The use of topical PUVA for palmoplantar dermatoses

Palmoplantar dermatoses have a tendency to be chronic and are frequently recalcitrant to treatment. We summarize our experience with paint PUVA in the treatment of 125 patients with palmoplantar dermatoses between the years 1996 and 2000. The dominant clinical picture of the lesions was hyperkeratosis in 84, pustulosis in 11 and exudative dermatitis in the remaining 30 patients. The treatment was applied thrice weekly on alternate days. The affected skin was painted with methoxsalen 0.1% solution, and exposed 30 minutes later to UVA radiation, starting at 0.25 J/cm(2), with increments of 0.25-0.50 J/cm(2) every third treatment. Complete response was considered if all signs disappeared, and partial response if improvement occurred in more than 75% of each of the clinical findings of scaling erythema, fissuring, pustule formation and infiltration. Sixty-nine percent of the patients had a good response (i.e. a complete or partial response), which was achieved in 78.5% of the exudative dermatitis lesions, but in only 46.7% of the pustular lesions. The average time to achieve good response was 13 weeks (range 1-42), with an average total dose of 50 J/cm(2) (range 0.50-366). Maintenance therapy every 1-4 weeks was recommended for all responding patients, but only 58 consented and were treated for an average period of 10 additional weeks. Side effects were minor and transient, mainly mild first-degree superficial skin burns in 10 patients, and patchy hyperpigmentation in three patients, which resolved after a few weeks.