Oral psoralen photochemotherapy in severe childhood atopic eczema: an update

Over a 6-year period, oral psoralen photochemotherapy (oral PUVA) has been used to treat 53 children (mean age 11.2 years) with severe atopic eczema unresponsive to other therapy. Twice-weekly treatment resulted in clearance or near-clearance of disease in 39 (74%) after a mean of 9 weeks. Thirty-two (82%) of these 39 children were subsequently able to achieve remission of disease following gradual withdrawal of treatment; the mean duration of treatment to remission was 37 weeks; the mean cumulative UVA dose was 1118J/cm2, and the mean number of treatments was 59. Twenty-two remain in remission a year after discontinuing treatment. Short- and medium-term adverse effects, other than occasional intolerance of treatment, have not been prominent. Despite anxieties about possible long-term hazards, it is our view that oral PUVA is justified in a small proportion of older children with disabling atopic eczema. We believe that it has substantial advantages over other therapeutic options in selected cases, particularly in providing improved growth and an opportunity for sustained remission.