This protocol applies to patients with polymorphic light eruption (PLE) in whom the standard first-line approach has failed — the rash has not settled adequately with sun avoidance and topical treatment, and itch relief has not been achieved.
The initial regimen combines: avoidance of intense UV exposure between 11:00 and 15:00, use of protective clothing, application of a broad-spectrum sunscreen, and a potent topical corticosteroid to relieve itch and manage mild episodes.
Target not met: Mild rash settling within a few days of sun avoidance, with relief of itch. Failure to reach this outcome triggers escalation to the second-line approach described here.
Settling of itch and rash within 48 hours of initiating the oral treatment option, and a sustained reduction in the frequency and severity of PLE episodes.
DOI: 10.1034/j.1600-0781.2003.00048.x
The authors suggested the use of 25 mg prednisolone daily for 4–5 days at the onset of an attack.
A course of psoralen and UVA therapy (PUVA), narrowband (NBUVB) or broadband UVB (BBUVB) phototherapy, usually administered in early spring, can be effective as prophylactic treatment.
Courses of phototherapy/photochemotherapy are generally given over 5–6 weeks, although the regimes vary between centres.
Thrice-weekly NBUVB for 5 weeks has been shown to be as effective as oral 8-MOP PUVA in reducing the frequency and severity of PLE symptoms.
Half the patients used the corticosteroid first if they experienced PLE symptoms and half used the placebo first, and they were instructed to switch to the alternative therapy if symptoms persisted after 48 h.
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