What is the effectiveness of Psoralen plus Ultraviolet A (PUVA) therapy for treating hand eczema (atopic dermatitis)?

From the Guidelines

Hand PUVA therapy is not recommended as a first-line treatment for hand eczema due to limited evidence of its effectiveness compared to other treatments. According to the British Association of Dermatologists and British Photodermatology Group guidelines 1, while some uncontrolled studies have shown topical PUVA to be associated with good degrees of improvement, comparative studies have not demonstrated it to be more effective than placebo, UVB, UVA1, or superficial X-ray therapy.

Key Points to Consider

• The evidence from prospective contemporaneous controlled studies has shown oral PUVA to be effective and superior to UVB in hand eczema, but this is not the case for topical PUVA 1.
• Topical PUVA has been compared to other treatments in several studies, but the results have been inconsistent and often lacking in statistical significance 1.
• The treatment involves soaking the hands in a solution containing 8-methoxypsoralen, followed by UVA light exposure, and requires careful monitoring and precautions to avoid side effects.
• Patients should undergo a medical evaluation before starting treatment and take precautions to avoid sun exposure and wear UVA-blocking sunglasses for 24 hours after psoralen exposure.

Treatment Alternatives

• Other treatments, such as topical steroids, UVB, or UVA1 therapy, may be more effective and have a stronger evidence base for the treatment of hand eczema 1.
• The choice of treatment should be individualized based on the severity and type of hand eczema, as well as the patient's medical history and preferences.

From the Research

Hand PUVA for Hand Eczema

• Hand eczema is a common skin disease that can be challenging to treat, and various therapies are used to manage its symptoms 2, 3, 4, 5, 6.
• PUVA (psoralen plus UVA) therapy is one of the treatment options for hand eczema, and it has been shown to be effective in reducing symptoms 2, 4, 6.
• Topical PUVA therapy is preferable to systemic PUVA treatment due to the localized nature of the disease 2.
• Cream PUVA therapy is a simple, safe, and highly effective treatment option for hand eczema 2.
• A study comparing local narrowband UVB phototherapy with paint-PUVA found that both treatments were effective in reducing symptoms of chronic hand eczema, with no significant difference in clinical response between the two treatment modalities 6.
• Another study found that local combination ultraviolet light therapy (PUVA) may lead to improvement in investigator-rated symptom control when compared to local narrow-band UVB after 12 weeks of treatment, although the evidence was rated as moderate certainty 3.

Comparison with Other Treatments

• Topical corticosteroids are commonly used to treat hand eczema, but the evidence is insufficient to support one specific treatment over another 3, 5.
• Alitretinoin has been shown to be effective in controlling symptoms of hand eczema, but its advantages over other treatments need to be evaluated 3, 5.
• Systemic treatments such as cyclosporine and methotrexate may be effective in treating hand eczema, but more research is needed to compare their efficacy with other treatments 4, 5.

Safety and Efficacy

• PUVA therapy has relatively few side effects, but it can cause skin burning and pruritus 2, 6.
• Narrowband UVB phototherapy has been shown to be well-tolerated, with mild xerosis being the only reported side effect 6.
• The efficacy and safety of PUVA therapy and other treatments for hand eczema need to be further evaluated in well-designed and well-reported studies 3, 5.