Fototerapia en población pediátrica...

Phototherapy for Childhood Vitiligo, Atopic Dermatitis, and Psoriasis: Report From SPD 2016

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 Sarah L Chamlin MD

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Leslie Castelo-Soccio, MD, PhD, from the Children's Hospital of Philadelphia, provided a review of phototherapy, both UVB and excimer, in pediatric patients with skin diseases including psoriasis, vitiligo, atopic dermatitis, and vitamin D deficiency.

• The biggest challenge when providing phototherapy to children with skin disease is safe delivery; often children do not keep eyewear on and have trouble staying still, and occurrence of acute side effects must be kept in mind.
• In addition, long-term risks of skin cancer must be considered, although there are few data showing a link between malignancy and phototherapy. There is one report of a child with psoriasis treated with PUVA therapy who developed two basal cell carcinomas before the age of 21 years.
• Often, repeat therapy and frequent doctor visits are inconvenient for school children, and this decreases compliance with visits. Home phototherapy should be considered in compliant patients, patients with no access to in-office light therapy, and those patients who have had success with in-office phototherapy. 
• Vitiligo 
  • Data support use of the excimer laser for childhood vitiligo, with a 2011 study showing >50% repigmentation in study participants; this study included good results in childhood segmental vitiligo. The mean number of treatments was approximately 80, and data suggest that if a patient is not responding by treatment number 40, he or she will likely not respond to more. 
  • Similar efficacy holds true for nbUVB therapy of vitiligo. Notably, early treatment may be more successful.
• Atopic dermatitis (AD)
  • UVB therapy should also be considered in AD, and published data support use in patients with severe AD.
  • There are no data on the efficacy of excimer in AD.
• Psoriasis
  • Both nbUVB and excimer are effective for pediatric psoriasis, with fewer therapies required for psoriasis and high numbers of near-complete or complete response.
• Vitamin D deficiency
  • UVB therapy can also be considered in certain instances for vitamin D deficiency, such as critically ill children without access to natural light and children with malabsorption and severe vitamin D deficiency.
• Pearls
• The best response is usually achieved after 40 treatments. If there is a suboptimal response, therapy should be discontinued after 6 months.
• Facial vitiligo seems have the best response to phototherapy.
• Interval increases of 20% per protocol with nbUVB and 10% to 20% for excimer were suggested.

1. Castelo-Soccio L. Medical Phototherapy in Childhood Skin Disease. Paper presented at: 42nd Annual Society for Pediatric Dermatology Meeting; July 14-17, 2016; Minneapolis, MN.