Atopic dermatitis (AD) remains one of the most common chronic inflammatory dermatoses, accompanied by excruciating itch, xerosis, and recurrent eczematous lesions. Management traditionally relies on emollients and topical anti-inflammatory agents and, in moderate to severe cases, systemic pharmacotherapy and narrowband ultraviolet B (UVB) phototherapy with a peak around 311 nm. At the same time, the need for long-term application of topical agents is often associated with poor patient adherence or the risk of adverse events (such as steroid-induced skin atrophy). In turn, total-body phototherapy in cabins inevitably affects intact areas of the skin.

Accordingly, interest in modern dermatology is growing in targeted, device-based technologies. In theory, laser systems deliver high energy density strictly to the focus of inflammation, minimizing effects on healthy tissue. However, to what extent objective clinical data support this premise, and whether lasers can already be considered a full-fledged tool for dermatologists in AD, the authors of an overview study—a scoping review summarizing existing publications on the topic—attempted to assess [1].

Review design: what the researchers analyzed

The authors conducted a systematic literature search in Ovid MEDLINE, EMBASE, and Web of Science. According to the Methods section, the authors searched in October 2025, and the declared publication inclusion period was 2015–2025. At the same time, the abstract gives different dates: September 2023 and 2013–2023. This internal inconsistency in the primary source must be considered when appraising the review.

The researchers aimed to bring together data on laser technologies, phototherapy, and disease mechanisms. The final selection includes not only experiments and clinical observations but also review articles and treatment guidelines. Therefore, the 27 included publications cannot be regarded as 27 studies of laser efficacy in AD.

For each paper, the authors described the design, the models or participants used, the main results, and the limitations. However, this heterogeneous selection allows researchers primarily to outline research directions rather than establish the comparative efficacy of the methods.

Preclinical effects

Experimental studies focus on different tasks: reducing inflammation and scratching, altering cellular responses to light, and enhancing the penetration of topical components. These are not interchangeable approaches. Radiation's anti-inflammatory effect and increased skin permeability to a peptide are different outcomes, each requiring separate verification of clinical relevance.

1. Excimer laser: local action on inflammation and itch

Why this technology: the 308 nm excimer laser allows individual foci to be irradiated, limiting exposure to the surrounding skin. The ability to localize ultraviolet exposure makes it of interest for investigating localized lesions.

In experimental mouse models, the authors described the following changes:

• Suppression of itch and scratching frequency. In mice with induced atopic dermatitis, targeted laser exposure led to a reduction in the number of scratching episodes — a behavioral indicator of itch.
• Reduction in inflammatory parameters. The review cites data on a reduction in the serum level of immunoglobulin E (IgE), interleukins (IL-1α, IL-1β, IL-6, and IL-31, as well as certain other inflammatory mediators.
• Changes in the structure of inflamed skin. In animal models, a reduction in epidermal thickness and mast cell degranulation was noted. Oh et al. also showed reduced severity of AD-like lesions and improved skin barrier function [2].

Separately, the review discusses an excimer lamp experiment: reduced scratching was accompanied by nerve fiber degeneration and decreased density in the skin. These findings cannot be automatically attributed to all excimer laser protocols: a lamp and a laser are different radiation sources. Nerve fiber degeneration also requires evaluation of potential adverse consequences, not just the antipruritic effect.

2. Low-level laser therapy: photobiomodulation with minimal thermal effect

Why this technology: low-level laser therapy (LLLT) is studied as a way to alter cellular processes without marked tissue heating. Such an action is termed photobiomodulation. Light absorption by intracellular photoacceptors, including mitochondrial cytochrome c oxidase, is one hypothesized mechanism. However, a general explanation of photobiomodulation cannot be passed off as a mechanism directly proven in a specific AD model.

In Kim et al., red radiation at 650 nm at energy densities of 2, 4, 6, and 8 J/cm² was used. Mice with chemically induced AD-like dermatitis underwent daily procedures for two weeks — 14 sessions in total [3].

Compared with the control dermatitis group, the researchers observed:

• A decrease in serum IgE in all laser-exposure groups.
• A decrease in serum IL-4 in all irradiated groups except the 8 J/cm² group, and reduced gene expression of IL-6 and tumor necrosis factor α (TNF-α).
• A decrease in epidermal thickness and the number of mast cells in skin samples.

These results support interest in the anti-inflammatory effect of LLLT, but do not establish an optimal dose for humans. The listed results did not directly confirm accelerated closure of microfissures, barrier recovery due to adenosine triphosphate synthesis, or the blocking of specific signaling pathways.

3. Non-ablative Nd:YAG laser: enhancing the delivery of topical peptides

Why this technology: the neodymium-doped yttrium aluminum garnet (Nd:YAG) laser in nanosecond and picosecond modes was investigated as an instrument to increase skin permeability. Unlike previous approaches, the main goal here is not direct suppression of inflammation, but enhancing the delivery of molecules to the skin with less tissue damage than ablative exposure.

In Lee et al., they evaluated the penetration of cosmeceutical peptides and the recovery of barrier function in pig and mouse skin models. Among the studied components was the copper tripeptide CT-1. Its use in the experiment does not imply that this component is of proven efficacy for the treatment of AD [4].

In preclinical tests, the researchers obtained two main results:

• An increase in permeability to peptides. In an experiment on skin models, picosecond and nanosecond exposure from the Nd:YAG laser enhanced the penetration of certain topical peptides. The magnitude of the effect depended on molecular size and lipophilicity; the nanosecond mode particularly enhanced follicular delivery.
• Faster barrier recovery compared with microsecond ablative lasers. This is a comparative experimental result, not proof of the absence of skin damage or an infection risk. The review does not detail the mechanism behind the increase in permeability.

What the clinic says: reality versus expectations

Preclinical studies were conducted in cell and tissue models, as well as in animals. Clinical data on the use of lasers in human atopic dermatitis are significantly scarcer in the review.

One of the examples is the report by LaBrasca et al. on two patients with long-standing, poorly controlled AD. For treatment, the authors used a high-peak-power 1064 nm Nd:YAG laser; procedures were repeated periodically, and follow-up spanned nine years. The authors reported symptom improvement and disease control; however, two cases without a control group do not allow the comparative efficacy of the method to be determined [5].

The clinical selection also includes papers in which conditions accompanying AD, rather than AD itself, were treated. For example, a pilot study of the 2790 nm Er:YSGG laser in ten patients focused on dark circles under the eyes, and a series on the application of a fractional CO₂ laser addressed lichen amyloidosis against the background of AD. An improvement in such conditions cannot be presented as proof of laser efficacy against the primary dermatosis.

The review also contains inaccuracies in its presentation of clinical data: the description of Kurosaki et al.'s work on excimer light conflates patient and mouse data. Therefore, based on this table, one cannot reliably reproduce the protocol and results. Overall, the review does not provide sufficient data to compare laser technologies with standard AD therapy.

Safety and adverse event

With an impaired epidermal barrier, an intervention's safety is no less important than its potential therapeutic effect. However, the review contains no systematized data on the frequency and severity of adverse events for each laser technology.

In individual papers, satisfactory tolerability or the absence of severe adverse events was noted. But these data relate to specific procedures, models, and small cohorts of participants. They do not allow the assertion that all discussed methods are safe in AD.

The list of erythema, edema, burning, and hyperpigmentation in certain phototypes in the previous version of the note is not supported by the review text. Nor does it provide grounds to claim that infections, scarring, or generalized exacerbations are absent across all included studies. Long-term safety and the consequences of repeated exposures remain insufficiently studied.

Limitations of the available data

The authors of the review focus attention on several fundamental limitations of the current scientific base:

1. Small sample sizes and differences in design: experimental studies, clinical cases, and studies of concomitant conditions answer different questions.
2. Heterogeneity of protocols: wavelengths, energy parameters, and exposure durations make direct comparison of results difficult.
3. Absence of control groups and long-term follow-up in a portion of the studies. This does not mean that long-term follow-up was completely absent: the report on Nd:YAG therapy spanned nine years.
4. The study underrepresents different patient groups, limiting the generalizability of conclusions to people of different ages and backgrounds.
   Additional caution is required due to inconsistencies within the primary source itself: differing search dates and selection criteria in the abstract and the Methods, as well as errors in the description of individual studies.

Practical implications and conclusions

The review shows why laser technologies attract researchers' attention, but it does not provide a solid basis for their widespread introduction into AD treatment. Localized excimer exposure and LLLT show anti-inflammatory potential in experimental models, while short-pulsed Nd:YAG may enhance the delivery of topical peptides. These directions cannot be conflated into a single proof of clinical efficacy.

For the practicing specialist, it is important to distinguish the established role of phototherapy in AD from the significantly more limited data on specific laser protocols. Based on a single review, one cannot draw a universal conclusion about whether to include all laser technologies in current clinical recommendations. Furthermore, the presented results do not support using ablative modalities on inflamed skin for presumed barrier recovery.

Treatment choices must rely on clinical recommendations, disease severity, and individual indications, rather than on directly translating experimental mechanisms into practice. Skin barrier care, emollients, and tailored anti-inflammatory therapy remain valuable. Clarifying the role of lasers will require controlled clinical studies with reproducible protocols that evaluate symptoms, safety, and the durability of results.

References

1. Persson C., Niu L., Oualid C. et al. Efficacy of laser therapy in patients with atopic dermatitis: a scoping review. Cureus 2026; 18(3): e105694.
2. Oh C.T., Kwon T.R., Seok J. et al. Effect of a 308-nm excimer laser on atopic dermatitis-like skin lesions in NC/Nga mice. Lasers Surg Med 2016; 48: 629–637.
3. Kim Y.L., Lim H.S., Lee S.M. Effect of low-level laser intervention on dermatitis symptoms and cytokine changes in DNCB-induced atopy mouse model: a randomized controlled trial. Exp Ther Med 2021; 22: 1196.
4. Lee W.R., Hsiao C.Y., Chang Z.Y. et al. Cutaneous delivery of cosmeceutical peptides enhanced by picosecond- and nanosecond-domain Nd:YAG lasers with quick recovery of the skin barrier function: comparison with microsecond-domain ablative lasers. Pharmaceutics 2022; 14(2): 450.
5. LaBrasca M., Stalling S., Poulos G.A., Obagi S. Successful treatment of refractory atopic dermatitis with the use of high-peak power 1064 nm Nd:YAG laser therapy. Am J Cosmet Surg 2021; 38: 143–149.