TABLE 2.
Commonly encountered clinical challenges
| 1. The patient with Fitzpatrick phototypes I–IV especially those with fair skin | PLE-hc may be used adjunctively with a broad spectrum sunscreen and other photoprotective measures (clothing, staying in shaded areas) to reduce the adverse effects of acute and chronic photodamage. A reasonable starting dose for daily use is 1–2 capsules in the morning before outdoor exposure and 1–2 capsules in the early afternoon. |
| 2. The patient with photo-damage/actinic keratosis | Similar to #1 above. PLE-hc may also be used adjunctively with therapies for actinic keratosis (AK). One study has demonstrated improved clearance of AKs (P<0.001) and reduction in AK recurrence over 6 months (P=0.040) in patients treated with photodynamic therapy (PDT) with PLE-hc supplementation as compared to PDT alone.38 |
| 3. The patient who is aware of an upcoming increase in sun exposure | When an increase in sun exposure is anticipated, such as on vacation or involved with work or sports outdoors, it may be prudent to increase the dose of PLE-hc to 5 capsules on the day of greater exposure, divided over 2 doses, as in #1 above. This is especially relevant in fair-skinned individuals. |
| 4. The patient with polymorphous light eruption, those with idiopathic photodermatoses, those ingesting doxycycline, those with photosensitive skin disorders | Studies have shown that PLE-hc can block or reduce the severity of PMLE and other idiopathic photodermatoses.32,33,35 PLE-hc has been shown to reduce phototoxicity in psoralen plus ultraviolet light therapy (PUVA)-exposed skin, which may be extrapolated to possible utility in reducing the potential for drug-associated phototoxicity.13,14 PLE-hc was shown to markedly reduce flares in a patient with subacute cutaneous lupus erythematosus when added to their treatment regimen.39 In these scenarios, the author recommends individualizing the daily dose at 480mg to 960mg given in 2 divided doses in the mid-morning and early afternoon. |
| 5. The patient with vitiligo | Adults treated for vitiligo (N=50) with narrowband UVB and PLE-hc (750mg/day) over 25–26 weeks showed greater repigmentation of the head and neck as compared to narrowband UVB and placebo (44% vs. 27%; P=0.06).34 A second study comparing narrowband UVB with PLE-hc 480mg/day (n=29) or placebo (n=28) for up to 6 months exhibited 40% and 22%, respectively.42 The combination of PUVA and PLE-hc was shown to produce greater repigmentation as compared to PUVA alone (N=39; P<0.01).36 |
| 6. The patient with melasma | In a 12-week randomized study, the combination of sunscreen (SPF 45) and PLE-hc 240mg twice daily proved to be superior to sunscreen (SPF 45) and placebo in females with epidermal melasma, with a statistically significant decrease in the Melasma Area and Severity Index scores demonstrated only in the PLE-hc study arm (N=21; P<0.05).43 |