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Phototherapy represents an attractive route for treating a range of challenging dermatological diseases. Existing skin phototherapy modalities rely on direct UV illumination, although with limited efficacy in addressing disorders of deeper tissue and with requirements for specialized illumination equipment and masks to shield unaffected regions of the skin. This work introduces a skin‐integrated optoelectronic device that incorporates an array of UVA (360 nm) light emitting diodes in layouts that match those of typical lesional plaques and in designs that couple to biocompatible, penetrating polymer microneedle light waveguides to provide optical access to deep skin. Monte Carlo simulations and experimental results in phantom skin suggest that these waveguides significantly enhance light delivery to deep skin, with a >4‐fold increase for depths of >500 µm. In ex vivo human skin, the devices show reduced measures of phototoxicity compared to direct illumination and enhanced modulation of gene expression relevant to sclerosing skin diseases. These systems are also compatible with design principles in soft, skin‐compatible electronics and battery‐powered wireless operation. Collectively, the favorable mechanical and light delivery properties of these devices expand possibilities in targeting of deep skin lesions beyond those attainable with clinical‐standard UV light therapy approaches.