Phototherapy in children: Considerations and indications

doi:10.1016/j.clindermatol.2016.05.018

Clinics in Dermatology

Volume 34, Issue 5, September–October 2016, Pages 633-639

https://doi.org/10.1016/j.clindermatol.2016.05.018 Get rights and content

Abstract

Phototherapy can be a safe and effective treatment for various skin diseases in children. Special considerations governing the use of this treatment modality in pediatric populations include patient, family, and facility-based factors that are oriented around heightened concerns with regard to safety and tolerability of treatment. Although phototherapy has been found to be effective in a wide range of dermatologic conditions affecting pediatric populations, including psoriasis, atopic dermatitis, pityriasis lichenoides, cutaneous T-cell lymphoma, and vitiligo, there is need for additional research on other conditions in which phototherapy has shown promise.

Introduction

Phototherapy can be a well-tolerated and effective treatment for various skin diseases in children; however, special considerations should be taken when employing this mode of therapy, particularly in young children. In this review, we provide guidance regarding the evaluation and management of pediatric candidates and review associated risks. We also discuss the most common dermatologic indications for phototherapy in children, including psoriasis, atopic dermatitis, pityriasis lichenoides, cutaneous T-cell lymphoma, and vitiligo. Our discussion focuses on modalities of phototherapy with evidence-based efficacy. The reader should be mindful that data on safety and efficacy of phototherapy are limited in children, emphasizing the need for future studies.

Section snippets

Evaluation of the newborn

The most common use of phototherapy in the pediatric population is the treatment of unconjugated hyperbilirubinemia in preterm and term infants. The evaluation of an infant with elevated bilirubin is beyond the scope of this contribution, but the provided sources may serve as references.[1], [2]

Evaluation of the child and adolescent

Determining the ideal pediatric candidate for phototherapy is a multifactorial process and should involve both the patient and parents.

The evaluation should begin with a thorough history including

Psoriasis

Modalities	NBUVB, broadband UVB (BBUVB), PUVA
Supporting evidence	Multiple large retrospective reviews
Indications	Potential first-line treatment for patients with diffuse involvement, especially those with guttate psoriasis or thin plaque disease

Phototherapy therapy is an effective treatment for pediatric patients with psoriasis (Table 1). NBUVB (311-313 nm) is the most studied and commonly prescribed because of its relatively positive safety profile, efficacy, and ease of administration. In the

Other conditions

Other conditions successfully treated with phototherapy in pediatric patients include localized scleroderma, morphea, nodular prurigo, Langerhans cell histiocytosis, and cutaneous graft-versus-host disease (GVHD), although efficacy evaluation in these conditions is limited to relatively few cases.[24], [51], [52]

Phototherapy has also been used to diminish manifestations of various light-sensitive cutaneous eruptions, such as erythropoietic protoporphyria and polymorphic light eruption. Such

Conclusions

Current literature suggests children may be treated safely and effectively with various forms of phototherapy for common skin conditions, including psoriasis, atopic dermatitis, and vitiligo; however, larger prospective studies are needed to further understand the long term risks of these therapies, particularly in young children.

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Cited by (21)

Comparison of Phototherapy in Pediatric and Adult Patients
2020, Actas Dermo-Sifiliograficas
La fototerapia se basa en el uso de radiación ultravioleta para el tratamiento de distintas enfermedades dermatológicas. Su eficacia y seguridad está ampliamente establecida en adultos y existen publicaciones que también lo avalan como un tratamiento efectivo y seguro en pacientes pediátricos con afecciones cutáneas recalcitrantes.
Estudio retrospectivo desde 2002 hasta 2017 que incluye a todos los pacientes menores de 17 años que recibieron fototerapia en nuestro servicio. Además, se seleccionaron al azar 122 pacientes adultos que recibieron este tratamiento durante el mismo periodo de tiempo.
Se realizaron un total de 98 tratamientos pediátricos, 61% en niñas y 39% en niños, con una media de edad de 10,5 años. Las 3 enfermedades más frecuentemente tratadas fueron la psoriasis (48% de pacientes), el vitíligo (17%) y la dermatitis atópica (16%). El 86% de los pacientes recibió fototerapia con radiación ultravioleta B de banda estrecha (UVB-BE), mientras que el 7% recibió fototerapia con radiación ultravioleta A con psoralenos (PUVA). No existían diferencias estadísticamente significativas en cuanto a dosis, duración o número de sesiones con respecto a la población adulta tratada con UVB-BE ni con PUVA. Se alcanzó una respuesta completa en el 35% de los pacientes pediátricos, sin diferencias con respecto a los adultos. Únicamente el 16% de los pacientes mostró efectos adversos, en su mayoría en forma de eritema leve. Encontramos mayor adherencia al tratamiento en los pacientes pediátricos que en los adultos (p < 0,05).
La fototerapia con UVB-BE y/o PUVA parece un tratamiento seguro y eficaz en niños, sin ser necesarios protocolos de tratamiento diferentes a los empleados en adultos. La adherencia al tratamiento es mayor que en los pacientes adultos.
Phototherapy involves the use of UV radiation to treat different dermatologic diseases. Its efficacy and safety have been thoroughly established in adults and some publications indicate that it is also an effective and safe treatment in pediatric patients with refractory skin diseases.
Retrospective study that included all patients under 17 years of age and 122 randomly selected adults who received phototherapy in our department between 2002 and 2017.
Ninety-eight pediatric patients (61% girls and 39% boys) with a mean age of 10.5 years received phototherapy. The 3 most frequently treated diseases were psoriasis (48% of patients), vitiligo (17%), and atopic dermatitis (16%). Eighty-six percent of the patients received phototherapy with narrowband UV-B, whereas 7% received phototherapy with psoralen and UV-A (PUVA). No statistically significant differences were found in terms of dosage, duration, or number of sessions compared to the adult population treated with narrowband UV-B therapy or PUVA. A complete response was achieved in 35% of the pediatric patients and no differences were found with respect to the adults. Only 16% of the children showed adverse effects, mostly in the form of mild erythema. We found greater adherence to treatment in the pediatric patients than in the adult patients (P < .05).
Narrowband UV-B therapy and PUVA appear to be safe and effective in children and can be administered using the same treatment protocols as those used in adults. Adherence to treatment is greater in children than in adult patients.
Changing perspectives in atopic dermatitis
2018, Allergologia et Immunopathologia
Citation Excerpt :
Usually, phototherapy is advisable only in addition to topical anti-inflammatory and antimicrobial therapy.6 Phototherapy as a second-line treatment after maximising topical treatments and oral cyclosporine is also efficacious in children.111 Issues related to the child's fear of the cabin, loss of school time, and adverse effects must be considered.
Atopic dermatitis (AD) is a multifaceted disease that involves a complex interplay between the skin and the immune system. The course of the disease depends strongly on the genetic background of the patient and on yet poorly-defined environmental factors. Changes in lifestyle could be behind the dramatic rise in the prevalence of AD across continents; including hygienic conditions, food, social habits, skin microbiome or exposure to a number of allergens. Although AD typically develops in childhood and disappears after a few years, in a relatively large number of patients it continues into adulthood. Adult AD can also appear de novo but it is often underdiagnosed and its treatment can be challenging. New, highly effective drugs are being developed to manage moderate and severe forms of the disease in adults. In this review, we highlight the most recent developments in diagnostic tools, current insights into the mechanistic basis of this disease, and therapeutic innovations.
Novel applications of Phototherapy
2016, Clinics in Dermatology
Narrowband ultraviolet B phototherapy for pityriasis lichenoides: A real-life experience
2023, Photodermatology Photoimmunology and Photomedicine
Phototherapy as a Treatment for Dermatological Diseases, Cancer, Aesthetic Dermatologic Conditions and Allergenic Rhinitis in Adult and Paediatric Medicine
2023, Life
Phototherapy in children: Epidemiology, clinical profile, and outcome
2021, Photodermatology Photoimmunology and Photomedicine

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Phototherapy in children: Considerations and indications

Abstract

Introduction

Section snippets

Evaluation of the newborn

Evaluation of the child and adolescent

Psoriasis

Other conditions

Conclusions

Pediatr Clin N Am

J Pediatr

J Invest Dermatol

Lancet

J Am Acad Dermatol

J Am Acad Dermatol

Dermatol Clin

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

Clin Dermatol

J Am Acad Dermatol

Neonatal hyperbilirubinemia

N Engl J Med

Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation

Pediatrics

Phototoxicity to the newborn primate retina

Invest Ophthalmol Vis Sci

Neonatal blue-light phototherapy does not increase nevus count in 9-year-old children

Pediatrics

Long-term hazards of neonatal blue-light phototherapy

Br J Dermatol

Neonatal blue light phototherapy increases café-au-lait macules in preschool children

Eur J Pediatr

Neonatal blue light phototherapy and melanocytic nevi: a twin study

Pediatrics

Neonatal blue-light phototherapy could increase the risk of dysplastic nevus development

Pediatrics

Narrowband ultraviolet B (UVB) phototherapy in children

Clin Exp Dermatol

Narrow band UVB: Is it effective and safe for paediatric psoriasis and atopic dermatitis?

J Eur Acad Dermatol Venereol

The carcinogenic risk of treatments for severe psoriasis

Cancer

Incidence of skin cancers in 3867 patients treated with narrow-band ultraviolet B phototherapy

Br J Dermatol

Indoor tanning among high school students in the United States, 2009 and 2011

JAMA Dermatol

Narrowband UVB phototherapy in children. A New Zealand experience

Australas J Dermatol