What is the treatment for Polymorphic Light Eruption (PMLE)?

From the Guidelines

The most effective treatment for Polymorphic Light Eruption (PMLE) is phototherapy, specifically PUVA, administered twice weekly for 12-20 treatments, as it helps desensitize the skin to sunlight and reduce the risk of provocation. This approach is supported by the British Association of Dermatologists and British Photodermatology Group guidelines 1. When using PUVA therapy, it is essential to consider the timing of treatment during the year to maximize the photoprotective effect and minimize the risk of provocation.

Some key considerations for PUVA therapy include:

• Administering treatment twice weekly, as this is the standard regimen in the U.K. 1
• Starting treatment at the right time of year to ensure the photoprotective effect lasts throughout the summer
• Managing provocation episodes with potent topical steroids and adjusting the treatment schedule as needed 1
• Considering prophylactic measures, such as oral prednisolone or routine application of potent topical steroids, to prevent provocation 1

In addition to phototherapy, other treatment options for PMLE include:

• Sun protection measures, such as broad-spectrum sunscreens and protective clothing
• Topical corticosteroids to reduce inflammation
• Antihistamines to control itching
• Gradual, controlled sun exposure to build natural tolerance

It is crucial to weigh the benefits and risks of each treatment option and consider the individual patient's needs and circumstances. By taking a comprehensive approach to treatment, healthcare providers can help patients with PMLE manage their symptoms and reduce the risk of provocation.

From the Research

Treatment Options for Polymorphic Light Eruption (PMLE)

• The treatment for PMLE can be divided into preventive measures and therapeutic approaches 2, 3, 4, 5, 6
• Preventive measures include:
  • The use of broad-spectrum topical sunscreens and a gradual increase in sunlight exposure to induce a "hardening" phenomenon 2, 3
  • Natural photohardening with graduate exposure to sunlight in early spring 3
  • Sunscreens containing DNA repair enzymes 3
• Therapeutic approaches include:
  • Phototherapy, mainly with narrow band UVB rays, which is more appropriate for severe cases of the disease 2, 3, 6
  • Local and systemic glucocorticoids, which can be used to treat acute attacks of PMLE 4
  • Systemic nonsedative antihistamines for itch relief 3
  • Immunomodulatory agents, such as afamelanotide, which can induce a melanization of the skin and provide photoprotection 3
  • Targeting the main pruritogenic cytokine, IL-31, which opens a new road for the development of novel therapeutic approaches to combat moderate and severe itching in cases of PMLE with intense pruritus 3

Efficacy of Treatment Options

• A short desensitization protocol with narrow band UVB phototherapy has been shown to be effective in preventing PMLE, with a sustained effect in 87.5% of desensitization treatments 2
• A short course of moderate-dose oral prednisolone has been shown to be effective in treating acute attacks of PMLE, with a rapid response and minimal side effects 4
• Other treatment options, such as antioxidants and topical calcipotriol, have been proposed as adjuvant prevention methods, but more research is needed to confirm their efficacy 3