The Pros and Cons of Eczema Light Therapy

Some people with eczema may turn to moisturizers and corticosteroid creams to help prevent and calm flare-ups, but topical treatments don't always work for every patient. And, while systemic medications like injectable biologics and oral JAK inhibitors have improved eczema treatment, light therapy may be an alternative first-line therapy when used in combination with topical corticosteroids.

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, says Elizabeth H. Page, MD, a dermatologist at Beth Israel Lahey Health and an 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," Dr. Page says.

It can also smooth lesions, decreasing skin thickening, says Emma Guttman-Yassky, MD, PhD, a dermatologist and the director of the laboratory of inflammatory skin diseases at Mount Sinai in New York City.

Narrowband UVB Light Therapy

Although there are different types of eczema phototherapy, 90 to 95 percent of light therapy for eczema is narrowband UVB, says Whitney High, MD, a dermatology professor at the University of Colorado in Anschutz.

Dr. Guttman-Yassky adds, "Narrowband UVB may be best as it's safe and effective."

PUVA Light Therapy

There are some serious risks with UVA light treatment. "We use far less of this treatment because of the skin cancer risk," says Melissa Piliang, MD, a dermatologist at Cleveland Clinic in Ohio. This treatment is more commonly used to treat psoriasis than eczema.

While light therapy is not typically the first line of defense for people with eczema (moisturizers and corticosteroids are usually the first step), it could be a good option, especially for people who are trying to reduce the amount of creams and ointments they apply, says Page.

Dr. Piliang and Page also say light therapy may be a good option for the following circumstances:

• If you don't want to take injections
• If you don't like the side effects of a medication
• If you are targeting eczema in a particular area, like the hands or feet
• If you're targeting widespread eczema and want to reduce your usage of prescription creams

Is Light Therapy Right for Your Eczema Treatment Plan?

For some people, light therapy is the "backbone of their care," says High. But it typically isn't the only aspect of an eczema treatment plan, he says. There is really no eczema therapy that doesn't require other medications or lifestyle recommendations.

"We might still use topical therapies like corticosteroids. We always recommend skin moisturizers and gentle bathing practices," he says.

Light therapy for eczema is not the same as basking in the sun all day or using a tanning bed. "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.

This medical route is different from a tanning bed, says Piliang. Medical light boxes filter out some UV wavelengths, making this therapy a safer option. The U.S. Food and Drug Administration approves medical UV phototherapy — it does not approve indoor tanning devices, according to the American Academy of Dermatology Association.

What to Expect at Your Light Therapy Appointment

At the light therapy appointment, you'll moisturize your skin, then stand undressed (except for underwear) in a light box, with goggles on to protect your eyes. "The box is kind of like a tanning bed, but you stand up instead of lying down. At first, the session will be very short — maybe only 15 or 20 seconds," says High.

People usually go to light therapy appointments two or three times a week, and you need to skip at least one day in between sessions, he says.

"Each time you come back for light therapy, you get a little tiny bit longer ‘dosage’ until eventually you might end up getting three or four minutes of light therapy at a time," says High.

Once people have an adequate treatment response — maybe after 10 to 12 weeks — the sessions are spaced farther apart until they are eventually stopped, he says.

"Eventually, you do what's called ‘riding the remission,' where their eczema symptoms have improved, and their skin is in good shape. At that point, you see how long they can just use topical medicines and moisturizers," says High.

A person can always do a round of light therapy again when they need it, but because additional ultraviolet light can be a risk factor for skin cancer, you don't want to do it indefinitely for the rest of your life, he says.

While light therapy can be beneficial for some people, it may not be right for everyone, especially 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 says.

• A history of skin cancers or melanoma
• Pregnant or nursing
• Eczema on sensitive areas, such as the genitals
• Liver disease
• Medications that cause sensitivity to sunlight
• Lupus
• Sensitivity to sunlight

As with any therapy, there are benefits and drawbacks to light therapy, says High.

Light Therapy Is Time Consuming

For many people considering light therapy, the time required is a potential drawback. It takes 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.

You May Experience Burning and Skin Damage

Artificial UV light, like natural sunlight, can result in tender sunburn and even blistering.

"People who have a light complexion have more tendency to burn, and dosing needs to be adjusted accordingly," says Page.

Though not as painful, you may experience skin damage from this therapy. Over time, age spots and other signs of aging like wrinkles may appear, says Page.

There May Be a Risk of Skin Cancer

Light therapy carries an extra risk of skin cancer, which needs to be factored in with the risks and benefits, says High.

"For some people, the benefits for eczema treatment outweigh the risk, while for others, it may not," he says.

It May Cost You

The cost of light therapy will vary according to insurance coverage and how many sessions you have. Although it could get pricey, it might still be more affordable than other eczema therapies.

• Eczema light therapy, or phototherapy, uses UV light to tamp down overactive white blood cells and reduce inflammation to treat skin rash and itching.
• Light therapy works well for eczema on specific areas, such as hands and feet, and for widespread eczema.
• Some potential drawbacks are convenience, side effects, and cost. It may be a good option if you want to avoid or reduce the need for injections or the side effects of systemic medications.