Phototherapy

Abstract

UV radiation acts primarily by its immunosuppressive effects and its influence on the release of various pro-inflammatory and anti-inflammatory mediators. With regard to hand eczema, few RCT on the efficacy of UV regimens have been published yet. Many of them are insufficiently powered to detect statistically significant differences in efficacy between the treatment groups and the results are difficult to compare due to differing methodologies. Both UVB irradiation and PUVA are effective and safe for the treatment of chronic hand eczema, but PUVA therapy is likely to be superior to UVB therapy according to the results of the published trials. Published data suggest that neither local NB-UVB nor topic PUVA increase the risk of skin cancer. However, for safety reasons, the number of local PUVA treatments should be limited to 150-200 and a simultaneous treatment with cyclosporine, azathioprine, or topical calcineurin inhibitors should be avoided. Due to the lack of controlled studies, UV-free phototherapy is not recommended by current guidelines on the management of hand eczema.