From the Guidelines
Treatment for polymorphic light eruption (PLE) should prioritize phototherapy with narrowband UVB or PUVA, administered 2-3 times weekly for 4-6 weeks before sun exposure season, as it can induce hardening and prevent reactions, with PUVA considered if UVB has failed or is not tolerated, as recommended by the British Association of Dermatologists and British Photodermatology Group guidelines 1.
First-Line Management
First-line management includes sun avoidance during peak hours (10am-4pm), wearing protective clothing, and using broad-spectrum sunscreen (SPF 30+) applied 15-30 minutes before sun exposure and reapplied every 2 hours. For mild symptoms, topical corticosteroids like betamethasone valerate 0.1% cream applied twice daily for 7-14 days can reduce inflammation.
Moderate to Severe Cases
For moderate to severe cases, oral antihistamines such as cetirizine 10mg daily may help with itching. If these measures are insufficient, short courses of oral corticosteroids like prednisolone 20-30mg daily for 3-5 days can be used for acute flares.
Phototherapy
Phototherapy, specifically narrowband UVB, is the preferred first-line phototherapy treatment, but PUVA should be considered if UVB has failed, or has previously triggered the eruption sufficiently to compromise a course of therapy, or if there are other practical issues, as stated in the guidelines 1. The regimens for PUVA vary, but most administer 8-MOP, with a twice-weekly regimen being standard in the U.K. 1.
Prophylactic Medications
For severe recurrent cases, prophylactic medications like hydroxychloroquine 200mg twice daily starting 2 weeks before sun exposure and continuing throughout the summer may be beneficial. Beta-carotene supplements (25mg daily) might help some patients by increasing skin tolerance to sunlight.
Key Considerations
It's crucial to manage the risk of provoking PLE during phototherapy, particularly with the first few exposures, and to have strategies in place for managing provocation episodes, such as using potent topical steroids and adjusting the treatment regimen as needed 1. Post-treatment advice should include continued natural sunlight exposure, with recommendations on cautious exposure and sunscreen use.
From the Research
Treatment Options for Polymorphic Light Eruption
- The main treatment options for polymorphic light eruption (PMLE) include sun avoidance, sun protection, oral carotenoids, and antimalarials 2.
- Artificial hardening or desensitization of the skin through repeated irradiation is considered the most effective treatment option 2, 3.
- A springtime course of prophylactic artificial hardening with ultraviolet B (UVB) phototherapy or psoralen plus ultraviolet A (PUVA) photochemotherapy can help patients tolerate more sunlight and give them greater freedom during the summer 3.
- Sun protection, corticosteroids, and desensitization phototherapy are the mainstays of management for PMLE 4.
Preventive Measures
- Preventive treatment with broad-spectrum sunscreens and sunscreens containing DNA repair enzymes can be sufficient in milder cases 5.
- Natural photohardening with graduate exposure to sunlight in early spring can also be effective in preventing PMLE 5.
- Antioxidants and topical calcipotriol are promising approaches for adjuvant prevention 5.
Therapeutic Options
- Phototherapy, mainly with narrow band UVB rays, is a more appropriate method in severe cases of the disease 5.
- Established treatment options for PMLE include local and systemic glucocorticoids, systemic nonsedative antihistamines for itch relief, and rarely, immunosuppressive drugs in refractory cases 5.
- Afamelanotide has the potential of photoprotection by inducing a melanization of the skin and is believed to be a possible new treatment option for very severe and refractory cases of PMLE 5.
- Targeting the main pruritogenic cytokine, IL-31, opens a new road for the development of novel therapeutic approaches to combat moderate and severe itching in cases of PMLE with intense pruritus 5.