I. García-Doval" "autores" => array:10 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Pérez-Ferriols" "email" => array:1 [ 0 => "perez_ampferr@gva.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "B." "apellidos" => "Aranegui" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J.A." "apellidos" => "Pujol-Montcusí" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Martín-Gorgojo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "M." 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"apellidos" => "García-Doval" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:9 [ 0 => array:3 [ "entidad" => "Dermatología, Hospital General Universitario de Valencia, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Investigación, Fundación Academia Española de Dermatología y Venereología, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Dermatología, Hospital Universitari Joan XXIII, Tarragona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, Dermatología, Clínica Ruber, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Dermatología, Hospital Universitario la Paz, Madrid, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Dermatología, Hospital San Jorge, Huesca, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Dermatología, Hospital Universitario de Fuenlabrada, Madrid, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Hospital Star Médica Querétaro, Santiago de Querétaro, Querétaro, Mexico" "etiqueta" => "i" "identificador" => "aff0045" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding auhtor." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Modalidades de fototerapia para el tratamiento de la dermatitis atópica: revisión sistemática de la literatura" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3041 "Ancho" => 2341 "Tamanyo" => 509720 ] ] "descripcion" => array:1 [ "en" => "Risk of bias. + indicates low risk of bias; ?, unknown risk of bias; –, high risk of bias; 1, generation of random allocation sequence (selection bias); 2, intervention allocation (selection bias); 3, masking of participants and personnel (performance bias); 4, masking of assessors (detection bias); 5, incomplete outcome data (attrition bias); 6, selective reporting (reporting bias); 7, other biases; BJD, British Journal of Dermatology." ] ] ] "textoCompleto" => "IntroductionAtopic dermatitis (AD) is a chronic and recurring inflammatory disease that affects individuals of any age, especially children and young adults.<a class="elsevierStyleCrossRef" href="#bib0205">1</a>Therapeutic guidelines encourage an individualized approach to treating AD and include recommendations on skin moisturizing, corticosteroids and/or topical calcineurin inhibitors, systemic antihistamines, and topical or systemic antibiotics, when required. The most complex cases often require treatment with photochemotherapy, systemic corticosteroids, and/or immunosuppressants, sometimes in combination.<a class="elsevierStyleCrossRefs" href="#bib0205">1,2</a>Phototherapy has been widely used in AD since the 1970s. Over the years, various modalities of phototherapy with UV light have been introduced, namely psoralen plus UV-A (PUVA or photochemotherapy), broadband UV-B (BB UV-B, 280-315nm), narrowband UV-B (NB UV-B, peak=311nm), UV-A (315-400nm), UV-A1 (340-400nm), and UV-AB (UV-A followed by UV-B or simultaneous exposure to both). Data from controlled clinical trials on the efficacy of phototherapy are scarce.The first systematic review<a class="elsevierStyleCrossRef" href="#bib0215">3</a> on phototherapy in the management of AD was published in 2007. Another recent systematic review<a class="elsevierStyleCrossRef" href="#bib0220">4</a> provided—like the present study—an update on the results of clinical trials published in the past few years, including studies on PUVA.The main objective of this study was to evaluate, through a systematic review of the literature, the efficacy of the various modalities and regimens of phototherapy and photochemotherapy used in the treatment of patients with moderate to severe AD.Material and MethodsIdentification of StudiesWe used the MEDLINE (via Ovid) and Embase databases and the Cochrane Central Register of Controlled Trials (CENTRAL) to identify articles through the seventh week of 2013 (Embase) and through February 18, 2013 (MEDLINE and CENTRAL). The search terms related to patient type and interventions were Medical Subject Headings (MeSH) terms and free terms. The search terms related to design type were based on the Cochrane Highly Sensitive Search Strategy.<a class="elsevierStyleCrossRef" href="#bib0225">5</a> The results were limited to studies conducted in humans and published in English, French, or Spanish. Before carrying out the online searches, we identified 2 articles that met the inclusion criteria and were expected to be retrieved by the searches in all of the databases.<a class="elsevierStyleCrossRefs" href="#bib0230">6,7</a> The search strategies will be provided on request by the corresponding author.Additionally, we carried out a search in PubMed Clinical Queries using the narrow search filter and a manual search of potentially relevant references cited in the included studies. We also asked Dr José Manuel Carrascosa, an expert on the treatment of AD with phototherapy, to review our results in order to detect the possible absence of relevant studies.Finally, we also searched for clinical trials registered with Current Controlled Trials (<a href="http://www.controlled-trials.com/">www.controlled-trials.com</a>) and with the World Health Organization's International Clinical Trials Registry Platform (<a href="http://apps.who.int/trialsearch/">http://apps.who.int/trialsearch/</a>).Study Inclusion CriteriaWe considered all randomized clinical trials (RCTs) performed in patients clinically diagnosed with atopic dermatitis, without any age limit. We accepted as interventions all types of phototherapy as well as phototherapy in combination with psoralens (photochemotherapy). We excluded animal studies, studies in which the intervention was applied in localized areas (hands or feet), and studies in which the use of topical and/or systemic corticosteroids and immunosuppressants was not systematized or controlled. We accepted all outcome measures, although measures of disease improvement or quality of life were preferred over economic or laboratory measures.Data Management and ExtractionThe results obtained by the searches were downloaded to a reference management software package (EndNote, Thomson Reuters, 2011), which allowed us to filter the articles by title and abstract. Potentially relevant articles were independently evaluated in their entirety by pairs of reviewers. During data extraction, we used a questionnaire that included a study quality assessment form based on the Cochrane Collaboration's risk of bias tool.<a class="elsevierStyleCrossRef" href="#bib0225">5</a> Throughout the process, all duplicate, rejected, and selected references were recorded in a PRISMA flow diagram (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>ResultsExcluded StudiesThirty-four articles were excluded from the analysis because they had a non-RCT design and/or they did not meet the patient-related inclusion criteria (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).Included StudiesTwenty-four records corresponding to 21 RCTs (961 patients) were included in the analysis. Three of the studies<a class="elsevierStyleCrossRefs" href="#bib0240">8–10</a> were also published as conference proceedings.<a class="elsevierStyleCrossRefs" href="#bib0255">11–13</a> Two studies<a class="elsevierStyleCrossRefs" href="#bib0270">14,15</a> included children and adolescents (32 patients). Two studies<a class="elsevierStyleCrossRefs" href="#bib0270">14,16</a> were carried out in Asia and the rest were carried out in Europe. Three were multicenter studies.<a class="elsevierStyleCrossRefs" href="#bib0230">6,17,18</a> Most of the studies compared different types of phototherapy, including high-dose (HD) UV-A1, medium-dose (MD) UV-A1, UV-B, UV-A and UV-B combination therapy (UV-AB), NB UV-B, and PUVA. Other modalities were excimer laser (EL),<a class="elsevierStyleCrossRef" href="#bib0240">8</a> full-spectrum-light phototherapy (FSL),<a class="elsevierStyleCrossRef" href="#bib0280">16</a> and synchronous balneophototherapy (sBPT).<a class="elsevierStyleCrossRef" href="#bib0230">6</a> One study evaluated the utility of a skin-reflectance-guided UV-B regimen as a means of reducing the cumulative dose of radiation.<a class="elsevierStyleCrossRef" href="#bib0295">19</a> Three studies compared phototherapy with other treatments, namely ciclosporin,<a class="elsevierStyleCrossRef" href="#bib0285">17</a> topical pimecrolimus,<a class="elsevierStyleCrossRef" href="#bib0270">14</a> and topical corticosteroid therapy combined with phototherapy.<a class="elsevierStyleCrossRef" href="#bib0275">15</a> The shortest follow-up period was 4 weeks<a class="elsevierStyleCrossRefs" href="#bib0245">9,14,20</a> and the longest periods were 6 months<a class="elsevierStyleCrossRefs" href="#bib0230">6,21</a> and 12 months.<a class="elsevierStyleCrossRefs" href="#bib0235">7,17</a> Several studies had no follow-up period.<a class="elsevierStyleCrossRefs" href="#bib0250">10,15,18,19,22–27</a> In most studies, the outcome measures were changes in scores on clinical scales. The most frequently used scales were SCORing Atopic Dermatitis (SCORAD) or a modified form of SCORAD,<a class="elsevierStyleCrossRefs" href="#bib0230">6,7,9,16,17,19,21,28</a> Costa's Simple Scoring System (SSS),<a class="elsevierStyleCrossRefs" href="#bib0250">10,15,18,27</a> the Leicester scale,<a class="elsevierStyleCrossRefs" href="#bib0275">15,27</a> and the severity score<a class="elsevierStyleCrossRef" href="#bib0345">29</a> of Hanifin and Rajka.<a class="elsevierStyleCrossRefs" href="#bib0315">23–26</a> Some studies also used quality-of-life scales (Eczema Disability Index,<a class="elsevierStyleCrossRef" href="#bib0285">17</a> Sickness Impact Profile<a class="elsevierStyleCrossRef" href="#bib0230">6</a>) and assessments of pruritus.<a class="elsevierStyleCrossRefs" href="#bib0240">8,14,20,22,27</a> Cumulative dosage was an outcome measure in 1 study<a class="elsevierStyleCrossRef" href="#bib0295">19</a> and length of remission was used in 2 studies.<a class="elsevierStyleCrossRefs" href="#bib0235">7,21</a>Risk of Bias in the Included StudiesIn general, the studies reviewed had a high risk of bias and relevant information was frequently missing (<a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1–6</a>, <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Effect of the InterventionsComparison of Different Phototherapy ModalitiesClassic Types of Phototherapy: UV-A, UV-B, and UV-AB (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>)Two RCTs<a class="elsevierStyleCrossRef" href="#bib0320">24</a> evaluated the optimal dose of UV-B radiation. The first study compared a UV-B dose of 0.5 times the minimal erythema dose (MED) to a UV-B dose of 1 MED and to visible light. The second study compared a UV-B dose of 0.8 MED to a UV-B dose of 0.4 MED. UV-B radiation was found to be more effective than visible light, but the second study found no differences in efficacy between 0.8 MED and 0.4 MED. In an RCT<a class="elsevierStyleCrossRef" href="#bib0325">25</a> comparing UV-B to UV-AB, statistically significant differences in favor of UV-AB were observed for most variables. In another RCT,<a class="elsevierStyleCrossRef" href="#bib0330">26</a> UV-A was found to be superior to UV-B in the total score and in the overall evaluation, but not in the pruritus score. Two other studies<a class="elsevierStyleCrossRef" href="#bib0315">23</a> compared UV-AB to UV-B and to UV-A, respectively, and found that UV-AB yielded the most favorable results (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).High-Dose UV-A1 and Medium-Dose UV-A1 (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>)An RCT<a class="elsevierStyleCrossRef" href="#bib0250">10</a> carried out in patients with an acute flare of AD found that the decrease in SSS scores at 6 and 15 days after HD UV-A1 phototherapy was statistically significant as compared to UV-AB. Another multicenter RCT<a class="elsevierStyleCrossRef" href="#bib0290">18</a> compared HD UV-A1 (130J/cm2), UV-AB, and 0.5% topical fluocortolone. Significant differences were found in SSS scores on day 5 and day 10 in favor of HD UV-A1 and fluocortolone as compared to UV-AB and in favor of HD UV-A1 as compared to fluocortolone, although no absolute data were reported. A pilot study<a class="elsevierStyleCrossRef" href="#bib0305">21</a> compared MD UV-A1 with HD UV-A1. The decrease in modified SCORAD scores after 3 weeks of treatment was 34.7% in the HD UV-A1 group and 28.2% in the MD UV-A1 group (P>.05), and there were no bilateral differences in time until recurrence or in intensity of recurrence. The cold-light UV-A1 modality dissipates the excessive heat load generated by UV-A1. One study<a class="elsevierStyleCrossRef" href="#bib0245">9</a> found that cold-light UV-A1 was more effective than UV-A1 and UV-AB at clearing lesions and reducing their duration. After 3 weeks, mean SCORAD scores had decreased (P<.05) in all 3 groups—23.3 (10.6) for cold-light UV-A1, 28.8 (6.9) for UV-A1, and 41.4 (9.9) for UV-AB—although the decrease was most striking in the cold-light UV-A1 group (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).Narrowband UV-B (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>)One RCT<a class="elsevierStyleCrossRef" href="#bib0350">30</a> found that NB UV-B was superior to UV-A and to visible light and that the results were maintained at 3 months. In a pilot RCT,<a class="elsevierStyleCrossRef" href="#bib0335">27</a> a half-side comparison study assessed the efficacy of NB UV-B vs MD UV-A1 in patients with AD. In the areas treated with NB UV-B, there was a statistically significant decrease in SSS, Leicester, and lesion severity scores. Another RCT<a class="elsevierStyleCrossRef" href="#bib0300">20</a> included patients who received NB UV-B on one half of the body and UV-A1 on the other. Both treatments resulted in lower scores on the Leicester scale and on a visual analogue scale for pruritus, and there were no significant differences between the groups. In a randomized double-blind controlled crossover trial<a class="elsevierStyleCrossRef" href="#bib0310">22</a> of UV-A1 and NB UV-B, no statistically significant differences were found.Psoralen Plus UV-A Therapy (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>)An RCT<a class="elsevierStyleCrossRef" href="#bib0340">28</a> with low statistical power compared 8-methoxypsoralen (8-MOP) PUVA bath therapy to NB UV-B and did not find any significant differences, although the results were consistent with the possibility of clinically relevant differences. A randomized controlled crossover trial<a class="elsevierStyleCrossRef" href="#bib0235">7</a> compared UV-A1 to oral 5-methoxypsoralen (5-MOP) PUVA therapy. The minimum washout period was 4 weeks and patients were followed up until 12 months after the first treatment. The median length of remission was 4 weeks after UV-A1 and 12 weeks after PUVA. The mean reduction in SCORAD scores was greater after PUVA.Studies Comparing Phototherapy to Other Treatments for Atopic Dermatitis (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>)A multicenter study<a class="elsevierStyleCrossRef" href="#bib0285">17</a> compared ciclosporin A to UV-AB. The mean number of days in remission was 186 (84) after ciclosporin A compared with 114 (118) after UV-AB. Both the patients and the researchers rated ciclosporin A treatment more highly than UV-AB phototherapy. An RCT<a class="elsevierStyleCrossRef" href="#bib0270">14</a> compared 1% pimecrolimus cream to NB UV-B in patients between the ages of 5 and 17 years. Both interventions were beneficial, and concomitant use of both treatments was not found to be superior. Another RCT<a class="elsevierStyleCrossRef" href="#bib0275">15</a> compared UV-AB to UV-AB plus topical fluticasone or topical hydrocortisone butyrate. Significant improvement was seen in both groups. In patients who received a corticosteroid, fewer phototherapy sessions were required and the total mean UV-B dose was lower.Other Studies (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>)One pilot study<a class="elsevierStyleCrossRef" href="#bib0240">8</a> compared 308nm EL with 0.05% clobetasol propionate ointment in patients with the prurigo form of AD. EL yielded optimal results as assessed using the Physician Assessment of Individual Signs (PAIS), the Physician's Global Assessment (PGA), the Patient's Global Assessment (PaGA), and a pruritus scale. In another study,<a class="elsevierStyleCrossRef" href="#bib0280">16</a> FSL phototherapy (wavelengths of 320-5000nm) used in conjunction with an emollient yielded a significantly greater improvement in SCORAD scores at 4 weeks as compared to the emollient alone. One RCT<a class="elsevierStyleCrossRef" href="#bib0230">6</a> compared NB UV-B treatment and synchronous bathing in 10% Dead Sea salt solution—also known as synchronous balneophototherapy (sBPT)—to monotherapy with NB UV-B. sBPT yielded a greater reduction in SCORAD scores than NB UV-B as monotherapy (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>) and remained superior 1 month and 6 months after treatment. One RCT<a class="elsevierStyleCrossRef" href="#bib0295">19</a> evaluated the utility of determining UV-B dose on the basis of skin reflectance (reflectance-guided UV-B). At each session, the UV-B dosage used on one side of the body was established on the basis of skin pigmentation, as measured by reflectance, and a conventional UV-B regimen was used on the other side of the body. The cumulative UV-B dosage was lower in the reflectance-guided regimen, and both treatment options had the same clinical outcome.Registered Studies Currently Underway (<a class="elsevierStyleCrossRef" href="#tbl0035">Table 7</a>)Of the in-progress RCTs registered with Current Controlled Trials and the World Health Organization's International Clinical Trials Registry Platform, 2 studies met the inclusion criteria. One RCT is comparing NB UV-B as monotherapy to PUVA bath therapy and to NB UV-B plus salt water baths. Another RCT is comparing UV-AB phototherapy to UV-B in patients with various pruritic inflammatory dermatoses, including AD (<a class="elsevierStyleCrossRef" href="#tbl0035">Table 7</a>).<elsevierMultimedia ident="tbl0035"></elsevierMultimedia>DiscussionSummary of Main ResultsThis is the first systematic review on phototherapy in AD to be published in Spanish. We analyzed 21 studies that met the inclusion criteria. These studies included a total of 961 patients, of whom 32 were younger than 18 years of age.The use of the various phototherapy modalities had a chronological distribution. In the 1980s and 1990s, studies of UV-A, UV-B, and UV-AB phototherapy were predominant. PUVA, NB UV-B, and UV-A1 emerged later, followed by modalities such as EL and FSL.In some studies, there were statistically significant differences between combined UV-AB phototherapy and UV-A or UV-B phototherapy (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). HD UV-A1 was subsequently found to be superior to UV-AB.<a class="elsevierStyleCrossRefs" href="#bib0250">10,18</a> Later studies showed that MD UV-A1 had similar efficacy and fewer side effects than HD UV-A1<a class="elsevierStyleCrossRefs" href="#bib0245">9,21</a> (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).The most homogeneous studies are those that compare UV-A1 to NB UV-B (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Two studies<a class="elsevierStyleCrossRefs" href="#bib0335">27,30</a> found NB UV-B to be superior to UV-A1. In an RCT with a large number of participants and low risk of selection bias, the superiority of NB UV-B was maintained after 3 months of follow-up.<a class="elsevierStyleCrossRef" href="#bib0350">30</a> The other 2 studies<a class="elsevierStyleCrossRefs" href="#bib0300">20,22</a> that compared UV-A1 to NB UV-B found no important differences between the treatment modalities. It should be noted that an unconventional UV-A1 regimen was used in all 4 studies (2 or 3 weekly sessions instead of 5); the effectiveness of UV-A1 could, therefore, be greater.A RCT<a class="elsevierStyleCrossRef" href="#bib0340">28</a> with no follow-up period compared 8-MOP PUVA bath therapy to NB UV-B. The results were consistent with clinically relevant differences between the treatments, but the statistical power of the study was low. Another study<a class="elsevierStyleCrossRef" href="#bib0235">7</a> found that oral 5-MOP PUVA therapy yielded a significantly longer remission time than UV-A1, although differences in treatment duration and frequency of application may have influenced the results.As for the more novel techniques, FSL<a class="elsevierStyleCrossRef" href="#bib0280">16</a> and EL<a class="elsevierStyleCrossRef" href="#bib0240">8</a> have each been evaluated in an RCT and found to have optimal results, although publication bias may have played a role. Similarly, there is scant evidence on combined therapies. One study<a class="elsevierStyleCrossRef" href="#bib0230">6</a> found sBPT to be superior to NB UV-B. In another study,<a class="elsevierStyleCrossRef" href="#bib0275">15</a> the addition of topical corticosteroids to UV-AB therapy was found to reduce UV-B dose and treatment duration. In an RCT<a class="elsevierStyleCrossRef" href="#bib0270">14</a> carried out in children, concomitant use of topical pimecrolimus during NB UV-B therapy did not yield any added benefit. Only 1 RCT<a class="elsevierStyleCrossRef" href="#bib0285">17</a> has compared an immunosuppressive treatment—ciclosporin A—to UV-AB. Ciclosporin A had significantly better results, but the UV-AB doses were suboptimal and the study had a high risk of bias.All phototherapy modalities were generally described as well-tolerated, although adverse effects were recorded systematically in only a few RCTs. The absence of standardized protocols for the application of these techniques—determination of initial dose according to skin phototype or MED, incremental dose increases, frequency of sessions, etc.—makes it difficult to interpret and compare the results. Given the heterogeneity of the treatments and the reporting deficiencies, we opted not to conduct a meta-analysis.Quality of EvidenceIn general, the studies had a high or uncertain risk of bias<a class="elsevierStyleCrossRef" href="#bib0225">5</a> and omitted relevant information. In many studies, the number of participants was small, the randomization method was unclear, and patients lost to follow-up were excluded from statistical analysis. The follow-up period was short or nonexistent in most of the studies. In RCTs that used within-patient comparisons, there is a possibility of bias resulting from the possible systemic effect of phototherapy applied to each side of the body.Patient inclusion and exclusion criteria varied, and the criteria of Hanifin and Rajka were not used in all of the RCTs. In one RCT,<a class="elsevierStyleCrossRef" href="#bib0270">14</a> the inclusion and exclusion criteria were not mentioned explicitly.Potential Biases in the Review ProcessTo ensure that we compiled as many studies as possible, we reviewed the Global Resource of Eczema Trials database (Centre of Evidence Based Dermatology, <a href="http://www.greatdatabase.org.uk/">http://www.greatdatabase.org.uk/</a>) and found no RCTs that had not been included in our results. However, we restricted our search to studies in English, French, and Spanish. Dr José Manuel Carrascosa, an expert in phototherapy treatment, reviewed our results and detected only the absence of studies in German. Another recent systematic review<a class="elsevierStyleCrossRef" href="#bib0220">4</a> included only 1 article<a class="elsevierStyleCrossRef" href="#bib0355">31</a> in German.Finally, publication bias is possible, given that most of the studies reported a positive result for the tested treatment modality; however, this bias is less likely because none of the studies were placebo-controlled.Comparison With Previous Systematic ReviewsThere have been 2 previous systematic reviews on phototherapy in AD. The first review<a class="elsevierStyleCrossRef" href="#bib0215">3</a> did not include studies of PUVA therapy. This review concluded that UV-A1 phototherapy, if available, should be used to treat acute forms of AD and that NB UV-B should be used to treat chronic forms of AD. In our opinion, these conclusions are difficult to justify because these clinical differences are not well established in the cited studies. As for the more recent systematic review,<a class="elsevierStyleCrossRef" href="#bib0220">4</a> there were 4 discrepancies between the RCTs we selected and those selected by the other authors. We included 2 studies<a class="elsevierStyleCrossRefs" href="#bib0240">8,14</a> comparing topical therapy to phototherapy that the other review omitted because the authors considered the diagnosis of AD to be doubtful. We also included a study<a class="elsevierStyleCrossRef" href="#bib0295">19</a> that evaluated the utility of reflectance-guided UV-B for reducing UV-B dose. Finally, we omitted 1 study<a class="elsevierStyleCrossRef" href="#bib0355">31</a> included in the other review because it was published in German.ConclusionsImplications for Practice<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•There is evidence to support the use of NB UV-B and UV-A1 phototherapy in moderate to severe forms of AD. There is scant evidence to support the use of PUVA.</li><li class="elsevierStyleListItem" id="lsti0010">•It may be possible to find indications for modalities such as EL in the prurigo form of AD, FSL, and sBPT, but further studies are needed.</li><li class="elsevierStyleListItem" id="lsti0015">•Data on the use of phototherapy in childhood AD are limited, and therefore caution must be exercised when this technique is used in children. There is no evidence to support the use of phototherapy in pregnant women with AD.</li><li class="elsevierStyleListItem" id="lsti0020">•There are few data on the long-term effects of phototherapy in AD, including possible carcinogenic effects.</li><li class="elsevierStyleListItem" id="lsti0025">•We found no RCTs comparing the use of phototherapy to the use of oral corticosteroids.</li></ul>Implications for Future Research<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030">•Only 1 RCT has compared systemic immunosuppressive therapies to phototherapy, and it did not include the modalities for which the strongest evidence is available (NB UV-B and UV-A1).</li><li class="elsevierStyleListItem" id="lsti0035">•AD severity assessment criteria, irradiation techniques, and assessment scales and other outcome measures should be standardized; this is the objective of the Harmonizing Outcome Measures for Eczema initiative (<a href="http://homeforeczema.org/">http://homeforeczema.org/</a>).</li><li class="elsevierStyleListItem" id="lsti0040">•Given the impact of AD, it is surprising that only 2 studies included quality-of-life measures (Skindex and the Eczema Disability Index) and that only 2 other studies included subjective assessment scales.</li><li class="elsevierStyleListItem" id="lsti0045">•A minimum follow-up period should be included and tolerability parameters and adverse effects should be recorded.</li><li class="elsevierStyleListItem" id="lsti0050">•Results should be reported in accordance with the Consolidated Standards of Reporting Trials statement.</li></ul>Conflicts of InterestThe authors declare that they have no conflicts of interest.Ethical DisclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this investigation.Data confidentialityThe authors declare that no private patient data are disclosed in this article.Right to privacy and informed consentThe authors declare that no private patient data are disclosed in this article." "textoCompletoSecciones" => array:1 [ "secciones" => array:15 [ 0 => array:3 [ "identificador" => "xres520376" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Material and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec540933" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres520377" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec540932" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Identification of Studies" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Study Inclusion Criteria" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Data Management and Extraction" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Excluded Studies" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Included Studies" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Risk of Bias in the Included Studies" ] ] ] 7 => array:3 [ "identificador" => "sec0050" "titulo" => "Effect of the Interventions" "secciones" => array:1 [ 0 => array:3 [ "identificador" => "sec0055" "titulo" => "Comparison of Different Phototherapy Modalities" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Classic Types of Phototherapy: UV-A, UV-B, and UV-AB (Table 1)" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "High-Dose UV-A1 and Medium-Dose UV-A1 (Table 2)" ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Narrowband UV-B (Table 3)" ] 3 => array:2 [ "identificador" => "sec0075" "titulo" => "Psoralen Plus UV-A Therapy (Table 4)" ] 4 => array:2 [ "identificador" => "sec0080" "titulo" => "Studies Comparing Phototherapy to Other Treatments for Atopic Dermatitis (Table 5)" ] 5 => array:2 [ "identificador" => "sec0085" "titulo" => "Other Studies (Table 6)" ] ] ] ] ] 8 => array:2 [ "identificador" => "sec0090" "titulo" => "Registered Studies Currently Underway (Table 7)" ] 9 => array:3 [ "identificador" => "sec0095" "titulo" => "Discussion" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0100" "titulo" => "Summary of Main Results" ] 1 => array:2 [ "identificador" => "sec0105" "titulo" => "Quality of Evidence" ] 2 => array:2 [ "identificador" => "sec0110" "titulo" => "Potential Biases in the Review Process" ] 3 => array:2 [ "identificador" => "sec0115" "titulo" => "Comparison With Previous Systematic Reviews" ] ] ] 10 => array:3 [ "identificador" => "sec0120" "titulo" => "Conclusions" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0125" "titulo" => "Implications for Practice" ] 1 => array:2 [ "identificador" => "sec0130" "titulo" => "Implications for Future Research" ] ] ] 11 => array:2 [ "identificador" => "sec0135" "titulo" => "Conflicts of Interest" ] 12 => array:3 [ "identificador" => "sec0140" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0145" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0150" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0155" "titulo" => "Right to privacy and informed consent" ] ] ] 13 => array:2 [ "identificador" => "xack178204" "titulo" => "Acknowledgments" ] 14 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-09-30" "fechaAceptado" => "2014-12-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec540933" "palabras" => array:4 [ 0 => "Atopic dermatitis" 1 => "Phototherapy" 2 => "Photochemotherapy: Systematic review" 3 => "Psoralen+ultraviolet A" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec540932" "palabras" => array:5 [ 0 => "Dermatitis atópica" 1 => "Fototerapia" 2 => "Fotoquimioterapia" 3 => "Revisión sistemática" 4 => "Psoraleno + terapia ultravioleta A" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundPhototherapy is a treatment option for atopic dermatitis recommended by several guidelines. ObjectiveTo perform a systematic review of the efficacy of different modalities of phototherapy and photochemotherapy in moderate to severe atopic dermatitis. Material and methodsWe considered all randomized clinical trials (RCTs) performed in patients with atopic dermatitis, and accepted all outcome measures. Articles were identified via an online search of the MEDLINE (via Ovid) and Embase databases and the Cochrane Central Register of Controlled Trials. We also searched for clinical trials registered in Current Controlled Trials and in the World Health Organization's International Clinical Trials Registry Platform. ResultsTwenty-one RCTs (961 patients) were included in the qualitative analysis. Two of the trials included children and adolescents (32 patients). The efficacy of narrow-band UV-B and UV-A1 phototherapy was similar for the different outcome measures contemplated. Two RCTs assessed the efficacy of psoralen plus UV-A therapy (PUVA). No serious adverse events were described. In general, the publications reviewed were characterized by a high risk of bias and poor reporting of methodology and results. ConclusionsThere is evidence for the use of narrow-band UV-B and UV-A1 phototherapy in moderate to severe atopic dermatitis. Evidence supporting the use of PUVA in atopic dermatitis is scarce and there is little information on the use of phototherapy in childhood. For the purpose of future studies, it would be advisable to use comparable criteria and scales for the evaluation of disease severity and patients, to standardize radiation methods, and to establish a minimum follow-up time." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Material and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "AntecedentesLa fototerapia es una opción terapéutica empleada en dermatitis atópica (DA) y recomendada en múltiples guías. ObjetivosEvaluar la eficacia de las distintas modalidades de fototerapia y fotoquimioterapia en el tratamiento de pacientes con DA moderada-grave, mediante una revisión sistemática. Material y métodosConsideramos los ensayos clínicos aleatorizados (ECA) realizados en pacientes con DA, aceptando cualquier medida de desenlace. Localizamos los artículos mediante una búsqueda electrónica, utilizando Medline (vía Ovid), Embase y Cochrane Central Register of Controlled Trials. Adicionalmente, buscamos los ensayos clínicos registrados en Current Controlled Trials y en la WHO International Clinical Trials Registry Platform. ResultadosIncluimos 21 ECA en el análisis cualitativo (961 pacientes). Dos ECA incluyeron niños y adolescentes (32 pacientes). Las modalidades UVBBE y UVA1 mostraron resultados de eficacia similares en diversas medidas de desenlace. Dos ECA incluyeron la terapia PUVA. No se describieron efectos secundarios graves. En general, el riesgo de sesgos fue elevado y la calidad de las publicaciones baja, en cuanto a comunicación de la metodología empleada y los resultados obtenidos. ConclusionesExiste evidencia para el uso de UVBBE y UVA1 en DA moderada-grave. La evidencia para el uso de PUVA en DA es mínima, así como los datos del uso de la fototerapia en la infancia. En futuros estudios sería recomendable estandarizar los criterios de gravedad de la DA y las escalas de valoración de los pacientes, homogeneizar las técnicas de irradiación y establecer un periodo de seguimiento mínimo." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Pérez-Ferriols A, Aranegui B, Pujol-Montcusí JA, Martín-Gorgojo A, Campos-Domínguez M, Feltes RA, et al. Modalidades de fototerapia para el tratamiento de la dermatitis atópica: revisión sistemática de la literatura. Actas Dermosifiliogr. 2015;106:387–401." ] ] "multimedia" => array:9 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3503 "Ancho" => 3253 "Tamanyo" => 405150 ] ] "descripcion" => array:1 [ "en" => "Flow of articles during the review process. a Kowalzick et al<a class="elsevierStyleCrossRef" href="#bib0360">32</a> b Kowalzick et al,<a class="elsevierStyleCrossRef" href="#bib0360">32</a> David,<a class="elsevierStyleCrossRef" href="#bib0365">33</a> Der-Petrossian et al,<a class="elsevierStyleCrossRef" href="#bib0370">34</a> Granlund Het,<a class="elsevierStyleCrossRef" href="#bib0375">35</a> Niedner and Iliev,<a class="elsevierStyleCrossRef" href="#bib0380">36</a> Potekaev et al,<a class="elsevierStyleCrossRef" href="#bib0385">37</a> Raap et al,<a class="elsevierStyleCrossRef" href="#bib0390">38</a> Schiener et al,<a class="elsevierStyleCrossRef" href="#bib0395">39</a> Sowden et al<a class="elsevierStyleCrossRef" href="#bib0400">40</a> c Heinlin et al,<a class="elsevierStyleCrossRef" href="#bib0230">6</a> Der-Petrossian et al,<a class="elsevierStyleCrossRef" href="#bib0340">28</a> Reynolds et al.<a class="elsevierStyleCrossRef" href="#bib0350">30</a>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3041 "Ancho" => 2341 "Tamanyo" => 509720 ] ] "descripcion" => array:1 [ "en" => "Risk of bias. + indicates low risk of bias; ?, unknown risk of bias; –, high risk of bias; 1, generation of random allocation sequence (selection bias); 2, intervention allocation (selection bias); 3, masking of participants and personnel (performance bias); 4, masking of assessors (detection bias); 5, incomplete outcome data (attrition bias); 6, selective reporting (reporting bias); 7, other biases; BJD, British Journal of Dermatology." ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "Abbreviations: ITT, intention to treat; MED, minimal erythema dose; NS, not specified; PI, principal investigator; UV-AB; combined UV-A and UV-B phototherapy." "tablatextoimagen" => array:4 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="6" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Jekler and Larkö 1988<a class="elsevierStyleCrossRef" href="#bib0320">24</a>: UV-B vs visible light, 8 weeks or until clearance</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Study 1: 0.5 or 1.0 MED UV-B vs visible light; 28 patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Outcome measure:Total score<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>Pruritus scoreOverall evaluationHealing score<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Baseline9.9 (6.5-19)2.2 (1-3)1.5 (1-3)- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UV-B5 (1-9)0.8 (0-2)0.7 (0-1.5)1.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Visible Light8 (4-13)1.8 (0.5-3)1.4 (0.5-2)0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">P<.001P<.001NSP<.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Study 2: 0.8 MED UV-B vs 0.4 MED UV-B;31 patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Total score<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>Pruritus scoreOverall evaluation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Baseline10.7 (6-19)2.4 (1-3)1.5 (1-3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.8 MED7 (0-21)1.2 (0-3)0.7 (0-1.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.4 MED6.6 (0-21) 1.2 (0-3)1.4 (0.5-2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">P<.01NSNS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Comment. Attrition was high in both studies (11 patients in Study 1 and 6 in Study 2). Study 1: High risk of detection bias (the PI was the assessor). Results were not reported as a function of MED. Study 2: Statistical analysis did not show differences in the efficacy of the 2 treatments. Selective reporting (changes in the affected surface were not reported).</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840227.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="6" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Jekler and Larkö 1990<a class="elsevierStyleCrossRef" href="#bib0325">25</a>: UV-B vs UV-AB, 3 sessions/week for 8 weeks; 39 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Outcome measure:Total score<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>Pruritus scoreOverall evaluation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Baseline10.8 (7-19)2.4 (1-3)1.7 (1-3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UV-B6.1 (0-17)1.2 (0-3)0.80 (0-3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UV-AB5.2 (0-15) 1.0 (0-3) 0.65 (0-2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">P=.002P=.04P=.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Healing score<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> (UV-B vs UV-AB, No. of patients out of 30)Subjective assessment of efficacyGreater use of hydrocortisoneAdverse effects \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 points, 4 vs 6; 2 points, 21 vs 20; 1 point, 4 vs 3; 0 points, 0 vs 0; –1 points, 1 vs 1.UV-AB preferred by 14; both preferred equally by 10.UV-B side, 3/20; UV-AB side, 1/20; same on both sides, 16/20.Mild or moderate xerosis, 15 vs 13; severe xerosis, 5 vs 2; mild or moderate burns, 15 vs 3; severe burns, 6 vs 0. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Comment. Combined UV-AB therapy may be superior to UV-B with this regimen. Risk of bias: randomization process not described; high risk of detection bias in participants, researchers, and outcome assessor.</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840216.png" ] ] 2 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="6" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Jekler and Larkö 1991<a class="elsevierStyleCrossRef" href="#bib0330">26</a>: UV-A vs UV-B, 3 sessions/week for 8 weeks or until healing; 33 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Outcome measure:Total score<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>Pruritus scoreOverall evaluation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Baseline10.3 (6-18)2.2 (1-3)1.8 (1-3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UV-A5.5 (1-12)(0-2)1 (0-2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UV-B6.4 (3-15.5)1.3 (0-2)1.3 (0.5-2.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">P<.02P=.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Healing score<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> (UV-A vs UV-B)ExtentSubjective assessment of efficacy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 points, 1 vs 0; 2 points, 14 vs 13; 1 point, 6 vs 6; 0 points, 0 vs 2; –1 points, 0 vs 0.From 10.1% to 5.4% (UV-A) and from 10% to 6.2% (UV-B) (P<.05).13 noticed improvement in the area treated with UV-A; 4 noticed no difference. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Comment. UV-A may be superior to UV-B with this regimen. Randomization not described. High risk of performance bias, detection bias, and selective reporting: Only some variables were analyzed; 4 patients did not complete the subjective assessment of the efficacy of the interventions.</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840210.png" ] ] 3 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="6" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Jekler and Larkö 1991<a class="elsevierStyleCrossRef" href="#bib0315">23</a></th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Study 1:Low-dose UV-B vs UV-AB;20 patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Outcome MeasureTotal score<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>Pruritus scoreOverall evaluation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Baseline10.8 (7-15.5)2.4 (1-3)1.9 (1-2.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UV-B8.8 (4.5-14) 1.5 (0-2)1.8 (1-2.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UV-AB5.3 (1.1-11) 0.8 (0-2)0.9 (0-2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">P<.001P<.001P<.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Healing score<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> (patients in UV-B group vs patients in UV-AB group): 3 points, 0 vs 2; 2 points, 5 vs 15; 1 point, 11 vs 1; 0 points, 2 vs 0; –1 points, 0 vs 0. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Study 2:UV-A vs UV-AB; 28 patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UV-AB yielded better results than UV-A in total score and overall evaluation. No differences in pruritus. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Comment. UV-AB was apparently superior to UV-B and UV-A. High risk of detection bias (blinding of outcome assessor), attrition bias (no ITT analysis performed in excluded individuals, lack of patient questionnaires), and reporting bias (more variables were recorded than were analyzed; specific results of Study 2 were not reported).</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840211.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "The total score is the sum of the scores for 8 variables evaluated on a scale of 0-3 (pruritus, lichenification, desquamation, erythema, xerosis, vesiculation, excoriations, and overall evaluation)." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "The healing scale is a 5-point scale: 3, healed; 2, considerable improvement; 1, some improvement; 0, no change; –1, worsening." ] ] ] "descripcion" => array:1 [ "en" => "Studies Comparing UV-A, UV-B, and UV-AB." ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "Abbreviations: CR, complete remission; HD, high-dose; ITT, intention to treat; MD, medium-dose; MED, minimal erythema dose; SCORAD, SCORing Atopic Dermatitis; SSS, Simple Scoring System; UV-AB; combined UV-A and UV-B phototherapy." "tablatextoimagen" => array:4 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="4" align="right" valign="top" scope="col" style="border-bottom: 2px solid black">Krutmann et al, 1992<a class="elsevierStyleCrossRefs" href="#bib0250">10,13</a>: HD UV-A1 (130J/cm2) vs UV-AB, 15 sessions; 25 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Outcome measures:Total SSS score<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a>Severity scoreTopographic score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Baseline53 (1.9)36.4 (1.7)18.7 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HD UV-A114 (3.2)8.9 (1.1)6.3 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Statistically significant differences (P<.01) in all 3 measures comparing HD UV-A1 to UV-AB \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Comment. HD UV-A1 appeared to be more effective than UV-AB against acute exacerbations. High risk of attrition bias and reporting bias: Results for the UV-AB group were not reported (except baseline scores) and there are discrepancies between the baseline values reported in the initial table and those which appear in the text. The most appropriate analysis would be a comparison between the baseline and final values for each outcome measure, rather than comparisons at each time point. Adverse effects were not systematically specified. It is not known whether the tenth patient in the UV-AB group, who abandoned the treatment on the third day, was included in the analysis.</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840220.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="4" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Krutmann et al, 1998<a class="elsevierStyleCrossRef" href="#bib0290">18</a>: HD UV-A1 vs UV-AB vs 0.5% fluocortolone cream or ointment, 10 days; 53 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Outcome measure: SSS score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Significant differences were found in SSS scores in favor of HD UV-A1 and fluocortolone as compared to UV-AB (P<.0001 in both cases) and in favor of HD UV-A1 as compared to fluocortolone (P<.002). \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Comment. HD UV-A1 appeared to be superior to UV-AB and at least as effective as topical treatment with fluocortolone. The randomization sequence was explicitly described; block randomization was used. High risk of attrition bias: Results were not specified; only the statistical significance levels of the differences obtained were reported and represented in a figure. The most appropriate analysis would be a comparison between the baseline and final values for each outcome measure, rather than comparisons at each time point. No adverse effects were described.</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840226.png" ] ] 2 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Tzaneva et al, 2001<a class="elsevierStyleCrossRef" href="#bib0305">21</a>: HD UV-A1 (130J/cm2 or a dose equivalent to 1 MED if <130J/cm2, with increments of 10J/cm2 up to a maximum of 130J/cm2) vs MD UV-A1 (50% of the HD UV-A1 regimen), 5 sessions/week for 3 weeks and 6 months of follow-up</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Outcome measures:Modified SCORAD,<a class="elsevierStyleCrossRef" href="#tblfn0020">b</a> week 1Modified SCORAD, week 2Modified SCORAD, week 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HD UV-A133.4% (8.8%-52.7%)38.4% (1.5%-56.7%)34.7% (0%-46.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MD UV-A129.7% (8.3%-46.8%)36.4% (12.6%-56.6%)28.2% (0%-46.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">P>.05 in all cases \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Recurrences: 6 patients at 2, 4, and 12 weeks; 1 patient in remission at 6 months.There were no bilateral differences in time until recurrence or in intensity of recurrence.</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Comment. There were no statistically significant differences in the efficacy of the 2 treatments, although the sample size was small. Of the 10 initial patients, only 7 were followed up and recurrences were frequent. Risk of bias related to randomization (the procedure is not described). Patients were not masked. “Recurrences” were not defined.</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840218.png" ] ] 3 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top" style="border-bottom: 2px solid black">Kobyletzki et al, 1999,<a class="elsevierStyleCrossRef" href="#bib0245">9</a> Kobyletzki, 1999<a class="elsevierStyleCrossRef" href="#bib0260">12</a>: Cold-light UV-A1 vs UV-A1 vs UV-AB, 5 sessions/week for 3 weeks and 4 weeks of follow-up</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Outcome measures:CR90% clearance60% clearanceBaseline SCORAD<a class="elsevierStyleCrossRef" href="#tblfn0025">c</a>SCORAD week 3SCORAD week 7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cold-light UV-A185.4%27.1%58.3%71.7 (12.6)23.3 (10.6) (P<.05)24.9 (10.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UV-A177.3%15.9%61.4%69.8 (10.2)28.8 (6.9) (P<.05)30.8 (9.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UV-AB37.5%6.3%31.3%71 (9.4)41.4 (9.9) (P<.05)52.3 (11.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Attrition: 5 patients in the UV-A1 group (discomfort, pruritus, and exacerbation).</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Comment. Cold-light UV-A1 appeared to be superior to UV-A1 and both appeared to be superior to UV-AB, although the decrease in SCORAD scores was significant in all 3 modalities. After 4 weeks of follow-up, SCORAD scores remained lowest with cold-light UV-A1. The randomization method was not described. No ITT analysis was performed and attrition was high in some groups.</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840221.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "Costa's Simple Scoring System scores 10 severity criteria (erythema, edema, vesicles, oozing, crusts, lichenification, desquamation, pruritus, and sleep loss) on a scale of 0 to 6 and 10 topographic sites (face, neck, anterior trunk, posterior trunk, buttocks, arms, hands, legs, knees, and feet) on a scale of 0 to 3, according to the extent of the lesions." ] 1 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "b" "nota" => "Modified SCORAD scale: Assessment of the degree of facial involvement was excluded because the face was only irradiated with UV-A1. Subjective assessment of impact on sleep was also excluded." ] 2 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "c" "nota" => "SCORAD assesses the severity of atopic dermatitis on the basis of 3 aspects: extent or affected surface area; intensity (erythema, edema/papules, excoriations, oozing, lichenification, and dryness are scored on a severity scale of 0 to 3); and pruritus and sleeplessness (scale of 0 to 10)." ] ] ] "descripcion" => array:1 [ "en" => "Studies Comparing HD UV-A1 (130J/cm2) and MD UV-A1." ] ] 4 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "Abbreviations: AD, atopic dermatitis; NB, narrowband; MD, medium-dose; RR, relative reduction; SASSAD, Six Area, Six Sign Atopic Dermatitis; SSS, Simple Scoring System; VAS, visual analog scale." "tablatextoimagen" => array:4 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Reynolds et al, 2001<a class="elsevierStyleCrossRef" href="#bib0350">30</a>: NB UV-B vs MD UV-A1 (maximum 15J/cm2) vs visible light (2 sessions/week for 12 weeks and 3 months of follow-up); 73 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Outcome measures:Mean reduction in total AD activity<a class="elsevierStyleCrossRef" href="#tblfn0030">a</a>Decrease in pruritusImprovement in sleepDecrease in topical corticosteroid use \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NB UV-B9.4 points>visible light (95% CI, 3.6-15.2) and 5 points> UV-A1 (95% CI: 0.6-10.5).90%71%65% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MD UV-A14.4 points> visible light (95% CI, –1-9.8).63%53%56% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Mean decrease in extent of AD with NB UV-B: 7.8%>MD UV-A1 (95% CI, 2.8-12.7) and 6.7%>visible light (95% CI, 1.5-11.9).At 3 months, total AD activity was lower in the NB UV-B group than in the MD UV-A1 group and the visible light group (–36% [7 vs 65] and –36% [8 vs 64], respectively).</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Comment. NB UV-B was superior in controlling AD, and the results were maintained after 3 months of follow-up. Randomization was carried out with a computer program and the researcher was not involved in patient assessment. The method of masking patients and assessors was not described.</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840219.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Legat et al, 2003<a class="elsevierStyleCrossRef" href="#bib0335">27</a>: NB UV-B vs MD UV-A1 (maximum dose 50J/cm2), 2 sessions/week for 8 weeks; 9 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Outcome measures:Decrease in SSS score,<a class="elsevierStyleCrossRef" href="#tblfn0035">b</a> %Decrease in Leicester score,<a class="elsevierStyleCrossRef" href="#tblfn0040">c</a> %Decrease in skin lesion VAS score, %Decrease in pruritus VAS score, %Overall evaluation of effect of treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NB UV-B40 (2-61) (P=.004)50 (2-74) (P=.01)71 (3-98) (P=.004)67 (−8-98) (P=.055)6.4 (1.2-9.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MD UV-A133 (8-48) (P=.055)30 (9-63) (P=.1)40 (7-99) (P=.04)34 (9-97) (P=.15)4.5 (0.5-9.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Attrition: 2 patients withdrew, after 4 and 6 weeks, respectively, because their scores after NB UV-B were<30% of the scores after MD UV-A1.</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Comment. NB UV-B was more effective than MD UV-A1, and the differences in the SSS scores, the Leicester scores, and the lesion assessment VAS scores were statistically significant. No long-term follow-up was conducted. Possible performance bias and detection bias (in randomization and masking). It is not known whether the 2 patients who withdrew were included in the analysis.</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840228.png" ] ] 2 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="4" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Majoie et al, 2009<a class="elsevierStyleCrossRef" href="#bib0300">20</a>: NB UV-B vs MD UV-A1 (30J/cm2 up to a maximum of 45J/cm2), 3 sessions/week for 8 weeks and 4 weeks of follow-up; 13 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Outcome measures:Decrease in Leicester score, medianDecrease in pruritus VAS score, median \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NB UV-BFrom 18 to 10From 7 to 1.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MD UV-A1From 19 to 12From 7 to 4.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(P<.01)(P<.01) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">There was a significant decrease in immunohistochemical findings suggestive of inflammation, and there were no significant differences between groups.</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Comment. MD UV-A1 and NB UV-B appear to be effective in clinical control and control of inflammatory markers in moderate to severe AD. The results obtained after follow-up were not analyzed because of the uncontrolled use of topical corticosteroids. Unknown risk of performance bias (randomization method not described). No adverse effects were described.</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840223.png" ] ] 3 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Gamblicher et al, 2009<a class="elsevierStyleCrossRef" href="#bib0310">22</a>: NB UV-B vs MD UV-A1 (50J/cm2) crossover study: 3 sessions/week for 6weeks →minimum 8 week washout period →3 sessions/week for 6 weeks; 47 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">No interaction was found between treatment sequence and treatment effects (P=.81).</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Outcome measures:SASSAD score, mean (SD) RR, %Pruritus VAS score, mean (SD) RR, %Skindex-29 score, mean (SD) RR, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NB UV-B39.4 (24.1)25.2 (30.5)16.5 (17.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MD UV-A143.7 (31.4)16 (61.8)12.7 (18.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">P=.4P=.49P=.35 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Adverse effects: mild erythema in 1 patient in the MD UV-A1 group and 3 patients in the NB UV-B group.</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Comment. The number of patients lost to follow-up was high but balanced between the 2 groups. The follow-up period was very short. Low risk of bias: Randomization was computer-generated and concealed, masking was carried out, adverse effects were recorded, protocol was registered, and all expected outcomes were reported.</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840213.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "a" "nota" => "After 24 treatments. Disease activity was measured using the modified scale described by Sowden et al.<a class="elsevierStyleCrossRef" href="#bib0400">40</a>" ] 1 => array:3 [ "identificador" => "tblfn0035" "etiqueta" => "b" "nota" => "Costa's Simple Scoring System: See <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>." ] 2 => array:3 [ "identificador" => "tblfn0040" "etiqueta" => "c" "nota" => "The Leicester scale scores 6 clinical features (erythema, purulence, excoriation or crusting, dryness or scaling, cracking or fissuring, and lichenification) at 6 body sites on a scale of 0 (none) to 3 (severe)." ] ] ] "descripcion" => array:1 [ "en" => "Studies Comparing NB UV-B and MD UV-A1." ] ] 5 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Abbreviations: 5-MOP, 5-methoxypsoralen; 8-MOP, 8-methoxypsoralen; ITT, intention to treat; MD, medium-dose; NB, narrowband; PUVA, psoralen plus UV-A; SCORAD, SCORing Atopic Dermatitis." "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="4" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Der-Petrossian et al, 2000<a class="elsevierStyleCrossRef" href="#bib0340">28</a>: 8-MOP PUVA bath therapy vs NB UV-B, 3 days/week for 6 weeks; 12 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Outcome measures: Decrease in modified SCORAD, %Week 2Week 4Week 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PUVA Bath Therapy32.947.165.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NB UV-B24.344.564.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">P=.09P=.51P=.48 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Comment. Confidence intervals were not provided, making it difficult to evaluate the observed clinical difference. The study had low statistical power. Studies with a larger number of patients are needed. Uncertain risk of selection and detection biases (patients were not blinded). No ITT analysis was performed (2 patients were excluded, 1 of whom received oral corticosteroids to treat a flare).</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840230.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Tzaneva et al, 2010<a class="elsevierStyleCrossRef" href="#bib0235">7</a>: MD UV-A1 (5 days/weekfor3 weeks, 70J/cm2) vs PUVA (5-MOP 1.2mg/kg; 3 days/weekfor5 weeks); 40 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Outcome measures:Length of remission, mean, wkReduction in SCORAD since baseline visit, mean (SD), % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MD UV-A1437.7 (22.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PUVA1254.3 (25.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">P=.012P=.041 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Adverse effects: Mild palmoplantar erythema (MD UV-A1, 2; PUVA, 9); folliculitis (MD UV-A1, 1; PUVA, 2); sensation of warmth or burning (MD UV-A1, 7); photo-onycholysis (PUVA, 2).</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Comment. PUVA appears to be superior to MD UV-A1 in reducing SCORAD scores and increasing length of remission. In this study, 5-MOP was used instead of 8-MOP. The difference in treatment duration (3 vs 5 weeks) may have influenced the results. Risk of biases: Interventions were allocated by coin toss, but the allocation sequence concealment method was not described (selection bias). Uncertain performance bias in relation to the masking of researchers. Patients were not masked. The second phase of the study was initiated in the event of substantial relapse (SCORAD≥50% of baseline score) or at the request of the patient.</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840212.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Studies Comparing PUVA to Other Interventions." ] ] 6 => array:7 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "Abbreviations: EASI, Eczema Area and Severity Index; EDI, Eczema Disability Index; NB, narrowband; NS, not specified; TCS, topical corticosteroids; UV-AB, combined UV-A and UV-B phototherapy." "tablatextoimagen" => array:3 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Granlund et al, 2001<a class="elsevierStyleCrossRef" href="#bib0285">17</a>: UV-AB (maximum 15J/cm2 UV-A and 0.26J/cm2 UV-B, 2-3 sessions/week) vs ciclosporin A (4mg/kg/d, increased or decreased in increments of 1mg/kg/d according to response) for 12 months; 72 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Outcome measures:Length of remission, d, mean (SD)Change in TCS use, mean (SD)<a class="elsevierStyleCrossRef" href="#tblfn0045">a</a>Change in emollient use, mean (SD)<a class="elsevierStyleCrossRef" href="#tblfn0045">a</a>Evaluation of treatment as good or very goodChange in quality of life, EDI score, mean (SD)Overall adverse effects \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ciclosporin A186 (84)45 (74)75 (166)Patients, 86%Researchers, 98%At 4 weeks: –17 (11)At 8 weeks: –17 (27)End of study: –13 (32)35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UV-AB114 (118)43 (99)41 (287)60%44%–9 (9)–12 (13)–12 (12)32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">P<.01P<.001P<.001P<.01NSNS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Comment. Results were in favor of ciclosporin but the study had a high risk of bias: The fluences used for both UV-A and UV-B were relatively low (patients in the phototherapy arm of the study may have been undertreated). Uncertain selection bias (randomization). Assessors were not masked. Attrition bias: Many patients were lost to follow-up, especially in the UV-AB group, and the number of treatment cycles was smaller in the UV-AB arm of the study. Funded by Novartis (manufacturer of ciclosporin A).</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840209.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Tzung et al, 2006<a class="elsevierStyleCrossRef" href="#bib0270">14</a>: Group 1: pimecrolimus + NB UV-B vs pimecrolimus. Group 2: pimecrolimus + NB UV-B vs NB UV-B for 6 weeks and 4 weeks of follow-up; 26 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Outcome measures:Reduction in EASI scores, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Group 156 vs 53 (P=.084) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Group 259 vs 55 (P=.059 at week 6 and P=.09 after 4 weeks of follow-up) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Reduction in mean pruritus score: NB UV-B + pimecrolimus, 3.1; pimecrolimus, 3; NB UV-B, 3 (P<.001, P=.002, and P=.004, respectively)</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Comment. The pimecrolimus + NB UV-B combination was not demonstrated to be superior. Inclusion and exclusion criteria were not clearly specified. Uncertain risk of selection bias (randomization), performance bias (participants were not blinded), and attrition bias (withdrawals were not explained). Selective reporting: Flares after treatment were measured, although this variable does not appear in the methods section. Measures of dispersion were not provided.</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840224.png" ] ] 2 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Valkova and Velkova 2004<a class="elsevierStyleCrossRef" href="#bib0275">15</a>: UV-AB vs UV-AB + topical corticosteroids (fluticasone or hydrocortisone butyrate), 5 sessions/week for 12 weeks; 31 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Reduction in severity score, mean (SD)Reduction in topographic score, mean (SD)Reduction in general score, mean (SD)No. of sessionsUV-B dose, mean (SD), J/cm<a class="elsevierStyleCrossRef" href="#bib0210">2</a>Length of remission, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UV-ABFrom 659.8 (62.6) to 132 (28.8) (P<.0001); from 46.2 (4.8) to 9.7 (1.8) (P<.0001); from 360.4 (37.6) to 37.9 (6.7) (P<.0001); 18.3 (0.8) (P=.02);2.3 (0.12) (P=.03);4.5 (0.4) (P=.39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UV-AB + corticosteroidsFrom 682.5 (50.5) to 136.9 (33.2) (P<.0001);from 43.6 (3.9) to 8.9 (1.8) (P<.0001);from 395.4 (35) to 36.9 (7.3) (P<.0001);15.6 (0.6) (P=.02);1.9 (0.14) (P=.03);4.1 (0.4) (P=.39) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Comment. Both treatments induced significant improvement; the addition of topical corticosteroids decreased the total UV-B dose and the duration of treatment without influencing the duration of remissions or the frequency of adverse effects. Neither the amount of corticosteroids applied nor the length of the follow-up period were quantified. High risk of detection bias (masking) and uncertain risk of selection bias (randomization).</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840222.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0045" "etiqueta" => "a" "nota" => "In the first treatment cycle." ] ] ] "descripcion" => array:1 [ "en" => "Studies Comparing Phototherapy to Other Atopic Dermatitis Treatment Modalities." ] ] 7 => array:7 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Abbreviations: CP, clobetasol propionate; EL, excimer laser; FSL, full-spectrum light; F/U, follow-up; ITT, intention to treat; NB, narrowband; sBPT, synchronous balneophototherapy; SED, standard erythema dose; SIP, Sickness Impact Profile; PaGA, Patient's Global Assessment; PAIS, Physician Assessment of Individual Signs; PGA, Physician's Global Assessment; PGI, Patient Global Impression; SCORAD, SCORing Atopic Dermatitis.aP<.001.bP<.01.cP<.05 between EL and CP." "tablatextoimagen" => array:4 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Brenninkmeijer et al, 2010,<a class="elsevierStyleCrossRef" href="#bib0240">8</a> 2009<a class="elsevierStyleCrossRef" href="#bib0255">11</a>: 308nm EL (2 sessions/week) vs 0.05% CP (1 application/day) for 10 weeks and follow-up through week 34; 13 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Outcome measures:PAIS score, baseline, mean (SD)PAIS score, week 10, mean (SD)PAIS score, weeks 5-34, mean (SD)c>40% improvement in PAIS score, week 34Pruritus, week 34“Nearly clear” PGA score, week 34PaGA score, week 34Patient's preference \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">EL12.80 (1.5)7.5 (2.9)a8.38 (2.5)a8 lesions63% reduction6 patients7 prefer EL8 prefer EL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CP12.90 (1.2)8.0 (3.2)b9.30 (2)a3 lesions49% reduction2 patients4 prefer CP2 prefer CP \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Adverse effects: Mild and transient, 2 exacerbations.</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Comment. EL could be an alternative treatment for the prurigo form of atopic dermatitis. High risk of bias. It was impossible to blind the assessor because of the hyperpigmentation caused by EL. Therefore, histopathologic changes were studied at weeks 0 and 10 in the last 5 patients enrolled in the study. No ITT analysis was performed. Two patients withdrew due to exacerbation and 1 due to nonadherence.</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840215.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Byun et al, 2011<a class="elsevierStyleCrossRef" href="#bib0280">16</a>: FSL (320-5000nm, 2 sessions/week) + emollient vs emollient for 4 weeks; 38 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Changes in SCORAD scoresBaselineWeek 4Week 8Subjective assessment of patients, week 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">FSL + emollient47.8736.81 (–23.1%, P<.01)30.76 (–35.7%, P<.001)Excellent, 6/20; good, 9/20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Emollient39.4735.3933.85, P=.236Excellent, 7/18; good, 7/18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Adverse effects in FSL group: erythema, 6/20; dryness, 6/20; pruritus, 4/20; burning sensation, 2/20. Transient exacerbation in 6 patients (first 2 weeks).</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Comment. High risk of performance and detection biases (open study, lack of blinding, unspecified randomization method). Dissimilar baseline characteristics (the baseline SCORAD score difference was 47.87 in the FSL group and 39.79 in the control group).</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840214.png" ] ] 2 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Heinlin et al, 2011<a class="elsevierStyleCrossRef" href="#bib0230">6</a>: sBPT vs NB UV-B, 3-5 sessions/week until end of treatment (35 sessions or early cure), 6months of follow-up; 180 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Baseline SCORAD, mean (SD)SCORAD session 35, mean (SD)SCORAD 1 mo F/U, mean (SD)SCORAD 6 mo F/U, mean (SD)Baseline SIP, mean (SD)SIP session 35, mean (SD)SIP 1 mo F/U, mean (SD)SIP 6 mo F/U, mean (SD)PGI session 35PGI 1 mo F/UPGI 6 mo F/U \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">sBPT61.8(14.1)25.6(22)19.0(17.6)18.0(16.4)6.3(8)4.6(6.8)3.7(6.3)4.3(7.4)76.3%73.6%77.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NB UV-B61.5(12.4)34.6(22.3)31.1(19.6)25.3(21.9)5.5(5.6)4(5.5)3(3.6)3.3(5.7)55.4%52.6%49% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">P=.004P<.0001P=.04P=.77P=.98P=.98P=.99P=.002P=.004P=.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Comment. sBPT had better results than NB UV-B and remained superior after 6months. Low risk of biases. Assessors were not blinded because they worked at different private practices.</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840217.png" ] ] 3 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Selvaag et al, 2005<a class="elsevierStyleCrossRef" href="#bib0295">19</a>: UV-B vs reflectance-guided UV-B for up to 6 weeks or until a SCORAD score <10; 20 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">UV-B dose, SED (×10mJ/cm2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UV-BInitial 2.6 (1.9-2.8)Final 9.1 (4.7-14.7)Cumulative 124 (29-186) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reflectance-guided UV-B3.4 (2.6-5.8)4.9 (3.1-9.2)39 (16-88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">P<.01P<.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Comment. The radiation dose and the cumulative dose were lower with reflectance-guided UV-B. This was an open study with a high risk of performance and detection biases. No specific data were provided on adverse effects (it was noted that there were no differences).</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840225.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Studies Using Less Common Phototherapy Modalities." ] ] 8 => array:7 [ "identificador" => "tbl0035" "etiqueta" => "Table 7" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Abbreviations: NB, narrowband; PUVA, psoralen plus UV-A; SASSAD, Six Area, Six Sign Atopic Dermatitis; UV-AB, combined UV-A and UV-B phototherapy." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Identification number \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NCT01402414 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Title \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Narrow-band (NB)-UVB vs Bath-PUVA and NB-UVB Plus Salt Water Baths in Atopic Dermatitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Method \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Randomized observer-blinded controlled crossover trial \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Date registered \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">July 19, 2011 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Current status \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recruiting participants \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Estimated date of completion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">September 2014 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Participants \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Patients with atopic dermatitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Interventions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Group 1: NB UV-BGroup 2: PUVA bath therapyGroup 3: NB UV-B plus salt water baths \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Outcome measures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Primary:1. Clinical improvement using SASSAD indexSecondary:2. Evaluation of pruritus and sleeplessness using visual analogue scales (0-10)3. Patient satisfaction, safety and quality of life using Skindex-294. Immunohistochemical and serologic parameters \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Contact \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sarah Terras, MD (s.terras@klinikum-bochum.de) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Identification number \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NCT01254240 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Title \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Efficacy Study of Two Choices of Phototherapy on Itching Skin Diseases \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Method \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Randomized double-blind clinical trial \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Date registered \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">December 2, 2010 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Current status \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Recruiting participants \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Estimated date of completion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">June 2012 (end of data collection on main variable) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Participants \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Patients with pruritic inflammatory dermatoses (atopic dermatitis, other types of eczema, psoriasis, prurigo simplex subacuta) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Interventions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">UV-AB vs UV-B phototherapy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Outcome measures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Primary: 5-D pruritus score and visual analog scale score at 16 weeks \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Contact \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Guenther Hofbauer, MD, Leading Physician, University Hospital Zurich, Division of Dermatology (hofbauer@usz.ch);Alexander A. Navarini, MD PhD (alexander.navarini@usz.ch) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab840229.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Studies Currently Underway." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:40 [ 0 => array:3 [ "identificador" => "bib0205" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atopic dermatitis: Update and proposed management algorithm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Garnacho-Saucedo" 1 => "R. Salido-Vallejo" 2 => "J.C. 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Phototherapy in Atopic Dermatitis: A Systematic Review of the Literature

Modalidades de fototerapia para el tratamiento de la dermatitis atópica: revisión sistemática de la literatura

A. Pérez-Ferriolsa,

Corresponding author

perez_ampferr@gva.es

Corresponding auhtor.

, B. Araneguib, J.A. Pujol-Montcusíc, A. Martín-Gorgojod, M. Campos-Domíngueze, R.A. Feltesf, Y. Gilaberteg, B. Echeverría-Garcíah, A. Alvarez-Pérezi, I. García-Dovalb

a Dermatología, Hospital General Universitario de Valencia, Valencia, Spain

b Unidad de Investigación, Fundación Academia Española de Dermatología y Venereología, Madrid, Spain

c Dermatología, Hospital Universitari Joan XXIII, Tarragona, Spain

d Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, Dermatología, Clínica Ruber, Madrid, Spain

e Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain

f Dermatología, Hospital Universitario la Paz, Madrid, Spain

g Dermatología, Hospital San Jorge, Huesca, Spain

h Dermatología, Hospital Universitario de Fuenlabrada, Madrid, Spain

i Hospital Star Médica Querétaro, Santiago de Querétaro, Querétaro, Mexico

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Another recent systematic review<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> provided&#8212;like the present study&#8212;an update on the results of clinical trials published in the past few years&#44; including studies on PUVA&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The main objective of this study was to evaluate&#44; through a systematic review of the literature&#44; the efficacy of the various modalities and regimens of phototherapy and photochemotherapy used in the treatment of patients with moderate to severe AD&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Identification of Studies</span><p id="par0030" class="elsevierStylePara elsevierViewall">We used the MEDLINE &#40;via Ovid&#41; and Embase databases and the Cochrane Central Register of Controlled Trials &#40;CENTRAL&#41; to identify articles through the seventh week of 2013 &#40;Embase&#41; and through February 18&#44; 2013 &#40;MEDLINE and CENTRAL&#41;&#46; The search terms related to patient type and interventions were Medical Subject Headings &#40;MeSH&#41; terms and free terms&#46; The search terms related to design type were based on the Cochrane Highly Sensitive Search Strategy&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a> The results were limited to studies conducted in humans and published in English&#44; French&#44; or Spanish&#46; Before carrying out the online searches&#44; we identified 2 articles that met the inclusion criteria and were expected to be retrieved by the searches in all of the databases&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">6&#44;7</span></a> The search strategies will be provided on request by the corresponding author&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Additionally&#44; we carried out a search in PubMed Clinical Queries using the narrow search filter and a manual search of potentially relevant references cited in the included studies&#46; We also asked Dr Jos&#233; Manuel Carrascosa&#44; an expert on the treatment of AD with phototherapy&#44; to review our results in order to detect the possible absence of relevant studies&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Finally&#44; we also searched for clinical trials registered with Current Controlled Trials &#40;<a href="http://www.controlled-trials.com/">www&#46;controlled-trials&#46;com</a>&#41; and with the World Health Organization&#39;s International Clinical Trials Registry Platform &#40;<a href="http://apps.who.int/trialsearch/">http&#58;&#47;&#47;apps&#46;who&#46;int&#47;trialsearch&#47;</a>&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Study Inclusion Criteria</span><p id="par0045" class="elsevierStylePara elsevierViewall">We considered all randomized clinical trials &#40;RCTs&#41; performed in patients clinically diagnosed with atopic dermatitis&#44; without any age limit&#46; We accepted as interventions all types of phototherapy as well as phototherapy in combination with psoralens &#40;photochemotherapy&#41;&#46; We excluded animal studies&#44; studies in which the intervention was applied in localized areas &#40;hands or feet&#41;&#44; and studies in which the use of topical and&#47;or systemic corticosteroids and immunosuppressants was not systematized or controlled&#46; We accepted all outcome measures&#44; although measures of disease improvement or quality of life were preferred over economic or laboratory measures&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Data Management and Extraction</span><p id="par0050" class="elsevierStylePara elsevierViewall">The results obtained by the searches were downloaded to a reference management software package &#40;EndNote&#44; Thomson Reuters&#44; 2011&#41;&#44; which allowed us to filter the articles by title and abstract&#46; Potentially relevant articles were independently evaluated in their entirety by pairs of reviewers&#46; During data extraction&#44; we used a questionnaire that included a study quality assessment form based on the Cochrane Collaboration&#39;s risk of bias tool&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a> Throughout the process&#44; all duplicate&#44; rejected&#44; and selected references were recorded in a PRISMA flow diagram &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Excluded Studies</span><p id="par0055" class="elsevierStylePara elsevierViewall">Thirty-four articles were excluded from the analysis because they had a non-RCT design and&#47;or they did not meet the patient-related inclusion criteria &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Included Studies</span><p id="par0060" class="elsevierStylePara elsevierViewall">Twenty-four records corresponding to 21 RCTs &#40;961 patients&#41; were included in the analysis&#46; Three of the studies<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">8&#8211;10</span></a> were also published as conference proceedings&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">11&#8211;13</span></a> Two studies<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">14&#44;15</span></a> included children and adolescents &#40;32 patients&#41;&#46; Two studies<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">14&#44;16</span></a> were carried out in Asia and the rest were carried out in Europe&#46; Three were multicenter studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">6&#44;17&#44;18</span></a> Most of the studies compared different types of phototherapy&#44; including high-dose &#40;HD&#41; UV-A1&#44; medium-dose &#40;MD&#41; UV-A1&#44; UV-B&#44; UV-A and UV-B combination therapy &#40;UV-AB&#41;&#44; NB UV-B&#44; and PUVA&#46; Other modalities were excimer laser &#40;EL&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">8</span></a> full-spectrum-light phototherapy &#40;FSL&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a> and synchronous balneophototherapy &#40;sBPT&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">6</span></a> One study evaluated the utility of a skin-reflectance-guided UV-B regimen as a means of reducing the cumulative dose of radiation&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a> Three studies compared phototherapy with other treatments&#44; namely ciclosporin&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> topical pimecrolimus&#44;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a> and topical corticosteroid therapy combined with phototherapy&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a> The shortest follow-up period was 4 weeks<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">9&#44;14&#44;20</span></a> and the longest periods were 6 months<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">6&#44;21</span></a> and 12 months&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">7&#44;17</span></a> Several studies had no follow-up period&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">10&#44;15&#44;18&#44;19&#44;22&#8211;27</span></a> In most studies&#44; the outcome measures were changes in scores on clinical scales&#46; The most frequently used scales were SCORing Atopic Dermatitis &#40;SCORAD&#41; or a modified form of SCORAD&#44;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">6&#44;7&#44;9&#44;16&#44;17&#44;19&#44;21&#44;28</span></a> Costa&#39;s Simple Scoring System &#40;SSS&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">10&#44;15&#44;18&#44;27</span></a> the Leicester scale&#44;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">15&#44;27</span></a> and the severity score<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a> of Hanifin and Rajka&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">23&#8211;26</span></a> Some studies also used quality-of-life scales &#40;Eczema Disability Index&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> Sickness Impact Profile<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">6</span></a>&#41; and assessments of pruritus&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">8&#44;14&#44;20&#44;22&#44;27</span></a> Cumulative dosage was an outcome measure in 1 study<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a> and length of remission was used in 2 studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">7&#44;21</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Risk of Bias in the Included Studies</span><p id="par0065" class="elsevierStylePara elsevierViewall">In general&#44; the studies reviewed had a high risk of bias and relevant information was frequently missing &#40;<a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1&#8211;6</a>&#44; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Effect of the Interventions</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Comparison of Different Phototherapy Modalities</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Classic Types of Phototherapy&#58; UV-A&#44; UV-B&#44; and UV-AB &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Two RCTs<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">24</span></a> evaluated the optimal dose of UV-B radiation&#46; The first study compared a UV-B dose of 0&#46;5 times the minimal erythema dose &#40;MED&#41; to a UV-B dose of 1 MED and to visible light&#46; The second study compared a UV-B dose of 0&#46;8 MED to a UV-B dose of 0&#46;4 MED&#46; UV-B radiation was found to be more effective than visible light&#44; but the second study found no differences in efficacy between 0&#46;8 MED and 0&#46;4 MED&#46; In an RCT<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a> comparing UV-B to UV-AB&#44; statistically significant differences in favor of UV-AB were observed for most variables&#46; In another RCT&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a> UV-A was found to be superior to UV-B in the total score and in the overall evaluation&#44; but not in the pruritus score&#46; Two other studies<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">23</span></a> compared UV-AB to UV-B and to UV-A&#44; respectively&#44; and found that UV-AB yielded the most favorable results &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">High-Dose UV-A1 and Medium-Dose UV-A1 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;</span><p id="par0075" class="elsevierStylePara elsevierViewall">An RCT<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a> carried out in patients with an acute flare of AD found that the decrease in SSS scores at 6 and 15 days after HD UV-A1 phototherapy was statistically significant as compared to UV-AB&#46; Another multicenter RCT<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a> compared HD UV-A1 &#40;130<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41;&#44; UV-AB&#44; and 0&#46;5&#37; topical fluocortolone&#46; Significant differences were found in SSS scores on day 5 and day 10 in favor of HD UV-A1 and fluocortolone as compared to UV-AB and in favor of HD UV-A1 as compared to fluocortolone&#44; although no absolute data were reported&#46; A pilot study<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> compared MD UV-A1 with HD UV-A1&#46; The decrease in modified SCORAD scores after 3 weeks of treatment was 34&#46;7&#37; in the HD UV-A1 group and 28&#46;2&#37; in the MD UV-A1 group &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#44; and there were no bilateral differences in time until recurrence or in intensity of recurrence&#46; The cold-light UV-A1 modality dissipates the excessive heat load generated by UV-A1&#46; One study<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">9</span></a> found that cold-light UV-A1 was more effective than UV-A1 and UV-AB at clearing lesions and reducing their duration&#46; After 3 weeks&#44; mean SCORAD scores had decreased &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; in all 3 groups&#8212;23&#46;3 &#40;10&#46;6&#41; for cold-light UV-A1&#44; 28&#46;8 &#40;6&#46;9&#41; for UV-A1&#44; and 41&#46;4 &#40;9&#46;9&#41; for UV-AB&#8212;although the decrease was most striking in the cold-light UV-A1 group &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Narrowband UV-B &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;</span><p id="par0080" class="elsevierStylePara elsevierViewall">One RCT<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a> found that NB UV-B was superior to UV-A and to visible light and that the results were maintained at 3 months&#46; In a pilot RCT&#44;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a> a half-side comparison study assessed the efficacy of NB UV-B vs MD UV-A1 in patients with AD&#46; In the areas treated with NB UV-B&#44; there was a statistically significant decrease in SSS&#44; Leicester&#44; and lesion severity scores&#46; Another RCT<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> included patients who received NB UV-B on one half of the body and UV-A1 on the other&#46; Both treatments resulted in lower scores on the Leicester scale and on a visual analogue scale for pruritus&#44; and there were no significant differences between the groups&#46; In a randomized double-blind controlled crossover trial<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a> of UV-A1 and NB UV-B&#44; no statistically significant differences were found&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Psoralen Plus UV-A Therapy &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;</span><p id="par0085" class="elsevierStylePara elsevierViewall">An RCT<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a> with low statistical power compared 8-methoxypsoralen &#40;8-MOP&#41; PUVA bath therapy to NB UV-B and did not find any significant differences&#44; although the results were consistent with the possibility of clinically relevant differences&#46; A randomized controlled crossover trial<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> compared UV-A1 to oral 5-methoxypsoralen &#40;5-MOP&#41; PUVA therapy&#46; The minimum washout period was 4 weeks and patients were followed up until 12 months after the first treatment&#46; The median length of remission was 4 weeks after UV-A1 and 12 weeks after PUVA&#46; The mean reduction in SCORAD scores was greater after PUVA&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Studies Comparing Phototherapy to Other Treatments for Atopic Dermatitis &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;</span><p id="par0090" class="elsevierStylePara elsevierViewall">A multicenter study<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> compared ciclosporin A to UV-AB&#46; The mean number of days in remission was 186 &#40;84&#41; after ciclosporin A compared with 114 &#40;118&#41; after UV-AB&#46; Both the patients and the researchers rated ciclosporin A treatment more highly than UV-AB phototherapy&#46; An RCT<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a> compared 1&#37; pimecrolimus cream to NB UV-B in patients between the ages of 5 and 17 years&#46; Both interventions were beneficial&#44; and concomitant use of both treatments was not found to be superior&#46; Another RCT<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a> compared UV-AB to UV-AB plus topical fluticasone or topical hydrocortisone butyrate&#46; Significant improvement was seen in both groups&#46; In patients who received a corticosteroid&#44; fewer phototherapy sessions were required and the total mean UV-B dose was lower&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Other Studies &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41;</span><p id="par0095" class="elsevierStylePara elsevierViewall">One pilot study<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">8</span></a> compared 308<span class="elsevierStyleHsp" style=""></span>nm EL with 0&#46;05&#37; clobetasol propionate ointment in patients with the prurigo form of AD&#46; EL yielded optimal results as assessed using the Physician Assessment of Individual Signs &#40;PAIS&#41;&#44; the Physician&#39;s Global Assessment &#40;PGA&#41;&#44; the Patient&#39;s Global Assessment &#40;PaGA&#41;&#44; and a pruritus scale&#46; In another study&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a> FSL phototherapy &#40;wavelengths of 320-5000<span class="elsevierStyleHsp" style=""></span>nm&#41; used in conjunction with an emollient yielded a significantly greater improvement in SCORAD scores at 4 weeks as compared to the emollient alone&#46; One RCT<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">6</span></a> compared NB UV-B treatment and synchronous bathing in 10&#37; Dead Sea salt solution&#8212;also known as synchronous balneophototherapy &#40;sBPT&#41;&#8212;to monotherapy with NB UV-B&#46; sBPT yielded a greater reduction in SCORAD scores than NB UV-B as monotherapy &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41; and remained superior 1 month and 6 months after treatment&#46; One RCT<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a> evaluated the utility of determining UV-B dose on the basis of skin reflectance &#40;reflectance-guided UV-B&#41;&#46; At each session&#44; the UV-B dosage used on one side of the body was established on the basis of skin pigmentation&#44; as measured by reflectance&#44; and a conventional UV-B regimen was used on the other side of the body&#46; The cumulative UV-B dosage was lower in the reflectance-guided regimen&#44; and both treatment options had the same clinical outcome&#46;</p></span></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Registered Studies Currently Underway &#40;<a class="elsevierStyleCrossRef" href="#tbl0035">Table 7</a>&#41;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Of the in-progress RCTs registered with Current Controlled Trials and the World Health Organization&#39;s International Clinical Trials Registry Platform&#44; 2 studies met the inclusion criteria&#46; One RCT is comparing NB UV-B as monotherapy to PUVA bath therapy and to NB UV-B plus salt water baths&#46; Another RCT is comparing UV-AB phototherapy to UV-B in patients with various pruritic inflammatory dermatoses&#44; including AD &#40;<a class="elsevierStyleCrossRef" href="#tbl0035">Table 7</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0035"></elsevierMultimedia></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Discussion</span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Summary of Main Results</span><p id="par0105" class="elsevierStylePara elsevierViewall">This is the first systematic review on phototherapy in AD to be published in Spanish&#46; We analyzed 21 studies that met the inclusion criteria&#46; These studies included a total of 961 patients&#44; of whom 32 were younger than 18 years of age&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The use of the various phototherapy modalities had a chronological distribution&#46; In the 1980s and 1990s&#44; studies of UV-A&#44; UV-B&#44; and UV-AB phototherapy were predominant&#46; PUVA&#44; NB UV-B&#44; and UV-A1 emerged later&#44; followed by modalities such as EL and FSL&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In some studies&#44; there were statistically significant differences between combined UV-AB phototherapy and UV-A or UV-B phototherapy &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; HD UV-A1 was subsequently found to be superior to UV-AB&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">10&#44;18</span></a> Later studies showed that MD UV-A1 had similar efficacy and fewer side effects than HD UV-A1<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">9&#44;21</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The most homogeneous studies are those that compare UV-A1 to NB UV-B &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Two studies<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">27&#44;30</span></a> found NB UV-B to be superior to UV-A1&#46; In an RCT with a large number of participants and low risk of selection bias&#44; the superiority of NB UV-B was maintained after 3 months of follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a> The other 2 studies<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">20&#44;22</span></a> that compared UV-A1 to NB UV-B found no important differences between the treatment modalities&#46; It should be noted that an unconventional UV-A1 regimen was used in all 4 studies &#40;2 or 3 weekly sessions instead of 5&#41;&#59; the effectiveness of UV-A1 could&#44; therefore&#44; be greater&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">A RCT<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a> with no follow-up period compared 8-MOP PUVA bath therapy to NB UV-B&#46; The results were consistent with clinically relevant differences between the treatments&#44; but the statistical power of the study was low&#46; Another study<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> found that oral 5-MOP PUVA therapy yielded a significantly longer remission time than UV-A1&#44; although differences in treatment duration and frequency of application may have influenced the results&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">As for the more novel techniques&#44; FSL<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a> and EL<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">8</span></a> have each been evaluated in an RCT and found to have optimal results&#44; although publication bias may have played a role&#46; Similarly&#44; there is scant evidence on combined therapies&#46; One study<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">6</span></a> found sBPT to be superior to NB UV-B&#46; In another study&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a> the addition of topical corticosteroids to UV-AB therapy was found to reduce UV-B dose and treatment duration&#46; In an RCT<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a> carried out in children&#44; concomitant use of topical pimecrolimus during NB UV-B therapy did not yield any added benefit&#46; Only 1 RCT<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> has compared an immunosuppressive treatment&#8212;ciclosporin A&#8212;to UV-AB&#46; Ciclosporin A had significantly better results&#44; but the UV-AB doses were suboptimal and the study had a high risk of bias&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">All phototherapy modalities were generally described as well-tolerated&#44; although adverse effects were recorded systematically in only a few RCTs&#46; The absence of standardized protocols for the application of these techniques&#8212;determination of initial dose according to skin phototype or MED&#44; incremental dose increases&#44; frequency of sessions&#44; etc&#46;&#8212;makes it difficult to interpret and compare the results&#46; Given the heterogeneity of the treatments and the reporting deficiencies&#44; we opted not to conduct a meta-analysis&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Quality of Evidence</span><p id="par0140" class="elsevierStylePara elsevierViewall">In general&#44; the studies had a high or uncertain risk of bias<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a> and omitted relevant information&#46; In many studies&#44; the number of participants was small&#44; the randomization method was unclear&#44; and patients lost to follow-up were excluded from statistical analysis&#46; The follow-up period was short or nonexistent in most of the studies&#46; In RCTs that used within-patient comparisons&#44; there is a possibility of bias resulting from the possible systemic effect of phototherapy applied to each side of the body&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Patient inclusion and exclusion criteria varied&#44; and the criteria of Hanifin and Rajka were not used in all of the RCTs&#46; In one RCT&#44;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a> the inclusion and exclusion criteria were not mentioned explicitly&#46;</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Potential Biases in the Review Process</span><p id="par0150" class="elsevierStylePara elsevierViewall">To ensure that we compiled as many studies as possible&#44; we reviewed the Global Resource of Eczema Trials database &#40;Centre of Evidence Based Dermatology&#44; <a href="http://www.greatdatabase.org.uk/">http&#58;&#47;&#47;www&#46;greatdatabase&#46;org&#46;uk&#47;</a>&#41; and found no RCTs that had not been included in our results&#46; However&#44; we restricted our search to studies in English&#44; French&#44; and Spanish&#46; Dr Jos&#233; Manuel Carrascosa&#44; an expert in phototherapy treatment&#44; reviewed our results and detected only the absence of studies in German&#46; Another recent systematic review<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> included only 1 article<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a> in German&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Finally&#44; publication bias is possible&#44; given that most of the studies reported a positive result for the tested treatment modality&#59; however&#44; this bias is less likely because none of the studies were placebo-controlled&#46;</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Comparison With Previous Systematic Reviews</span><p id="par0160" class="elsevierStylePara elsevierViewall">There have been 2 previous systematic reviews on phototherapy in AD&#46; The first review<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">3</span></a> did not include studies of PUVA therapy&#46; This review concluded that UV-A1 phototherapy&#44; if available&#44; should be used to treat acute forms of AD and that NB UV-B should be used to treat chronic forms of AD&#46; In our opinion&#44; these conclusions are difficult to justify because these clinical differences are not well established in the cited studies&#46; As for the more recent systematic review&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> there were 4 discrepancies between the RCTs we selected and those selected by the other authors&#46; We included 2 studies<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">8&#44;14</span></a> comparing topical therapy to phototherapy that the other review omitted because the authors considered the diagnosis of AD to be doubtful&#46; We also included a study<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a> that evaluated the utility of reflectance-guided UV-B for reducing UV-B dose&#46; Finally&#44; we omitted 1 study<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a> included in the other review because it was published in German&#46;</p></span></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Conclusions</span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0195">Implications for Practice</span><p id="par0165" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0170" class="elsevierStylePara elsevierViewall">There is evidence to support the use of NB UV-B and UV-A1 phototherapy in moderate to severe forms of AD&#46; There is scant evidence to support the use of PUVA&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0175" class="elsevierStylePara elsevierViewall">It may be possible to find indications for modalities such as EL in the prurigo form of AD&#44; FSL&#44; and sBPT&#44; but further studies are needed&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Data on the use of phototherapy in childhood AD are limited&#44; and therefore caution must be exercised when this technique is used in children&#46; There is no evidence to support the use of phototherapy in pregnant women with AD&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0185" class="elsevierStylePara elsevierViewall">There are few data on the long-term effects of phototherapy in AD&#44; including possible carcinogenic effects&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0190" class="elsevierStylePara elsevierViewall">We found no RCTs comparing the use of phototherapy to the use of oral corticosteroids&#46;</p></li></ul></p></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0200">Implications for Future Research</span><p id="par0195" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0200" class="elsevierStylePara elsevierViewall">Only 1 RCT has compared systemic immunosuppressive therapies to phototherapy&#44; and it did not include the modalities for which the strongest evidence is available &#40;NB UV-B and UV-A1&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0205" class="elsevierStylePara elsevierViewall">AD severity assessment criteria&#44; irradiation techniques&#44; and assessment scales and other outcome measures should be standardized&#59; this is the objective of the Harmonizing Outcome Measures for Eczema initiative &#40;<a href="http://homeforeczema.org/">http&#58;&#47;&#47;homeforeczema&#46;org&#47;</a>&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0210" class="elsevierStylePara elsevierViewall">Given the impact of AD&#44; it is surprising that only 2 studies included quality-of-life measures &#40;Skindex and the Eczema Disability Index&#41; and that only 2 other studies included subjective assessment scales&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0215" class="elsevierStylePara elsevierViewall">A minimum follow-up period should be included and tolerability parameters and adverse effects should be recorded&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0220" class="elsevierStylePara elsevierViewall">Results should be reported in accordance with the Consolidated Standards of Reporting Trials statement&#46;</p></li></ul></p></span></span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0205">Conflicts of Interest</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0210">Ethical Disclosures</span><span id="sec0145" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0215">Protection of human and animal subjects</span><p id="par0230" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation&#46;</p></span><span id="sec0150" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0220">Data confidentiality</span><p id="par0235" class="elsevierStylePara elsevierViewall">The authors declare that no private patient data are disclosed in this article&#46;</p></span><span id="sec0155" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0225">Right to privacy and informed consent</span><p id="par0240" class="elsevierStylePara elsevierViewall">The authors declare that no private patient data are disclosed in this article&#46;</p></span></span></span>"
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              "titulo" => "Comparison of Different Phototherapy Modalities"
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                  "titulo" => "Classic Types of Phototherapy&#58; UV-A&#44; UV-B&#44; and UV-AB &#40;Table 1&#41;"
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                  "titulo" => "High-Dose UV-A1 and Medium-Dose UV-A1 &#40;Table 2&#41;"
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                  "titulo" => "Narrowband UV-B &#40;Table 3&#41;"
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                  "titulo" => "Psoralen Plus UV-A Therapy &#40;Table 4&#41;"
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                  "titulo" => "Studies Comparing Phototherapy to Other Treatments for Atopic Dermatitis &#40;Table 5&#41;"
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    "fechaAceptado" => "2014-12-14"
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            0 => "Atopic dermatitis"
            1 => "Phototherapy"
            2 => "Photochemotherapy&#58; Systematic review"
            3 => "Psoralen&#43;ultraviolet A"
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      ]
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          "palabras" => array:5 [
            0 => "Dermatitis at&#243;pica"
            1 => "Fototerapia"
            2 => "Fotoquimioterapia"
            3 => "Revisi&#243;n sistem&#225;tica"
            4 => "Psoraleno &#43; terapia ultravioleta A"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Phototherapy is a treatment option for atopic dermatitis recommended by several guidelines&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To perform a systematic review of the efficacy of different modalities of phototherapy and photochemotherapy in moderate to severe atopic dermatitis&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We considered all randomized clinical trials &#40;RCTs&#41; performed in patients with atopic dermatitis&#44; and accepted all outcome measures&#46; Articles were identified via an online search of the MEDLINE &#40;via Ovid&#41; and Embase databases and the Cochrane Central Register of Controlled Trials&#46; We also searched for clinical trials registered in Current Controlled Trials and in the World Health Organization&#39;s International Clinical Trials Registry Platform&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Twenty-one RCTs &#40;961 patients&#41; were included in the qualitative analysis&#46; Two of the trials included children and adolescents &#40;32 patients&#41;&#46; The efficacy of narrow-band UV-B and UV-A1 phototherapy was similar for the different outcome measures contemplated&#46; Two RCTs assessed the efficacy of psoralen plus UV-A therapy &#40;PUVA&#41;&#46; No serious adverse events were described&#46; In general&#44; the publications reviewed were characterized by a high risk of bias and poor reporting of methodology and results&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">There is evidence for the use of narrow-band UV-B and UV-A1 phototherapy in moderate to severe atopic dermatitis&#46; Evidence supporting the use of PUVA in atopic dermatitis is scarce and there is little information on the use of phototherapy in childhood&#46; For the purpose of future studies&#44; it would be advisable to use comparable criteria and scales for the evaluation of disease severity and patients&#44; to standardize radiation methods&#44; and to establish a minimum follow-up time&#46;</p></span>"
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            "titulo" => "Background"
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            "titulo" => "Objective"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La fototerapia es una opci&#243;n terap&#233;utica empleada en dermatitis at&#243;pica &#40;DA&#41; y recomendada en m&#250;ltiples gu&#237;as&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Evaluar la eficacia de las distintas modalidades de fototerapia y fotoquimioterapia en el tratamiento de pacientes con DA moderada-grave&#44; mediante una revisi&#243;n sistem&#225;tica&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Consideramos los ensayos cl&#237;nicos aleatorizados &#40;ECA&#41; realizados en pacientes con DA&#44; aceptando cualquier medida de desenlace&#46; Localizamos los art&#237;culos mediante una b&#250;squeda electr&#243;nica&#44; utilizando Medline &#40;v&#237;a Ovid&#41;&#44; Embase y Cochrane Central Register of Controlled Trials&#46; Adicionalmente&#44; buscamos los ensayos cl&#237;nicos registrados en Current Controlled Trials y en la WHO International Clinical Trials Registry Platform&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Incluimos 21 ECA en el an&#225;lisis cualitativo &#40;961 pacientes&#41;&#46; Dos ECA incluyeron ni&#241;os y adolescentes &#40;32 pacientes&#41;&#46; Las modalidades UVBBE y UVA1 mostraron resultados de eficacia similares en diversas medidas de desenlace&#46; Dos ECA incluyeron la terapia PUVA&#46; No se describieron efectos secundarios graves&#46; En general&#44; el riesgo de sesgos fue elevado y la calidad de las publicaciones baja&#44; en cuanto a comunicaci&#243;n de la metodolog&#237;a empleada y los resultados obtenidos&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Existe evidencia para el uso de UVBBE y UVA1 en DA moderada-grave&#46; La evidencia para el uso de PUVA en DA es m&#237;nima&#44; as&#237; como los datos del uso de la fototerapia en la infancia&#46; En futuros estudios ser&#237;a recomendable estandarizar los criterios de gravedad de la DA y las escalas de valoraci&#243;n de los pacientes&#44; homogeneizar las t&#233;cnicas de irradiaci&#243;n y establecer un periodo de seguimiento m&#237;nimo&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0050">Please cite this article as&#58; P&#233;rez-Ferriols A&#44; Aranegui B&#44; Pujol-Montcus&#237; JA&#44; Mart&#237;n-Gorgojo A&#44; Campos-Dom&#237;nguez M&#44; Feltes RA&#44; et al&#46; Modalidades de fototerapia para el tratamiento de la dermatitis at&#243;pica&#58; revisi&#243;n sistem&#225;tica de la literatura&#46; Actas Dermosifiliogr&#46; 2015&#59;106&#58;387&#8211;401&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Flow of articles during the review process&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">a</span> Kowalzick et al<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">32</span></a></p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">b</span> Kowalzick et al&#44;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">32</span></a> David&#44;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">33</span></a> Der-Petrossian et al&#44;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">34</span></a> Granlund Het&#44;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a> Niedner and Iliev&#44;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">36</span></a> Potekaev et al&#44;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">37</span></a> Raap et al&#44;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">38</span></a> Schiener et al&#44;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">39</span></a> Sowden et al<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a></p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">c</span> Heinlin et al&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">6</span></a> Der-Petrossian et al&#44;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a> Reynolds et al&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a></p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 3041
            "Ancho" => 2341
            "Tamanyo" => 509720
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Risk of bias&#46;</p> <p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">&#43; indicates low risk of bias&#59; &#63;&#44; unknown risk of bias&#59; &#8211;&#44; high risk of bias&#59; 1&#44; generation of random allocation sequence &#40;selection bias&#41;&#59; 2&#44; intervention allocation &#40;selection bias&#41;&#59; 3&#44; masking of participants and personnel &#40;performance bias&#41;&#59; 4&#44; masking of assessors &#40;detection bias&#41;&#59; 5&#44; incomplete outcome data &#40;attrition bias&#41;&#59; 6&#44; selective reporting &#40;reporting bias&#41;&#59; 7&#44; other biases&#59; BJD&#44; <span class="elsevierStyleItalic">British Journal of Dermatology</span>&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; ITT&#44; intention to treat&#59; MED&#44; minimal erythema dose&#59; NS&#44; not specified&#59; PI&#44; principal investigator&#59; UV-AB&#59; combined UV-A and UV-B phototherapy&#46;</p>"
          "tablatextoimagen" => array:4 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="6" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Jekler and Lark&#246; 1988<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">24</span></a>&#58; UV-B vs visible light&#44; 8 weeks or until clearance</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Study 1&#58; 0&#46;5 or 1&#46;0 MED UV-B vs visible light&#59; 28 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Outcome measure&#58;Total score<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>Pruritus scoreOverall evaluationHealing score<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Baseline9&#46;9 &#40;6&#46;5-19&#41;2&#46;2 &#40;1-3&#41;1&#46;5 &#40;1-3&#41;-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UV-B5 &#40;1-9&#41;0&#46;8 &#40;0-2&#41;0&#46;7 &#40;0-1&#46;5&#41;1&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Visible Light8 &#40;4-13&#41;1&#46;8 &#40;0&#46;5-3&#41;1&#46;4 &#40;0&#46;5-2&#41;0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001NS<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Study 2&#58; 0&#46;8 MED UV-B vs 0&#46;4 MED UV-B&#59;31 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Total score<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>Pruritus scoreOverall evaluation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Baseline10&#46;7 &#40;6-19&#41;2&#46;4 &#40;1-3&#41;1&#46;5 &#40;1-3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;8 MED7 &#40;0-21&#41;1&#46;2 &#40;0-3&#41;0&#46;7 &#40;0-1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;4 MED6&#46;6 &#40;0-21&#41; 1&#46;2 &#40;0-3&#41;1&#46;4 &#40;0&#46;5-2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01NSNS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top">Comment&#46; Attrition was high in both studies &#40;11 patients in Study 1 and 6 in Study 2&#41;&#46; Study 1&#58; High risk of detection bias &#40;the PI was the assessor&#41;&#46; Results were not reported as a function of MED&#46; Study 2&#58; Statistical analysis did not show differences in the efficacy of the 2 treatments&#46; Selective reporting &#40;changes in the affected surface were not reported&#41;&#46;</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab840227.png"
              ]
            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="6" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Jekler and Lark&#246; 1990<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a>&#58; UV-B vs UV-AB&#44; 3 sessions&#47;week for 8 weeks&#59; 39 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Outcome measure&#58;Total score<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>Pruritus scoreOverall evaluation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Baseline10&#46;8 &#40;7-19&#41;2&#46;4 &#40;1-3&#41;1&#46;7 &#40;1-3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UV-B6&#46;1 &#40;0-17&#41;1&#46;2 &#40;0-3&#41;0&#46;80 &#40;0-3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UV-AB5&#46;2 &#40;0-15&#41; 1&#46;0 &#40;0-3&#41; 0&#46;65 &#40;0-2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;04<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Healing score<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> &#40;UV-B vs UV-AB&#44; No&#46; of patients out of 30&#41;Subjective assessment of efficacyGreater use of hydrocortisoneAdverse effects&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 points&#44; 4 vs 6&#59; 2 points&#44; 21 vs 20&#59; 1 point&#44; 4 vs 3&#59; 0 points&#44; 0 vs 0&#59; &#8211;1 points&#44; 1 vs 1&#46;UV-AB preferred by 14&#59; both preferred equally by 10&#46;UV-B side&#44; 3&#47;20&#59; UV-AB side&#44; 1&#47;20&#59; same on both sides&#44; 16&#47;20&#46;Mild or moderate xerosis&#44; 15 vs 13&#59; severe xerosis&#44; 5 vs 2&#59; mild or moderate burns&#44; 15 vs 3&#59; severe burns&#44; 6 vs 0&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top">Comment&#46; Combined UV-AB therapy may be superior to UV-B with this regimen&#46; Risk of bias&#58; randomization process not described&#59; high risk of detection bias in participants&#44; researchers&#44; and outcome assessor&#46;</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab840216.png"
              ]
            ]
            2 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="6" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Jekler and Lark&#246; 1991<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a>&#58; UV-A vs UV-B&#44; 3 sessions&#47;week for 8 weeks or until healing&#59; 33 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Outcome measure&#58;Total score<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>Pruritus scoreOverall evaluation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Baseline10&#46;3 &#40;6-18&#41;2&#46;2 &#40;1-3&#41;1&#46;8 &#40;1-3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UV-A5&#46;5 &#40;1-12&#41;&#40;0-2&#41;1 &#40;0-2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UV-B6&#46;4 &#40;3-15&#46;5&#41;1&#46;3 &#40;0-2&#41;1&#46;3 &#40;0&#46;5-2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;02<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Healing score<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> &#40;UV-A vs UV-B&#41;ExtentSubjective assessment of efficacy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 points&#44; 1 vs 0&#59; 2 points&#44; 14 vs 13&#59; 1 point&#44; 6 vs 6&#59; 0 points&#44; 0 vs 2&#59; &#8211;1 points&#44; 0 vs 0&#46;From 10&#46;1&#37; to 5&#46;4&#37; &#40;UV-A&#41; and from 10&#37; to 6&#46;2&#37; &#40;UV-B&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46;13 noticed improvement in the area treated with UV-A&#59; 4 noticed no difference&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top">Comment&#46; UV-A may be superior to UV-B with this regimen&#46; Randomization not described&#46; High risk of performance bias&#44; detection bias&#44; and selective reporting&#58; Only some variables were analyzed&#59; 4 patients did not complete the subjective assessment of the efficacy of the interventions&#46;</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab840210.png"
              ]
            ]
            3 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="6" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Jekler and Lark&#246; 1991<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">23</span></a></th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Study 1&#58;Low-dose UV-B vs UV-AB&#59;20 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Outcome MeasureTotal score<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>Pruritus scoreOverall evaluation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Baseline10&#46;8 &#40;7-15&#46;5&#41;2&#46;4 &#40;1-3&#41;1&#46;9 &#40;1-2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UV-B8&#46;8 &#40;4&#46;5-14&#41; 1&#46;5 &#40;0-2&#41;1&#46;8 &#40;1-2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UV-AB5&#46;3 &#40;1&#46;1-11&#41; 0&#46;8 &#40;0-2&#41;0&#46;9 &#40;0-2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Healing score<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> &#40;patients in UV-B group vs patients in UV-AB group&#41;&#58; 3 points&#44; 0 vs 2&#59; 2 points&#44; 5 vs 15&#59; 1 point&#44; 11 vs 1&#59; 0 points&#44; 2 vs 0&#59; &#8211;1 points&#44; 0 vs 0&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Study 2&#58;UV-A vs UV-AB&#59; 28 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UV-AB yielded better results than UV-A in total score and overall evaluation&#46; No differences in pruritus&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top">Comment&#46; UV-AB was apparently superior to UV-B and UV-A&#46; High risk of detection bias &#40;blinding of outcome assessor&#41;&#44; attrition bias &#40;no ITT analysis performed in excluded individuals&#44; lack of patient questionnaires&#41;&#44; and reporting bias &#40;more variables were recorded than were analyzed&#59; specific results of Study 2 were not reported&#41;&#46;</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab840211.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The total score is the sum of the scores for 8 variables evaluated on a scale of 0-3 &#40;pruritus&#44; lichenification&#44; desquamation&#44; erythema&#44; xerosis&#44; vesiculation&#44; excoriations&#44; and overall evaluation&#41;&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">The healing scale is a 5-point scale&#58; 3&#44; healed&#59; 2&#44; considerable improvement&#59; 1&#44; some improvement&#59; 0&#44; no change&#59; &#8211;1&#44; worsening&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Studies Comparing UV-A&#44; UV-B&#44; and UV-AB&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; CR&#44; complete remission&#59; HD&#44; high-dose&#59; ITT&#44; intention to treat&#59; MD&#44; medium-dose&#59; MED&#44; minimal erythema dose&#59; SCORAD&#44; SCORing Atopic Dermatitis&#59; SSS&#44; Simple Scoring System&#59; UV-AB&#59; combined UV-A and UV-B phototherapy&#46;</p>"
          "tablatextoimagen" => array:4 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="4" align="right" valign="top" scope="col" style="border-bottom: 2px solid black">Krutmann et al&#44; 1992<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">10&#44;13</span></a>&#58; HD UV-A1 &#40;130<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41; vs UV-AB&#44; 15 sessions&#59; 25 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Outcome measures&#58;Total SSS score<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>Severity scoreTopographic score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Baseline53 &#40;1&#46;9&#41;36&#46;4 &#40;1&#46;7&#41;18&#46;7 &#40;1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HD UV-A114 &#40;3&#46;2&#41;8&#46;9 &#40;1&#46;1&#41;6&#46;3 &#40;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Statistically significant differences &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41; in all 3 measures comparing HD UV-A1 to UV-AB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">Comment&#46; HD UV-A1 appeared to be more effective than UV-AB against acute exacerbations&#46; High risk of attrition bias and reporting bias&#58; Results for the UV-AB group were not reported &#40;except baseline scores&#41; and there are discrepancies between the baseline values reported in the initial table and those which appear in the text&#46; The most appropriate analysis would be a comparison between the baseline and final values for each outcome measure&#44; rather than comparisons at each time point&#46; Adverse effects were not systematically specified&#46; It is not known whether the tenth patient in the UV-AB group&#44; who abandoned the treatment on the third day&#44; was included in the analysis&#46;</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab840220.png"
              ]
            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="4" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Krutmann et al&#44; 1998<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a>&#58; HD UV-A1 vs UV-AB vs 0&#46;5&#37; fluocortolone cream or ointment&#44; 10 days&#59; 53 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Outcome measure&#58; SSS score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Significant differences were found in SSS scores in favor of HD UV-A1 and fluocortolone as compared to UV-AB &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001 in both cases&#41; and in favor of HD UV-A1 as compared to fluocortolone &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">Comment&#46; HD UV-A1 appeared to be superior to UV-AB and at least as effective as topical treatment with fluocortolone&#46; The randomization sequence was explicitly described&#59; block randomization was used&#46; High risk of attrition bias&#58; Results were not specified&#59; only the statistical significance levels of the differences obtained were reported and represented in a figure&#46; The most appropriate analysis would be a comparison between the baseline and final values for each outcome measure&#44; rather than comparisons at each time point&#46; No adverse effects were described&#46;</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab840226.png"
              ]
            ]
            2 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Tzaneva et al&#44; 2001<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a>&#58; HD UV-A1 &#40;130<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span> or a dose equivalent to 1 MED if &#60;<span class="elsevierStyleHsp" style=""></span>130<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#44; with increments of 10<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span> up to a maximum of 130<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41; vs MD UV-A1 &#40;50&#37; of the HD UV-A1 regimen&#41;&#44; 5 sessions&#47;week for 3 weeks and 6 months of follow-up</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Outcome measures&#58;Modified SCORAD&#44;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a> week 1Modified SCORAD&#44; week 2Modified SCORAD&#44; week 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HD UV-A133&#46;4&#37; &#40;8&#46;8&#37;-52&#46;7&#37;&#41;38&#46;4&#37; &#40;1&#46;5&#37;-56&#46;7&#37;&#41;34&#46;7&#37; &#40;0&#37;-46&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MD UV-A129&#46;7&#37; &#40;8&#46;3&#37;-46&#46;8&#37;&#41;36&#46;4&#37; &#40;12&#46;6&#37;-56&#46;6&#37;&#41;28&#46;2&#37; &#40;0&#37;-46&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>&#46;05 in all cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">Recurrences&#58; 6 patients at 2&#44; 4&#44; and 12 weeks&#59; 1 patient in remission at 6 months&#46;There were no bilateral differences in time until recurrence or in intensity of recurrence&#46;</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">Comment&#46; There were no statistically significant differences in the efficacy of the 2 treatments&#44; although the sample size was small&#46; Of the 10 initial patients&#44; only 7 were followed up and recurrences were frequent&#46; Risk of bias related to randomization &#40;the procedure is not described&#41;&#46; Patients were not masked&#46; &#8220;Recurrences&#8221; were not defined&#46;</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab840218.png"
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            ]
            3 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top" style="border-bottom: 2px solid black">Kobyletzki et al&#44; 1999&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">9</span></a> Kobyletzki&#44; 1999<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a>&#58; Cold-light UV-A1 vs UV-A1 vs UV-AB&#44; 5 sessions&#47;week for 3 weeks and 4 weeks of follow-up</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Outcome measures&#58;CR90&#37; clearance60&#37; clearanceBaseline SCORAD<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">c</span></a>SCORAD week 3SCORAD week 7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cold-light UV-A185&#46;4&#37;27&#46;1&#37;58&#46;3&#37;71&#46;7 &#40;12&#46;6&#41;23&#46;3 &#40;10&#46;6&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;24&#46;9 &#40;10&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UV-A177&#46;3&#37;15&#46;9&#37;61&#46;4&#37;69&#46;8 &#40;10&#46;2&#41;28&#46;8 &#40;6&#46;9&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;30&#46;8 &#40;9&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UV-AB37&#46;5&#37;6&#46;3&#37;31&#46;3&#37;71 &#40;9&#46;4&#41;41&#46;4 &#40;9&#46;9&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;52&#46;3 &#40;11&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">Attrition&#58; 5 patients in the UV-A1 group &#40;discomfort&#44; pruritus&#44; and exacerbation&#41;&#46;</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">Comment&#46; Cold-light UV-A1 appeared to be superior to UV-A1 and both appeared to be superior to UV-AB&#44; although the decrease in SCORAD scores was significant in all 3 modalities&#46; After 4 weeks of follow-up&#44; SCORAD scores remained lowest with cold-light UV-A1&#46; The randomization method was not described&#46; No ITT analysis was performed and attrition was high in some groups&#46;</td></tr></tbody></table>
                  """
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                0 => "xTab840221.png"
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          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Costa&#39;s Simple Scoring System scores 10 severity criteria &#40;erythema&#44; edema&#44; vesicles&#44; oozing&#44; crusts&#44; lichenification&#44; desquamation&#44; pruritus&#44; and sleep loss&#41; on a scale of 0 to 6 and 10 topographic sites &#40;face&#44; neck&#44; anterior trunk&#44; posterior trunk&#44; buttocks&#44; arms&#44; hands&#44; legs&#44; knees&#44; and feet&#41; on a scale of 0 to 3&#44; according to the extent of the lesions&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Modified SCORAD scale&#58; Assessment of the degree of facial involvement was excluded because the face was only irradiated with UV-A1&#46; Subjective assessment of impact on sleep was also excluded&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">SCORAD assesses the severity of atopic dermatitis on the basis of 3 aspects&#58; extent or affected surface area&#59; intensity &#40;erythema&#44; edema&#47;papules&#44; excoriations&#44; oozing&#44; lichenification&#44; and dryness are scored on a severity scale of 0 to 3&#41;&#59; and pruritus and sleeplessness &#40;scale of 0 to 10&#41;&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Studies Comparing HD UV-A1 &#40;130<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41; and MD UV-A1&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; AD&#44; atopic dermatitis&#59; NB&#44; narrowband&#59; MD&#44; medium-dose&#59; RR&#44; relative reduction&#59; SASSAD&#44; Six Area&#44; Six Sign Atopic Dermatitis&#59; SSS&#44; Simple Scoring System&#59; VAS&#44; visual analog scale&#46;</p>"
          "tablatextoimagen" => array:4 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Reynolds et al&#44; 2001<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a>&#58; NB UV-B vs MD UV-A1 &#40;maximum 15<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41; vs visible light &#40;2 sessions&#47;week for 12 weeks and 3 months of follow-up&#41;&#59; 73 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Outcome measures&#58;Mean reduction in total AD activity<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">a</span></a>Decrease in pruritusImprovement in sleepDecrease in topical corticosteroid use&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NB UV-B9&#46;4 points<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>visible light &#40;95&#37; CI&#44; 3&#46;6-15&#46;2&#41; and 5 points<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span> UV-A1 &#40;95&#37; CI&#58; 0&#46;6-10&#46;5&#41;&#46;90&#37;71&#37;65&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MD UV-A14&#46;4 points<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span> visible light &#40;95&#37; CI&#44; &#8211;1-9&#46;8&#41;&#46;63&#37;53&#37;56&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top">Mean decrease in extent of AD with NB UV-B&#58; 7&#46;8&#37;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>MD UV-A1 &#40;95&#37; CI&#44; 2&#46;8-12&#46;7&#41; and 6&#46;7&#37;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>visible light &#40;95&#37; CI&#44; 1&#46;5-11&#46;9&#41;&#46;At 3 months&#44; total AD activity was lower in the NB UV-B group than in the MD UV-A1 group and the visible light group &#40;&#8211;36&#37; &#91;7 vs 65&#93; and &#8211;36&#37; &#91;8 vs 64&#93;&#44; respectively&#41;&#46;</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top">Comment&#46; NB UV-B was superior in controlling AD&#44; and the results were maintained after 3 months of follow-up&#46; Randomization was carried out with a computer program and the researcher was not involved in patient assessment&#46; The method of masking patients and assessors was not described&#46;</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab840219.png"
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            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Legat et al&#44; 2003<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a>&#58; NB UV-B vs MD UV-A1 &#40;maximum dose 50<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41;&#44; 2 sessions&#47;week for 8 weeks&#59; 9 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Outcome measures&#58;Decrease in SSS score&#44;<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">b</span></a> &#37;Decrease in Leicester score&#44;<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">c</span></a> &#37;Decrease in skin lesion VAS score&#44; &#37;Decrease in pruritus VAS score&#44; &#37;Overall evaluation of effect of treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NB UV-B40 &#40;2-61&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#41;50 &#40;2-74&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;71 &#40;3-98&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#41;67 &#40;&#8722;8-98&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;055&#41;6&#46;4 &#40;1&#46;2-9&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MD UV-A133 &#40;8-48&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;055&#41;30 &#40;9-63&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;1&#41;40 &#40;7-99&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;04&#41;34 &#40;9-97&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;15&#41;4&#46;5 &#40;0&#46;5-9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top">Attrition&#58; 2 patients withdrew&#44; after 4 and 6 weeks&#44; respectively&#44; because their scores after NB UV-B were<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30&#37; of the scores after MD UV-A1&#46;</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top">Comment&#46; NB UV-B was more effective than MD UV-A1&#44; and the differences in the SSS scores&#44; the Leicester scores&#44; and the lesion assessment VAS scores were statistically significant&#46; No long-term follow-up was conducted&#46; Possible performance bias and detection bias &#40;in randomization and masking&#41;&#46; It is not known whether the 2 patients who withdrew were included in the analysis&#46;</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab840228.png"
              ]
            ]
            2 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="4" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Majoie et al&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a>&#58; NB UV-B vs MD UV-A1 &#40;30<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span> up to a maximum of 45<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41;&#44; 3 sessions&#47;week for 8 weeks and 4 weeks of follow-up&#59; 13 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Outcome measures&#58;Decrease in Leicester score&#44; medianDecrease in pruritus VAS score&#44; median&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NB UV-BFrom 18 to 10From 7 to 1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MD UV-A1From 19 to 12From 7 to 4&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">There was a significant decrease in immunohistochemical findings suggestive of inflammation&#44; and there were no significant differences between groups&#46;</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">Comment&#46; MD UV-A1 and NB UV-B appear to be effective in clinical control and control of inflammatory markers in moderate to severe AD&#46; The results obtained after follow-up were not analyzed because of the uncontrolled use of topical corticosteroids&#46; Unknown risk of performance bias &#40;randomization method not described&#41;&#46; No adverse effects were described&#46;</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab840223.png"
              ]
            ]
            3 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Gamblicher et al&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a>&#58; NB UV-B vs MD UV-A1 &#40;50<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41; crossover study&#58; 3 sessions&#47;week for 6<span class="elsevierStyleHsp" style=""></span>weeks &#8594;minimum 8 week washout period &#8594;3 sessions&#47;week for 6 weeks&#59; 47 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">No interaction was found between treatment sequence and treatment effects &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;81&#41;&#46;</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Outcome measures&#58;SASSAD score&#44; mean &#40;SD&#41; RR&#44; &#37;Pruritus VAS score&#44; mean &#40;SD&#41; RR&#44; &#37;Skindex-29 score&#44; mean &#40;SD&#41; RR&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NB UV-B39&#46;4 &#40;24&#46;1&#41;25&#46;2 &#40;30&#46;5&#41;16&#46;5 &#40;17&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MD UV-A143&#46;7 &#40;31&#46;4&#41;16 &#40;61&#46;8&#41;12&#46;7 &#40;18&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;4<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;49<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">Adverse effects&#58; mild erythema in 1 patient in the MD UV-A1 group and 3 patients in the NB UV-B group&#46;</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">Comment&#46; The number of patients lost to follow-up was high but balanced between the 2 groups&#46; The follow-up period was very short&#46; Low risk of bias&#58; Randomization was computer-generated and concealed&#44; masking was carried out&#44; adverse effects were recorded&#44; protocol was registered&#44; and all expected outcomes were reported&#46;</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab840213.png"
              ]
            ]
          ]
          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">After 24 treatments&#46; Disease activity was measured using the modified scale described by Sowden et al&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a></p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0035"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Costa&#39;s Simple Scoring System&#58; See <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0040"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0040">The Leicester scale scores 6 clinical features &#40;erythema&#44; purulence&#44; excoriation or crusting&#44; dryness or scaling&#44; cracking or fissuring&#44; and lichenification&#41; at 6 body sites on a scale of 0 &#40;none&#41; to 3 &#40;severe&#41;&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Studies Comparing NB UV-B and MD UV-A1&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; 5-MOP&#44; 5-methoxypsoralen&#59; 8-MOP&#44; 8-methoxypsoralen&#59; ITT&#44; intention to treat&#59; MD&#44; medium-dose&#59; NB&#44; narrowband&#59; PUVA&#44; psoralen plus UV-A&#59; SCORAD&#44; SCORing Atopic Dermatitis&#46;</p>"
          "tablatextoimagen" => array:2 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="4" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Der-Petrossian et al&#44; 2000<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a>&#58; 8-MOP PUVA bath therapy vs NB UV-B&#44; 3 days&#47;week for 6 weeks&#59; 12 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Outcome measures&#58; Decrease in modified SCORAD&#44; &#37;Week 2Week 4Week 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PUVA Bath Therapy32&#46;947&#46;165&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NB UV-B24&#46;344&#46;564&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;09<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;51<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">Comment&#46; Confidence intervals were not provided&#44; making it difficult to evaluate the observed clinical difference&#46; The study had low statistical power&#46; Studies with a larger number of patients are needed&#46; Uncertain risk of selection and detection biases &#40;patients were not blinded&#41;&#46; No ITT analysis was performed &#40;2 patients were excluded&#44; 1 of whom received oral corticosteroids to treat a flare&#41;&#46;</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab840230.png"
              ]
            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Tzaneva et al&#44; 2010<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a>&#58; MD UV-A1 &#40;5 days&#47;week<span class="elsevierStyleHsp" style=""></span>for<span class="elsevierStyleHsp" style=""></span>3 weeks&#44; 70<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41; vs PUVA &#40;5-MOP 1&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#59; 3 days&#47;week<span class="elsevierStyleHsp" style=""></span>for<span class="elsevierStyleHsp" style=""></span>5 weeks&#41;&#59; 40 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Outcome measures&#58;Length of remission&#44; mean&#44; wkReduction in SCORAD since baseline visit&#44; mean &#40;SD&#41;&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MD UV-A1437&#46;7 &#40;22&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PUVA1254&#46;3 &#40;25&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;012<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;041&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">Adverse effects&#58; Mild palmoplantar erythema &#40;MD UV-A1&#44; 2&#59; PUVA&#44; 9&#41;&#59; folliculitis &#40;MD UV-A1&#44; 1&#59; PUVA&#44; 2&#41;&#59; sensation of warmth or burning &#40;MD UV-A1&#44; 7&#41;&#59; photo-onycholysis &#40;PUVA&#44; 2&#41;&#46;</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">Comment&#46; PUVA appears to be superior to MD UV-A1 in reducing SCORAD scores and increasing length of remission&#46; In this study&#44; 5-MOP was used instead of 8-MOP&#46; The difference in treatment duration &#40;3 vs 5 weeks&#41; may have influenced the results&#46; Risk of biases&#58; Interventions were allocated by coin toss&#44; but the allocation sequence concealment method was not described &#40;selection bias&#41;&#46; Uncertain performance bias in relation to the masking of researchers&#46; Patients were not masked&#46; The second phase of the study was initiated in the event of substantial relapse &#40;SCORAD<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>50&#37; of baseline score&#41; or at the request of the patient&#46;</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab840212.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Studies Comparing PUVA to Other Interventions&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; EASI&#44; Eczema Area and Severity Index&#59; EDI&#44; Eczema Disability Index&#59; NB&#44; narrowband&#59; NS&#44; not specified&#59; TCS&#44; topical corticosteroids&#59; UV-AB&#44; combined UV-A and UV-B phototherapy&#46;</p>"
          "tablatextoimagen" => array:3 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Granlund et al&#44; 2001<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a>&#58; UV-AB &#40;maximum 15<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span> UV-A and 0&#46;26<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span> UV-B&#44; 2-3 sessions&#47;week&#41; vs ciclosporin A &#40;4<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#44; increased or decreased in increments of 1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d according to response&#41; for 12 months&#59; 72 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Outcome measures&#58;Length of remission&#44; d&#44; mean &#40;SD&#41;Change in TCS use&#44; mean &#40;SD&#41;<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">a</span></a>Change in emollient use&#44; mean &#40;SD&#41;<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">a</span></a>Evaluation of treatment as good or very goodChange in quality of life&#44; EDI score&#44; mean &#40;SD&#41;Overall adverse effects&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ciclosporin A186 &#40;84&#41;45 &#40;74&#41;75 &#40;166&#41;Patients&#44; 86&#37;Researchers&#44; 98&#37;At 4 weeks&#58; &#8211;17 &#40;11&#41;At 8 weeks&#58; &#8211;17 &#40;27&#41;End of study&#58; &#8211;13 &#40;32&#41;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UV-AB114 &#40;118&#41;43 &#40;99&#41;41 &#40;287&#41;60&#37;44&#37;&#8211;9 &#40;9&#41;&#8211;12 &#40;13&#41;&#8211;12 &#40;12&#41;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01NSNS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">Comment&#46; Results were in favor of ciclosporin but the study had a high risk of bias&#58; The fluences used for both UV-A and UV-B were relatively low &#40;patients in the phototherapy arm of the study may have been undertreated&#41;&#46; Uncertain selection bias &#40;randomization&#41;&#46; Assessors were not masked&#46; Attrition bias&#58; Many patients were lost to follow-up&#44; especially in the UV-AB group&#44; and the number of treatment cycles was smaller in the UV-AB arm of the study&#46; Funded by Novartis &#40;manufacturer of ciclosporin A&#41;&#46;</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab840209.png"
              ]
            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Tzung et al&#44; 2006<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a>&#58; Group 1&#58; pimecrolimus &#43; NB UV-B vs pimecrolimus&#46; Group 2&#58; pimecrolimus &#43; NB UV-B vs NB UV-B for 6 weeks and 4 weeks of follow-up&#59; 26 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Outcome measures&#58;Reduction in EASI scores&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Group 156 vs 53 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;084&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Group 259 vs 55 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;059 at week 6 and <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;09 after 4 weeks of follow-up&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top">Reduction in mean pruritus score&#58; NB UV-B &#43; pimecrolimus&#44; 3&#46;1&#59; pimecrolimus&#44; 3&#59; NB UV-B&#44; 3 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#44; and <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#44; respectively&#41;</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top">Comment&#46; The pimecrolimus &#43; NB UV-B combination was not demonstrated to be superior&#46; Inclusion and exclusion criteria were not clearly specified&#46; Uncertain risk of selection bias &#40;randomization&#41;&#44; performance bias &#40;participants were not blinded&#41;&#44; and attrition bias &#40;withdrawals were not explained&#41;&#46; Selective reporting&#58; Flares after treatment were measured&#44; although this variable does not appear in the methods section&#46; Measures of dispersion were not provided&#46;</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab840224.png"
              ]
            ]
            2 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Valkova and Velkova 2004<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a>&#58; UV-AB vs UV-AB &#43; topical corticosteroids &#40;fluticasone or hydrocortisone butyrate&#41;&#44; 5 sessions&#47;week for 12 weeks&#59; 31 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Reduction in severity score&#44; mean &#40;SD&#41;Reduction in topographic score&#44; mean &#40;SD&#41;Reduction in general score&#44; mean &#40;SD&#41;No&#46; of sessionsUV-B dose&#44; mean &#40;SD&#41;&#44; J&#47;cm<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a>Length of remission&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UV-ABFrom 659&#46;8 &#40;62&#46;6&#41; to 132 &#40;28&#46;8&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#59; from 46&#46;2 &#40;4&#46;8&#41; to 9&#46;7 &#40;1&#46;8&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#59; from 360&#46;4 &#40;37&#46;6&#41; to 37&#46;9 &#40;6&#46;7&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#59; 18&#46;3 &#40;0&#46;8&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;02&#41;&#59;2&#46;3 &#40;0&#46;12&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;03&#41;&#59;4&#46;5 &#40;0&#46;4&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UV-AB &#43; corticosteroidsFrom 682&#46;5 &#40;50&#46;5&#41; to 136&#46;9 &#40;33&#46;2&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#59;from 43&#46;6 &#40;3&#46;9&#41; to 8&#46;9 &#40;1&#46;8&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#59;from 395&#46;4 &#40;35&#41; to 36&#46;9 &#40;7&#46;3&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#59;15&#46;6 &#40;0&#46;6&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;02&#41;&#59;1&#46;9 &#40;0&#46;14&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;03&#41;&#59;4&#46;1 &#40;0&#46;4&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top">Comment&#46; Both treatments induced significant improvement&#59; the addition of topical corticosteroids decreased the total UV-B dose and the duration of treatment without influencing the duration of remissions or the frequency of adverse effects&#46; Neither the amount of corticosteroids applied nor the length of the follow-up period were quantified&#46; High risk of detection bias &#40;masking&#41; and uncertain risk of selection bias &#40;randomization&#41;&#46;</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab840222.png"
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          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0045"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0045">In the first treatment cycle&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Studies Comparing Phototherapy to Other Atopic Dermatitis Treatment Modalities&#46;</p>"
        ]
      ]
      7 => array:7 [
        "identificador" => "tbl0030"
        "etiqueta" => "Table 6"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0140" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; CP&#44; clobetasol propionate&#59; EL&#44; excimer laser&#59; FSL&#44; full-spectrum light&#59; F&#47;U&#44; follow-up&#59; ITT&#44; intention to treat&#59; NB&#44; narrowband&#59; sBPT&#44; synchronous balneophototherapy&#59; SED&#44; standard erythema dose&#59; SIP&#44; Sickness Impact Profile&#59; PaGA&#44; Patient&#39;s Global Assessment&#59; PAIS&#44; Physician Assessment of Individual Signs&#59; PGA&#44; Physician&#39;s Global Assessment&#59; PGI&#44; Patient Global Impression&#59; SCORAD&#44; SCORing Atopic Dermatitis&#46;</p><p id="spar0145" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">a</span><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#46;</p><p id="spar0150" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">b</span><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#46;</p><p id="spar0155" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">c</span><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05 between EL and CP&#46;</p>"
          "tablatextoimagen" => array:4 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Brenninkmeijer et al&#44; 2010&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">8</span></a> 2009<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">11</span></a>&#58; 308<span class="elsevierStyleHsp" style=""></span>nm EL &#40;2 sessions&#47;week&#41; vs 0&#46;05&#37; CP &#40;1 application&#47;day&#41; for 10 weeks and follow-up through week 34&#59; 13 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Outcome measures&#58;PAIS score&#44; baseline&#44; mean &#40;SD&#41;PAIS score&#44; week 10&#44; mean &#40;SD&#41;PAIS score&#44; weeks 5-34&#44; mean &#40;SD&#41;<span class="elsevierStyleSup">c</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>40&#37; improvement in PAIS score&#44; week 34Pruritus&#44; week 34&#8220;Nearly clear&#8221; PGA score&#44; week 34PaGA score&#44; week 34Patient&#39;s preference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">EL12&#46;80 &#40;1&#46;5&#41;7&#46;5 &#40;2&#46;9&#41;<span class="elsevierStyleSup">a</span>8&#46;38 &#40;2&#46;5&#41;<span class="elsevierStyleSup">a</span>8 lesions63&#37; reduction6 patients7 prefer EL8 prefer EL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CP12&#46;90 &#40;1&#46;2&#41;8&#46;0 &#40;3&#46;2&#41;<span class="elsevierStyleSup">b</span>9&#46;30 &#40;2&#41;<span class="elsevierStyleSup">a</span>3 lesions49&#37; reduction2 patients4 prefer CP2 prefer CP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top">Adverse effects&#58; Mild and transient&#44; 2 exacerbations&#46;</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top">Comment&#46; EL could be an alternative treatment for the prurigo form of atopic dermatitis&#46; High risk of bias&#46; It was impossible to blind the assessor because of the hyperpigmentation caused by EL&#46; Therefore&#44; histopathologic changes were studied at weeks 0 and 10 in the last 5 patients enrolled in the study&#46; No ITT analysis was performed&#46; Two patients withdrew due to exacerbation and 1 due to nonadherence&#46;</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab840215.png"
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            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Byun et al&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a>&#58; FSL &#40;320-5000<span class="elsevierStyleHsp" style=""></span>nm&#44; 2 sessions&#47;week&#41; &#43; emollient vs emollient for 4 weeks&#59; 38 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Changes in SCORAD scoresBaselineWeek 4Week 8Subjective assessment of patients&#44; week 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">FSL &#43; emollient47&#46;8736&#46;81 &#40;&#8211;23&#46;1&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;30&#46;76 &#40;&#8211;35&#46;7&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;Excellent&#44; 6&#47;20&#59; good&#44; 9&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Emollient39&#46;4735&#46;3933&#46;85&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;236Excellent&#44; 7&#47;18&#59; good&#44; 7&#47;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">Adverse effects in FSL group&#58; erythema&#44; 6&#47;20&#59; dryness&#44; 6&#47;20&#59; pruritus&#44; 4&#47;20&#59; burning sensation&#44; 2&#47;20&#46; Transient exacerbation in 6 patients &#40;first 2 weeks&#41;&#46;</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">Comment&#46; High risk of performance and detection biases &#40;open study&#44; lack of blinding&#44; unspecified randomization method&#41;&#46; Dissimilar baseline characteristics &#40;the baseline SCORAD score difference was 47&#46;87 in the FSL group and 39&#46;79 in the control group&#41;&#46;</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab840214.png"
              ]
            ]
            2 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Heinlin et al&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">6</span></a>&#58; sBPT vs NB UV-B&#44; 3-5 sessions&#47;week until end of treatment &#40;35 sessions or early cure&#41;&#44; 6<span class="elsevierStyleHsp" style=""></span>months of follow-up&#59; 180 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Baseline SCORAD&#44; mean &#40;SD&#41;SCORAD session 35&#44; mean &#40;SD&#41;SCORAD 1 mo F&#47;U&#44; mean &#40;SD&#41;SCORAD 6 mo F&#47;U&#44; mean &#40;SD&#41;Baseline SIP&#44; mean &#40;SD&#41;SIP session 35&#44; mean &#40;SD&#41;SIP 1 mo F&#47;U&#44; mean &#40;SD&#41;SIP 6 mo F&#47;U&#44; mean &#40;SD&#41;PGI session 35PGI 1 mo F&#47;UPGI 6 mo F&#47;U&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">sBPT61&#46;8<span class="elsevierStyleHsp" style=""></span>&#40;14&#46;1&#41;25&#46;6<span class="elsevierStyleHsp" style=""></span>&#40;22&#41;19&#46;0<span class="elsevierStyleHsp" style=""></span>&#40;17&#46;6&#41;18&#46;0<span class="elsevierStyleHsp" style=""></span>&#40;16&#46;4&#41;6&#46;3<span class="elsevierStyleHsp" style=""></span>&#40;8&#41;4&#46;6<span class="elsevierStyleHsp" style=""></span>&#40;6&#46;8&#41;3&#46;7<span class="elsevierStyleHsp" style=""></span>&#40;6&#46;3&#41;4&#46;3<span class="elsevierStyleHsp" style=""></span>&#40;7&#46;4&#41;76&#46;3&#37;73&#46;6&#37;77&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NB UV-B61&#46;5<span class="elsevierStyleHsp" style=""></span>&#40;12&#46;4&#41;34&#46;6<span class="elsevierStyleHsp" style=""></span>&#40;22&#46;3&#41;31&#46;1<span class="elsevierStyleHsp" style=""></span>&#40;19&#46;6&#41;25&#46;3<span class="elsevierStyleHsp" style=""></span>&#40;21&#46;9&#41;5&#46;5<span class="elsevierStyleHsp" style=""></span>&#40;5&#46;6&#41;4<span class="elsevierStyleHsp" style=""></span>&#40;5&#46;5&#41;3<span class="elsevierStyleHsp" style=""></span>&#40;3&#46;6&#41;3&#46;3<span class="elsevierStyleHsp" style=""></span>&#40;5&#46;7&#41;55&#46;4&#37;52&#46;6&#37;49&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;04<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;77<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;98<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;98<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;99<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">Comment&#46; sBPT had better results than NB UV-B and remained superior after 6<span class="elsevierStyleHsp" style=""></span>months&#46; Low risk of biases&#46; Assessors were not blinded because they worked at different private practices&#46;</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab840217.png"
              ]
            ]
            3 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Selvaag et al&#44; 2005<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a>&#58; UV-B vs reflectance-guided UV-B for up to 6 weeks or until a SCORAD score &#60;<span class="elsevierStyleHsp" style=""></span>10&#59; 20 patients</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">UV-B dose&#44; SED &#40;&#215;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UV-BInitial 2&#46;6 &#40;1&#46;9-2&#46;8&#41;Final 9&#46;1 &#40;4&#46;7-14&#46;7&#41;Cumulative 124 &#40;29-186&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reflectance-guided UV-B3&#46;4 &#40;2&#46;6-5&#46;8&#41;4&#46;9 &#40;3&#46;1-9&#46;2&#41;39 &#40;16-88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top">Comment&#46; The radiation dose and the cumulative dose were lower with reflectance-guided UV-B&#46; This was an open study with a high risk of performance and detection biases&#46; No specific data were provided on adverse effects &#40;it was noted that there were no differences&#41;&#46;</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab840225.png"
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Studies Using Less Common Phototherapy Modalities&#46;</p>"
        ]
      ]
      8 => array:7 [
        "identificador" => "tbl0035"
        "etiqueta" => "Table 7"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0165" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; NB&#44; narrowband&#59; PUVA&#44; psoralen plus UV-A&#59; SASSAD&#44; Six Area&#44; Six Sign Atopic Dermatitis&#59; UV-AB&#44; combined UV-A and UV-B phototherapy&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Identification number&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NCT01402414&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Title&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Narrow-band &#40;NB&#41;-UVB vs Bath-PUVA and NB-UVB Plus Salt Water Baths in Atopic Dermatitis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Method&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Randomized observer-blinded controlled crossover trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Date registered&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">July 19&#44; 2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Current status&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Recruiting participants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Estimated date of completion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">September 2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Participants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Patients with atopic dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Interventions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Group 1&#58; NB UV-BGroup 2&#58; PUVA bath therapyGroup 3&#58; NB UV-B plus salt water baths&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Outcome measures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Primary&#58;1&#46; Clinical improvement using SASSAD indexSecondary&#58;2&#46; Evaluation of pruritus and sleeplessness using visual analogue scales &#40;0-10&#41;3&#46; Patient satisfaction&#44; safety and quality of life using Skindex-294&#46; Immunohistochemical and serologic parameters&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Contact&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sarah Terras&#44; MD &#40;s&#46;terras&#64;klinikum-bochum&#46;de&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Identification number&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NCT01254240&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Title&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Efficacy Study of Two Choices of Phototherapy on Itching Skin Diseases</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Method&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Randomized double-blind clinical trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Date registered&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">December 2&#44; 2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Current status&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Recruiting participants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Estimated date of completion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">June 2012 &#40;end of data collection on main variable&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Participants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Patients with pruritic inflammatory dermatoses &#40;atopic dermatitis&#44; other types of eczema&#44; psoriasis&#44; prurigo simplex subacuta&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Interventions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">UV-AB vs UV-B phototherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Outcome measures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Primary&#58; 5-D pruritus score and visual analog scale score at 16 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Contact&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Guenther Hofbauer&#44; MD&#44; Leading Physician&#44; University Hospital Zurich&#44; Division of Dermatology &#40;hofbauer&#64;usz&#46;ch&#41;&#59;Alexander A&#46; Navarini&#44; MD PhD &#40;alexander&#46;navarini&#64;usz&#46;ch&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0160" class="elsevierStyleSimplePara elsevierViewall">Studies Currently Underway&#46;</p>"
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Article information

ISSN: 15782190
Original language: English

DOI:10.1016/j.adengl.2015.04.003

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Year/Month	Html	Pdf	Total

2024 November	16	5	21
2024 October	76	45	121
2024 September	96	26	122
2024 August	119	63	182
2024 July	76	43	119
2024 June	122	61	183
2024 May	85	49	134
2024 April	106	38	144
2024 March	87	36	123
2024 February	97	33	130
2024 January	79	44	123
2023 December	78	27	105
2023 November	98	40	138
2023 October	94	42	136
2023 September	109	47	156
2023 August	50	22	72
2023 July	62	40	102
2023 June	87	22	109
2023 May	80	31	111
2023 April	50	31	81
2023 March	93	28	121
2023 February	71	44	115
2023 January	55	50	105
2022 December	67	64	131
2022 November	49	37	86
2022 October	34	29	63
2022 September	26	42	68
2022 August	31	53	84
2022 July	43	42	85
2022 June	28	35	63
2022 May	45	43	88
2022 April	67	54	121
2022 March	55	52	107
2022 February	70	41	111
2022 January	72	63	135
2021 December	40	55	95
2021 November	40	65	105
2021 October	65	59	124
2021 September	76	51	127
2021 August	66	29	95
2021 July	34	29	63
2021 June	31	42	73
2021 May	33	44	77
2021 April	55	84	139
2021 March	62	17	79
2021 February	50	39	89
2021 January	53	36	89
2020 December	66	34	100
2020 November	46	32	78
2020 October	44	22	66
2020 September	58	24	82
2020 August	49	28	77
2020 July	52	29	81
2020 June	51	26	77
2020 May	42	23	65
2020 April	46	29	75
2020 March	45	27	72
2020 February	7	5	12
2020 January	0	1	1
2019 December	4	2	6
2019 November	0	1	1
2019 October	0	2	2
2019 September	6	1	7
2019 August	1	1	2
2019 July	4	4	8
2019 June	0	2	2
2019 May	2	11	13
2019 April	1	2	3
2019 March	0	4	4
2019 February	4	0	4
2019 January	2	0	2
2018 December	1	0	1
2018 November	2	0	2
2018 October	3	1	4
2018 September	3	0	3
2018 June	0	5	5
2018 May	0	10	10
2018 April	0	1	1
2018 March	0	1	1
2018 February	41	8	49
2018 January	44	14	58
2017 December	41	11	52
2017 November	31	7	38
2017 October	38	16	54
2017 September	23	22	45
2017 August	24	11	35
2017 July	20	16	36
2017 June	34	16	50
2017 May	30	21	51
2017 April	37	15	52
2017 March	22	55	77
2017 February	18	8	26
2017 January	13	18	31
2016 December	44	27	71
2016 November	39	17	56
2016 October	24	16	40
2016 September	0	5	5
2016 August	0	3	3
2016 July	9	9	18
2016 June	5	6	11
2016 May	5	8	13
2016 April	10	7	17
2016 March	6	17	23
2016 February	9	7	16
2016 January	4	7	11
2015 December	14	3	17
2015 November	1	5	6
2015 October	0	8	8
2015 September	0	8	8
2015 August	0	17	17
2015 July	15	21	36
2015 June	11	13	24

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