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Can hand eczema be effectively treated with psoralen-ultraviolet A? Hand eczema is a common inflammatory dermatosis that causes significant patient morbidity. Studies comparing psoralen–ultraviolet A with narrowband ultraviolet B have been small, non-randomised and retrospective.

An observer‐blinded randomised controlled pilot study in the UK used validated scoring criteria to compare immersion psoralen–ultraviolet A with narrowband ultraviolet B for the treatment of chronic hand eczema unresponsive to topical steroids.

Sixty patients with hand eczema unresponsive to clobetasol propionate 0·05% were randomised to receive either immersion psoralen–ultraviolet A or narrowband ultraviolet B twice weekly for 12 weeks with assessments at intervals of four weeks.

The primary outcome measure was the proportion of patients achieving ‘clear’ or ‘almost clear’ Physician’s Global Assessment (PGA) response at 12 weeks. Secondary outcome measures included assessment of the modified Total Lesion and Symptom Score (mTLSS) and the Dermatology Life Quality index (DLQI).

In both treatment arms, 23 patients completed the 12‐week assessment for the primary outcome measure. In the psoralen–ultraviolet A group, five patients achieved ‘clear’ and eight ‘almost clear’. In the narrowband ultraviolet B group, two achieved ‘clear’ and five ‘almost clear’.

For the secondary outcomes, median mTLSS scores were similar between groups at baseline (PUVA 9·5, NB‐UVB 9) and at 12 weeks (PUVA 3, NB‐UVB 4). Changes in DLQI were similar, with improvements in both groups.

In this study, recruitment was challenging. After randomisation, there were acceptable levels of compliance and safety in each treatment schedule, but lower levels of retention.

Using validated scoring systems as measures of treatment response, the trial demonstrated that both psoralen–ultraviolet A and narrowband ultraviolet B reduced the severity of chronic palmar hand eczema.

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Source: Brass, D. , Fouweather, T. , Stocken, D. , Macdonald, C. , Wilkinson, J. , Lloyd, J. , Farr, P. , Reynolds, N. and Hampton, P. (2018), An observer‐blinded randomized controlled pilot trial comparing localized immersion psoralen–ultraviolet A with localized narrowband ultraviolet B for the treatment of palmar hand eczema. Br J Dermatol, 179: 63-71. doi:10.1111/bjd.16238

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