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The Lowdown on Light Therapy for Eczema
Eczema light therapy, or phototherapy, refers to the use of ultraviolet (UV) light to treat the skin rash and itching of eczema. Exposing the skin to UV light suppresses overactive skin immune system cells that cause inflammation, explains Elizabeth H. Page, MD, a dermatologist at Beth Israel Lahey Health and assistant clinical professor of dermatology at Harvard Medical School in Boston. “Light therapy works by chasing away the white blood cells that trigger the inflammation, so light therapy is anti-inflammatory.” Another payoff? “Light therapy also smoothes the lesions, decreasing skin thickening,” says Emma Guttman-Yassky, MD, PhD, a dermatologist and the director of the Laboratory of Inflammatory Skin Diseases at the Icahn School of Medicine at Mount Sinai in New York City.
Who Is a Fit for Light Therapy’s Perks
While light therapy is usually not the first line of defense for people with eczema (moisturizers and corticosteroids are usually step one), it could be a good option if a person doesn’t want to take a medication that requires an injection, doesn’t like needles, or doesn’t want the side effects of a systemic medication, which is one that affects the entire body, says Dr. Piliang. For example, the medication methotrexate (Trexall, Rheumatrex), which is given by injection or taken as a pill, is used to help treat severe cases of eczema, but you can’t take it if you have liver disease or if you drink alcohol, notes Piliang; per the National Eczema Society, pregnant or breastfeeding women should not take it either. “Light therapy works well for people with targeted eczema, like on their hands or feet, because dermatologists can isolate those areas with the light,” says Piliang. In addition, it can be helpful for someone who has head-to-toe eczema. “It’s a good way to treat widespread eczema and reduces the need to put prescription creams and ointment over a large area of the body,” says Dr. Page. It’s also considered a safe treatment for kids, says Piliang. There is no age requirement; rather, the child needs to be mature enough to stand alone. Eczema light therapy is not given to infants, according to the Mayo Clinic. Piliang adds that it’s a nice option for pregnant women. Just know that light therapy for eczema is not the same as basking in the sun all day. “Natural sunlight can help relieve symptoms of eczema, but artificially produced UV light is best for eczema treatment because it can be controlled and given under supervision,” says Page. Taking this medical route is different than using tanning beds, explains Piliang, because the medical light boxes filter out some UV wavelengths, so this therapy is the safer option. RELATED: No, Eczema Isn’t Contagious, But Here’s How Secondary Infections Can Be Spread
How Light Therapy Works to Help Treat Eczema
Years ago, doctors used three types of eczema phototherapy, but these days one has come out on top. “The most common form of phototherapy is narrowband UVB, which has largely replaced other forms of phototherapy such as broadband UVB and PUVA,” says Page. Dr. Guttman-Yassky adds, “Narrowband UVB may be best as it’s safe and effective.”
PUVA Light Therapy
PUVA is when a doctor uses UVA wavelength light, says Page, but to make the treatment effective, the oral medication psoralen must be taken an hour beforehand (the abbreviation PUVA stands for psoralen plus UVA), so the skin is more sensitive to the light therapy. Some people are unable to tolerate PUVA because of nausea from psoralen, according to the American Osteopathic College of Dermatology. There are other serious risks with UVA light treatment. “We use far less of this treatment because of the skin cancer risk,” says Piliang. This treatment is more commonly used for treating psoriasis than eczema.
Narrowband UVB Light Therapy
“Narrowband UVB uses a small part of the UVB spectrum, which cuts down on exposure to UV radiation,” says Page. This makes it more appealing than broadband UVB, which is also less effective at penetrating the skin, according to the National Eczema Society. In addition, a review published in October 2019 in the Expert Review of Clinical Immunology called narrowband UVB light the “gold standard” of light therapy treatment for eczema in terms of safety and efficacy.
What to Expect at Your Light Therapy Appointment
“Patients usually go to light therapy appointments two or three times a week for several weeks to months,” says Piliang. At the appointment, you’ll moisturize your skin, then stand undressed (except for underwear) in a light box, with goggles on to protect your eyes, according to the National Eczema Association. Treatment can last anywhere from seconds to a couple of minutes, the society notes. While light therapy may sound like a simple way to help with eczema, it’s not without its drawbacks. RELATED: Bacteria Therapy for Eczema Shows Promise for More Effective, Cheaper Treatment
Possible Disadvantages of Eczema Light Therapy
Cost may be a con of eczema light therapy: For insured patients, there may be a copay involved for each time you receive treatment, plus deductible considerations. Another potential drawback is that it’s time-consuming and requires many trips to a doctor’s office over several weeks, Page says. “If you’re driving 30 minutes to your doctor’s office, waiting for your appointment, taking your clothes off, standing in the booth, then putting your clothes back on and driving home, it might be too much of a time commitment for you,” says Piliang. “If you live close to your doctor’s office, it may be convenient, but if not, it might be too difficult to do this several times a week.” Other drawbacks of eczema phototherapy may include these considerations: Burning Artificial UV light, like natural sunlight, can result in tender sunburn and even blistering. Skin may redden and itch. Though, according to NYU Langone Health, side effects to phototherapy happen infrequently and tend to go away quickly. Also worth noting: “People who have a light complexion have more tendency to burn, and dosing needs to be adjusted accordingly,” says Page. Skin Damage Over time, age spots and other signs of aging like wrinkles may appear, says Page. Skin Cancer PUVA, an older form of phototherapy, has been shown to cause skin cancer, Page says. “Although there is no proof that narrowband UVB causes skin cancer, this is a theoretical possibility, and it is important to limit exposure as much as possible,” she says. Separately, indoor tanning is not a good alternative to phototherapy and has been shown to increase the risk of skin cancer, Page notes. Varied Effectiveness While light therapy can be beneficial for some individuals, it may not be right for everyone — especially for people with extreme cases of the skin condition. “It doesn’t work on highly widespread disease and works less on very thick lesions,” says Guttman-Yassky. In very severe cases, a systemic biologic or oral medication may be needed at least initially, she advises. RELATED: The Best Natural and Essential Oils to Help Soothe Eczema-Prone Skin
Is Light Therapy Right for Your Eczema Treatment Plan?
Despite the potential drawbacks, “UV light therapy is an effective treatment for moderate to severe eczema if it is carefully controlled and the proper precautions are taken,” says Page. Talk to your dermatologist to see if eczema light treatment might work for you.
