What is the role of phototherapy in the treatment of vesicular palmoplantar eczema?

Updated: Aug 23, 2019
  • Author: Jessica Dunkley, MD, MHSc, CCFP; Chief Editor: Dirk M Elston, MD  more...
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Answer

Phototherapy, in particular PUVA, has been shown to be effective in dyshidrotic eczema for disease control and maintaining remission. [47] However, the use of psoralen has been associated with carcinogenic risk of the skin. Although conventionally used with psoralen for its photosensitizing effects, UVA-1 alone has also shown success in treating palmoplantar eczema, with the advantage that it does not require psoralen. [48, 24] PUVA can be administered orally or topically. In a study comparing the effectiveness of the 2 modalities, dyshidrotic eczema responded well to both oral and topical (bath) treatment, while hyperkeratotic eczema cleared significantly better with oral therapy than with topical (bath) PUVA. [49]  

Narrowband UVB therapy has been shown to be equally efficacious as PUVA therapy for dyshidrotic and "dry" types of hand eczema and can be used as an alternative to PUVA, with fewer adverse effects. [50] As UV radiation has an immunosuppressive effect, one case noted resolution of dyshidrotic eczema symptoms with repeated sunlight exposures (although recurrences were not reduced). [51] Only a few reports describe the role of narrowband UVB therapy in hyperkeratotic hand eczema. However, narrowband UVB has been used with some success in other hyperkeratotic disorders like palmoplantar psoriasis. One study comparing PUVA therapy with narrowband UVB for palmoplantar psoriasis demonstrated significant improvement with both modalities. However, PUVA was superior to narrowband UVB in reducing clinical severity scores. [52] PUVA may be superior to UVB modalities for hyperkeratotic hand eczema because of the deeper penetration of UVA rays into the skin.


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