Self-administered daylight-activated photodynamic therapy for the treatment of hand eczema: a prospective proof-of-concept study.

Kremer, Noa; Sherman, Shany; Lapidoth, Moshe; Enk, Claes D; Leshem, Yael Anne; Mimouni, Tomer; Dudkiewicz, Dean; Hodak, Emmilia; Levi, Assi

Photodynamic therapy (PDT), traditionally used in patients with nonmelanoma skin cancer, has been found to be effective for various inflammatory skin conditions. Daylight-activated PDT (DL-PDT), in which the sun serves as the light source, is substantially less painful than conventional PDT. To determine the safety and efficacy of DL-PDT in a series of patients with chronic hand eczema (CHE). A proof-of-concept prospective design was used. Eight patients diagnosed with CHE at a tertiary dermatology clinic underwent DL-PDT. The first treatment was administered at the clinic and subsequent treatments (up to 4 total) were self-administered at home at 2-week intervals. Outcome was evaluated with the Investigator Global Assessment (IGA) (score 0-4), Dermatology Life Quality Index (DLQI) (score 0-24), and blinded review of clinical photos (graded on a quartile scale by percent improvement). There were 6 male and 2 female patients of mean age 35 years. All underwent at least 3 treatments. The IGA score improved by 2.5 points at 1 month, 2.7 at 3 months, and 2.2 at 6 months post-treatment, and the DLQI score improved by 7.9, 6.6, and 6.1 points, respectively. Clinical photo grades improved by 2.9 points at 3 months. Side effects were mild and transient. All patients had some degree of recurrence 6 months after treatment. The self-administered DL-PDT is easy to perform, moderately effective, and safe for use in patients with CHE. Repeated treatments might be required to maintain remission.