Brass, D, Fouweather, T, Stocken, DD orcid.org/0000-0001-8031-1738 et al. (6 more authors) (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. British Journal of Dermatology, 179 (1). pp. 63-71. ISSN 0007-0963
Abstract
Background: Hand eczema is a common inflammatory dermatosis that causes significant patient morbidity. Previous studies comparing psoralen–ultraviolet A (PUVA) with narrowband ultraviolet B (NB‐UVB) have been small, nonrandomized and retrospective.
Objectives: To conduct an observer‐blinded randomized controlled pilot study using validated scoring criteria to compare immersion PUVA with NB‐UVB for the treatment of chronic hand eczema unresponsive to topical steroids.
Methods: Sixty patients with hand eczema unresponsive to clobetasol propionate 0·05% were randomized to receive either immersion PUVA or NB‐UVB twice weekly for 12 weeks with assessments at intervals of 4 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).
Results: In both treatment arms, 23 patients completed the 12‐week assessment for the primary outcome measure. In the PUVA group, five patients achieved ‘clear’ and eight ‘almost clear’ [intention‐to‐treat (ITT) response rate 43%]. In the NB‐UVB group, two achieved ‘clear’ and five ‘almost clear’ (ITT response rate 23%). 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.
Conclusions: In this randomized pilot trial recruitment was challenging. After randomization, there were acceptable levels of compliance and safety in each treatment schedule, but lower levels of retention. Using validated scoring systems – PGA, mTLSS and DLQI – as measures of treatment response, the trial demonstrated that both PUVA and NB‐UVB reduced the severity of chronic palmar hand eczema.
Metadata
Item Type: | Article |
---|---|
Authors/Creators: |
|
Copyright, Publisher and Additional Information: | © 2017 British Association of Dermatologists. This is the peer reviewed version of the following article: 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., which has been published in final form at https://doi.org/10.1111/bjd.16238. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. Uploaded in accordance with the publisher's self-archiving policy. |
Dates: |
|
Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Inst of Clinical Trials Research (LICTR) (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 04 Jan 2018 11:46 |
Last Modified: | 13 Dec 2018 01:39 |
Status: | Published |
Publisher: | Wiley |
Identification Number: | 10.1111/bjd.16238 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:125764 |