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Resumen Antecedentes La fototerapia es una opcion terapeutica empleada en dermatitis atopica (DA) y recomendada en multiples guias. Objetivos Evaluar la eficacia de las distintas modalidades de fototerapia y fotoquimioterapia en el tratamiento de pacientes con DA moderada-grave, mediante una revision sistematica. Material y metodos Consideramos los ensayos clinicos aleatorizados (ECA) realizados en pacientes con DA, aceptando cualquier medida de desenlace. Localizamos los articulos mediante una busqueda electronica, utilizando Medline (via Ovid), Embase y Cochrane Central Register of Controlled Trials. Adicionalmente, buscamos los ensayos clinicos registrados en Current Controlled Trials y en la WHO International Clinical Trials Registry Platform. Resultados Incluimos 21 ECA en el analisis cualitativo (961 pacientes). Dos ECA incluyeron ninos 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 comunicacion de la metodologia empleada y los resultados obtenidos. Conclusiones Existe evidencia para el uso de UVBBE y UVA1 en DA moderada-grave. La evidencia para el uso de PUVA en DA es minima, asi como los datos del uso de la fototerapia en la infancia. En futuros estudios seria recomendable estandarizar los criterios de gravedad de la DA y las escalas de valoracion de los pacientes, homogeneizar las tecnicas de irradiacion y establecer un periodo de seguimiento minimo.

Background Phototherapy is a treatment option for atopic dermatitis recommended by several guidelines. Objective To perform a systematic review of the efficacy of different modalities of phototherapy and photochemotherapy in moderate to severe atopic dermatitis. Material and methods We 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. Results Twenty-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. Conclusions There 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.