From the Guidelines
The treatment for polymorphous light eruption (PMLE) should prioritize prevention and symptom management, with phototherapy, specifically PUVA, considered if UVB has failed or is not suitable, as recommended by the British Association of Dermatologists and British Photodermatology Group guidelines 1. The first-line approach involves sun protection measures including wearing protective clothing, applying broad-spectrum sunscreen (SPF 30+), and avoiding peak sun exposure hours. For mild symptoms, topical corticosteroids like hydrocortisone 1% or triamcinolone 0.1% can be applied to affected areas 2-3 times daily until symptoms resolve. Oral antihistamines such as cetirizine 10mg daily or diphenhydramine 25-50mg every 6 hours can help reduce itching. Some key points to consider in the management of PMLE include:
- The risk of provoking PLE is high, particularly with the first few PUVA exposures, and can be managed with potent topical steroid and subsequent lower dose increments 1.
- Post-treatment advice generally includes continued natural sunlight exposure, ranging from 2 h weekly to ‘cautious exposure, with sunscreens for extended outdoor stay’ to ‘expose freely to sun’ 1.
- PUVA should be considered before other systemic treatments, and the treatment should be carried out with full knowledge of the patient’s action spectrum, in a specialist unit experienced in managing this disease 1. In severe or recurrent cases, systemic treatments may be necessary, including short courses of oral prednisone or prophylactic antimalarials like hydroxychloroquine, as well as beta-carotene supplements to increase skin tolerance to light 1.
From the Research
Treatment Options for Polymorphous Light Eruption
The treatment for polymorphous light eruption (PLE) includes several options, such as:
- Sun protection: using sunscreens with high protection levels against UVB and UVA radiation 2
- Corticosteroids: to reduce inflammation and prevent the eruption 3
- Desensitization phototherapy: to increase the skin's tolerance to sunlight 3
- Anti-inflammatory and immunomodulatory agents: to reduce the immune response and prevent the eruption 3
- Oral photochemotherapy (PUVA): to prevent the eruption, especially in cases of UVA-induced PLE 4, 5
- Topical formulations: containing antioxidants and UVA-protective agents, such as alpha-glucosylrutin and tocopheryl acetate, to prevent the eruption 6
Prevention of Polymorphous Light Eruption
Prevention of PLE can be achieved through:
- Using sunscreens with high protection levels against UVB and UVA radiation 2
- Wearing protective clothing and seeking shade when outdoors 2
- Undergoing desensitization phototherapy to increase the skin's tolerance to sunlight 3
- Applying topical formulations containing antioxidants and UVA-protective agents 6
Action Spectrum and Photoprotection
The action spectrum of PLE can be either UVA, UVB, or both, and photoprotection can be achieved through the use of sunscreens and protective clothing 5