Implications for clinical practice

Despite their widespread use, there is insufficient documented evidence of any steroid-sparing or additive effect in the treatment of hand eczema. In general, there seems to be no harm either, apart from the occasional contact allergy to an ingredient.

Is treatment of chronic hand eczema with local PUVA or UVB irradiation better in reducing patient- and doctor-rated severity scores than topical corticosteroids?

We identified no trial explicitly comparing PUVA or UVB therapy with topical steroids; only one RCT had ordinary topical treatment (not specified) as comparator. A further four controlled trials, one of which was an RCT, were identified that compared the efficacy of PUVA or UVB therapy with a control group or using a right-left design. Numerous case series without a control group reported the efficacy of different modalities of photo(chemo)therapy. There is insufficient evidence that PUVA/UVB therapy is more effective than conventional topical steroid therapy.

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