Should You Try Phototherapy for Your Eczema?

Although there’s no cure for eczema, there are many treatments available to help minimize flares and treat discomfort. From over-the-counter options like pain relievers and antihistamines to topical steroids and oral medications, there are treatments for various types of eczema that can be tailored to each individual. However, when those treatments don’t work, phototherapy is another treatment option typically used to address more severe eczema.

“In dermatology, phototherapy usually refers to the localized and targeted delivery of ultraviolet (UV) light to the skin, using nonlaser or laser devices, typically for the treatment of inflammatory skin conditions like eczema,” said Dr. Raj Chovatiya, dermatologist and founder of the Center for Medical Dermatology + Immunology Research in Chicago.

How does phototherapy help eczema? Does phototherapy work for all types of eczema, or just certain types?

As far as how UV light can help eczema, Dr. Chovatiya explained that phototherapy works by suppressing the activity of overactive immune cells. “The primary chromophore in skin, DNA, absorbs UVB light and this leads to the formation of very specific damage to the nucleotides found in DNA,” he said. “This is helpful when there are a lot of overactive immune cells in the skin such as T cells, which drive a lot of the inflammation seen in eczema.”  

One of the benefits of phototherapy is that it can work for all types of eczema. However, Dr. Chovatiya noted that phototherapy is a treatment that doctors tend to reserve “for individuals with moderate to severe disease that hasn’t adequately responded to topical therapies.” 

What types of light are used in phototherapy?

While it’s clear that phototherapy uses light, not just any light will do the trick. The main types of light used are UVA and UVB. “The UVB phototherapy most commonly used now is called narrowband UVB because it emits a very narrow range of wavelengths of light within the UVB spectrum,” said Dr. Joy Wan, dermatologist and assistant professor of dermatology at the Johns Hopkins University School of Medicine. “UVA phototherapy also comes in a couple of different forms, including one form that is combined with an oral or topical medication that sensitizes the skin to the UVA light (called PUVA phototherapy).” 

When should you try phototherapy for eczema?

Both Dr. Wan and Dr. Chovatiya agree that it might be a good idea to consider phototherapy if your eczema is on the moderate to severe scale and isn’t responding to topical therapies. It can be prescribed by a medical professional like a dermatologist. 

“Your dermatologist is the expert when it comes to phototherapy, and thus they would be the one prescribing it for the treatment of eczema,” said Dr. Chovatiya. “Not every dermatologist has phototherapy available in their office however, so they can help you identify where it might be most convenient for you to receive your treatment.” 

While the dermatologist is likely the one prescribing the treatments, actual phototherapy sessions can be administered by the dermatologist, or by a nurse or medical assistant following that treatment protocol outlined by that dermatologist. 

What can you expect if you go in for phototherapy treatment?

Dr. Wan outlined what a typical phototherapy session can look like. Here are some of the general steps:

• Before each treatment, you will be asked about your response to the last phototherapy treatment and any side effects. 
• The provider will have you undress so that the areas to be treated are exposed. 
• You may be asked to keep some sensitive areas covered or shielded during the treatment (e.g., goggles for the eyes or underwear for the genital area). 
• You will then step into the phototherapy booth and the door will be closed. 
• The nurse or provider will start the phototherapy machine and the lamps within the machine will emit light based on the dosing entered by the provider. 
• You may be in the booth for as little as a few minutes. After the lights turn off, the provider will open the door and you can step out of the booth.

“There are also other types of phototherapy machines in addition to the full-body booths so the above procedures may vary slightly,” she said. “Also, in the case of PUVA phototherapy, you will be asked to take an oral medication or apply a medicated cream to the skin prior to the phototherapy treatment.”

How often do you have to go for phototherapy?

In short, there isn’t a one-size-fits-all routine since phototherapy is tailored to the specific needs of each patient and the severity of their eczema. However, Dr. Chovatiya believes that a low dose — about three times a week — is a good starting point, and that dose can be increased over weeks or months. If the patient responds well after several months on a stable dose, sometimes the frequency of treatment can be reduced to about once or twice a week to maintain results. 

“Most dermatologists would agree that a good trial of phototherapy would be three to six months — if we were not seeing much of a response at that point, we would want to consider other treatment options,” he said.

What are the risks and benefits of phototherapy for eczema patients?

When considering a new treatment, it’s best to think about the benefits as well as potential risks, and like all treatments phototherapy has both pros and cons. The overall benefit of phototherapy is the improvement in eczema symptoms especially in moderate to severe cases when other options haven’t been as successful. 

“While there are some potential side effects with phototherapy, it remains a relatively safe treatment,” said Dr. Wan. “Since phototherapy targets only the skin, it does not carry some of the potential side effects that oral and injectable systemic medications for eczema may carry.”  

However, risks can include sunburn, premature skin aging and increased risk of skin cancer. “Potential long-term side effects include theoretical risks of photoaging and skin cancer, though based on studies to date, the risk of these appears quite small with targeted phototherapy (as opposed to nontargeted phototherapy approaches),” said Dr. Chovatiya. 

Dr. Wan noted that they try to prevent issues like sunburn by using an appropriate dosing of light treatment and reiterated that these risks are “still relatively low when phototherapy is done in a safe and appropriate manner.” 

If someone is undergoing PUVA phototherapy treatment (mentioned above), the oral medication that is given may have side effects like “nausea or vomiting, headaches, increased sun sensitivity and cataracts, making sun protection extremely important when getting PUVA treatment,” according to Dr. Wan.

So while there are risks that may present themself with this treatment it’s still a very viable and safe option that poses many benefits. “Phototherapy is one of the safer options that we have for eczema patients, as it is a completely external treatment and avoids many of the potential adverse events we associate with systemic therapies (i.e., pills and injections),” said Dr. Chovatiya.

Podcast on phototherapy

In this Eczema Out Loud podcast, Dr. Raj Chovatiya speaks at length about this treatment option for eczema. Listen now to learn more about phototherapy.