Secondary prevention

No primary preventive strategies have been identified; secondary preventive measures are the most effective approach in dealing with PLE patients. They include the following.

  • Avoidance of ultraviolet radiation (UVR) exposure: this prevents the clinical manifestation of PLE; however, is often not feasible.[60]​ Patients who meticulously photoprotect should be appropriately counselled regarding vitamin D replacement.[65]

  • Physical photoprotection: blocking the penetration of UVR on the skin by wearing thickly woven clothes, clothes with UVR filters, or using mineral sunscreens (e.g., with titanium dioxide).[66][67]

  • Chemical photoprotection (sunscreens): the topical application of potent UV-A and UV-B filter systems, together with strong antioxidants, such as alpha-glucosylrutin (a naturally occurring flavonoid), and tocopheryl acetate (vitamin E), is available as a sunscreen. It effectively reduces the oxidative stress response to UVR in the skin, thus maintaining the homeostasis of the endogenous redox system and preventing the elicitation of clinical symptoms of PLE.[31][44][68]

  • Natural skin conditioning (hardening): although sometimes difficult to achieve without eliciting PLE symptoms, slow, repetitive exposure to natural sunlight can prevent the provocation of further symptoms. This method is not advisable due to the risk of provocation and skin malignancy.

  • Phototherapy: various regimens of phototherapy have been employed to induce skin conditioning, so-called hardening. Although UVB (broad-band and narrow-band), UV-A, UV-A plus UV-B, psoralen (8-methoxypsoralen) plus ultraviolet A (PUVA), and psoralen plus ultraviolet B (PUVB) have been used with varying degrees of success, they also bear the risk of inducing or aggravating PLE skin lesions.[17][44][69][70][71][72][73]​​​ Patients may experience sunburn reactions or even phototoxic responses with PUVA.[74] A short-term treatment course at the beginning of the summer might be sufficient to achieve effective results in some patients;​​ however, the necessity for intense, repeated UVR exposures, with the goal of achieving prophylactic protection from clinical symptoms of PLE, might arise in some patients.[75]​[76]​[60]​ This increases the long-term risk of skin cancers and photo-ageing.[77][78][79]​ There are variable reports as to whether UV-B is preferred over PUVA. Guidelines suggest that PUVA should be considered if UV-B has failed, and it is preferable over systemic treatments.[80]

  • Systemic prophylactic treatments: supplementation with omega-3 fatty acids showed some improvement of the severity of PLE symptoms.[62] A nutritional supplement containing lycopene, beta-carotene, and Lactobacillus johnsonii has also demonstrated molecular and clinical benefits.[63]

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