Polymorphic light eruption
ICD-10 L56.4 · ICD-11 EJ30.0

Polymorphic Light Eruption When Third-Line Immunosuppression Has Not Achieved Adequate Phototesting Response

This protocol applies to patients with polymorphic light eruption (PLE) whose condition has progressed through third-line systemic immunosuppression without reaching the expected improvement in phototesting. A further tier of reported alternatives exists for this situation.

Previous Treatment — Goal Not Achieved

Third-line systemic immunosuppression — azathioprine or cyclosporin — was used but did not achieve the required goal: increased minimal erythemal responses on phototesting after 3 months. This protocol represents the step taken when that threshold is not met.

Treatment Approach

A range of alternative agents — both systemic and topical — has been reported in PLE after established lines have not succeeded, each used individually as a separate option. Which approach applies and the complete regimen details are available in the structured protocol.

Clinical Goals

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1034/j.1600-0781.2003.00048.x
The dose of hydroxychloroquine used was 400 mg daily for the first month and 200 mg thereafter for a total of 12 weeks.
When taken at a dose of 2–3 g daily before sun exposure, 60% patients reported complete abolition of symptoms despite continued sun exposure, while 26% reported no benefit.
In uncontrolled studies, 10 g mixed o-3 PUFAs (MaxEPAs, Seven Seas, Hull, UK), taken as five capsules twice daily day for 3 months, significantly increased the MED to UVB, and significantly increased the threshold for UVA-provocation of rash.
In a case series of 25 patients with 'PLE', 88% good to excellent lesion healing was reported with thalidomide.
A randomized, double-blind controlled study involving 30 PLE patients showed that three topical antioxidant mixtures (comprising a-glycosylrutin, tocopherol acetate and ferulic acid), significantly reduced the development and severity of PLE induced experimentally.
A small preliminary study involving nine patients suggested that its intramuscular, but not oral, administration significantly increased the provocation threshold of PLE to UVA.
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