Summary of findings 3. Irradiation with UV light: local narrow‐band UVB compared to local PUVA for hand eczema.

Irradiation with UV light: local narrow‐band UVB compared to local PUVA for hand eczema
Patient or population: people with hand eczema unresponsive to clobetasol propionate Setting: secondary care with outpatients in the United Kingdom. Intervention: local narrow‐band UVB twice weekly for 12 weeks Comparison: immersion PUVA twice weekly for 12 weeks
Outcomes	Anticipated absolute effects* (95% CI)		Relative effect (95% CI)	No. of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Assumed riska	Corresponding risk
	Risk with local PUVA	Risk with local narrow‐band UVB
Primary: investigator‐rated good/excellent control of symptoms Follow‐up: 12 weeks	Study population		RR 0.50 (0.22 to 1.16)	60 (1 RCT)	⊕⊕⊕⊝ Moderateb	‐
	400 per 1000	200 per 1000 (88 to 464)
Primary: participant‐rated good/excellent control of symptoms Not measured	See comment	See comment	Unable to estimate treatment effect	‐	See comment	No data reported
Primary: adverse events ‐ reported adverse events, mainly erythema Follow‐up: 12 weeks	See comment	See comment	RR 19.00 (1.16 to 312.42)	60 (1 RCT)	⊕⊕⊕⊝ Moderatec	PUVA: No adverse events reported (0/30) Narrow‐band UVB: 9 out of 30 participants reported an adverse event, mainly erythema Fisher's exact test  P = 0.0019
Secondary: investigator‐rated reduction in severity in mTLSSd Follow‐up: 12 weeks	‐	‐	Unable to estimate treatment effect	43 (1 RCT)	⊕⊕⊕⊝ Moderatee	Reduction in mTLSS PUVA: Median mTLSS of 8.5 (range 0 to 16) and 8 (range 3 to 15) for the left and right hand, to a median mTLSS 3 (range 0 to 13) and 3 (range 0 to 14) (n = 23) Reduction mTLSS local narrow‐band UVB group: Median mTLSS of 7 (range 0 to 16) and 8.5 (range 1 to 15) to a median mTLSS5 (range 0 to 11) and 4.5 (range 0 to 11) (n = 20)
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; mTLSS: modified total lesion symptom score; PUVA: oral psoralen combined with UVA; RCT: randomised controlled trial; RR: risk ratio; UV: ultraviolet. 2015
GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

^aThe assumed risk is the mean control group risk.

^bDowngraded by one level to moderate‐certainty evidence for imprecision. Small sample size, small number of events, and high dropout rate.

^cDowngraded by one level to moderate‐certainty evidence for imprecision. Wide confidence interval with small sample size, small number of events, and high dropout rate.

^dThe Modified Total Lesion Symptom Score (mTLSS) is the sum of seven items (erythema, oedema, vesiculation, scaling, lichenification/hyperkeratosis, fissures, and pruritus/pain) scored on a 4‐point scale (0 = absent, 1 = mild, 2 = moderate, 3 = severe). A high mTLSS represents severe hand eczema.

^eDowngraded by one level to moderate‐certainty evidence for imprecision. Small sample size based on single study.