Episode 46 - Narrowband vs broadband UVB phototherapy for moderate-to-severe atopic dermatitis

In this episode of BJD Talks, Sam and Meera discuss the article ‘Narrowband versus broadband ultraviolet B phototherapy for adults with moderate-to-severe atopic dermatitis: a randomized controlled trial’ by Drucker et al. The full article can be accessed at https://doi.org/10.1093/bjd/ljag161

 *This podcast was generated by an AI tool created by 67Bricks for the British Association of Dermatologists*

Transcript

SPEAKER_00 0:00

Welcome to BJD Talks, the official podcast of the BJD. I'm Sam.

SPEAKER_01 0:04

And I'm Mira. In this episode, we will be discussing the article by Aaron Drucker et al. Narrowband versus broadband ultraviolet B phototherapy for adults with moderate to severe atopic dermatitis, a randomised controlled trial, from April 2026 and included in the August 2026 issue.

SPEAKER_00 0:25

A topic dermatitis, or AD, is a chronic condition causing itchy inflamed skin. For moderate to severe cases, unresponsive to topical corticosteroids, ultraviolet B or UVB phototherapy has been a mainstay treatment. But a big question has remained. Is narrowband UVB more effective or better tolerated than broadband UVB?

SPEAKER_01 0:46

Exactly, and this study aims to answer that. Researchers ran a pragmatic, randomized controlled trial comparing the two. They studied 69 adults in Canada with moderate to severe AD who hadn't responded adequately to topical treatments, randomising them to receive narrowband or broadband UVB over 12 weeks. That distinction is vital. Unlike narrowband UVB, broadband UVB includes more erythemogenic wavelengths, which might have led to discomfort and erythema, reasons cited by those who withdrew. Narrowband UVB's narrower wavelength between 311 and 313 nanometers may minimize risks while maximising benefits.

SPEAKER_00 1:53

It ties in with what we've seen in other conditions like psoriasis, where narrowband largely replaced broadband UVB for similar reasons. This study emphasises that for AD, tolerability is crucial. AD's chronic relapsing nature demands a treatment patients can stick with.

SPEAKER_01 2:11

It does. I found the trial's pragmatic design particularly helpful. By incorporating real-world variability, such as differing phototherapy schedules, and allowing concomitant topical treatments, the results are applicable to everyday clinical practice. But this flexibility also introduces limitations, for example, not standardising all procedures like hand and foot phototherapy in the narrowband group.

SPEAKER_00 2:37

A fair point. Another limitation was the lack of long-term follow-up. While 12-week efficacy outcomes were similar, we don't know which treatment offers more sustained relief. The authors also raise the question of whether home-based phototherapy may be more feasible for AD.

SPEAKER_01 2:53

Indeed. Past studies in psoriasis have shown home-based narrowband UVB can match in-office treatments for efficacy with better adherence. Expanding home treatment options for AD with safe devices could significantly ease the burden on patients.

SPEAKER_00 3:09

Certainly. It's worth considering where phototherapy fits alongside newer systemic treatments like biologics. Phototherapy may be less expensive, but as this study highlights, requiring frequent clinic visits can limit adherence. Balancing effectiveness, accessibility, and patient preference will be critical.

SPEAKER_01 3:27

Exactly. To wrap up, this trial enhances our understanding of UVB phototherapy in moderate to severe AD. Both narrowband and broadband are effective, but narrowband stands out for tolerability, making it the better option for many patients.

SPEAKER_00 3:43

Precisely.