Home-based treatment as effective as hospital-based treatment for hand eczema

December 20, 2004

CHICAGO - An at-home hand dermatitis treatment with oral medication and use of a portable tanning unit appears to be as effective as a hospital-based treatment in reducing the symptoms of hand dermatitis, according to an article in the December issue of The Archives of Dermatology, one of the JAMA/Archives journals.

According to background information in the article, hand eczema, also called hand dermatitis, refers to the inflammation of the skin on the hands. This often chronic condition affects 10 percent of adults in the general population within one year, and includes scaling, redness, and blistering of the skin. One treatment option for hand dermatitis is psoralen-UV-A (PUVA). PUVA involves the administration of psoralen--either orally (as a pill) or locally (as a hand-bath soak, or applied as a gel or cream)--and subsequent exposure to UV-A light from tanning units.

A. Marco van Coevorden, M.D., from the University Hospital Groningen, the Netherlands, and colleagues compared the effectiveness of an at-home PUVA treatment (with portable tanning unit) to hospital-based hand bath PUVA in patients with moderate to severe chronic hand dermatitis. Patients in the home group (n = 78) received 30 treatments, three times a week for ten weeks. Two hours after taking an oral medication methoxsalen, the patients used a portable tanning unit on their hands, increasing the time and intensity of treatment throughout the study. Those in the hospital group (n = 80) received UV-A treatment 20 times during 10 weeks, preceded by a 15-minute hand bath with the medication trioxsalen.

The researchers found that, according to changes in hand dermatitis scores, the average improvement after ten weeks was 41 percent in the home group and 31 percent in the hospital group. Overall, the researchers reported no statistically significant difference over time and between groups. "In comparing hospital-administered bath PUVA with oral PUVA at home, both had a similar decrease in hand eczema score (clinical improvement) at the end of treatment. This effect was maintained during an eight-week follow-up period after completion of the treatment," the authors write. "In addition, patients treating themselves at home had substantially lower travel costs and substantially less time off work."
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(Arch Dermatol. 2004; 140:1463 - 1466. Available post-embargo at www.archdermatol.com) Editor's Note: This study was supported in part by the Netherlands Healthcare Insurance Board, Amstelveen, the Netherlands.

For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or e-mail mediarelations@jama-archives.org.

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