Maintenance psoralen plus ultraviolet A therapy: does it have a role in the treatment of severe atopic eczema?

Sir, Patients with severe atopic eczema necessitating second‐line treatment are commonly seen; they present a difficult therapeutic problem. We report the use of maintenance psoralen plus ultraviolet (UV) A (PUVA) photochemotherapy in such patients. PUVA remains a widely used treatment for atopic eczema, with proven efficacy.1 Good results can be expected in most patients, although relapse is common when treatment is discontinued. In recent years it has become clear that PUVA therapy is associated with an increased risk of skin cancer, both squamous cell carcinoma (SCC) and melanoma; the risk appears to be dose‐dependent.2, 3 Good clinical practice necessitates limiting PUVA exposure to minimize this risk. This is reflected in the British Photodermatology Group guidelines, which only advocate maintenance PUVA treatment for patients with mycosis fungoides and psoriasis who repeatedly relapse rapidly when PUVA therapy is discontinued.4 Although PUVA is effective for atopic eczema, clearance is less certain than for psoriasis, and may require a considerably higher number of treatments. However, there are patients with severe atopic eczema in whom PUVA seems to be the only effective treatment and occasionally patients refuse to consider other second‐line treatments. Management becomes difficult when these patients relapse rapidly after PUVA is discontinued.