PUVA Therapy

What is PUVA Therapy?

PUVA is a combination treatment which consists of psoralen taken orally or applied to the skin followed by exposure of the skin to long wave ultraviolet A (UVA) radiation. It is used for the treatment of certain types of skin diseases.

Psoralen is a drug that makes the skin temporarily sensitive to UVA. The ultraviolet light is emitted by special fluorescent light tubes. The treatment is given in a hospital set up, and cannot be administered at home. The treatment may require a variable number of sittings, depending on the condition being treated and its severity.

What is PUVA Therapy Used for?

PUVA therapy is used for the treatment of a number of skin diseases which include psoriasis, eczema, atopic dermatitis, cutaneous T-cell lymphoma, vitiligo, graft-versus-host disease, and polymorphic light eruptions. However, due to its disadvantages and side effects, it is recommended only when other treatments fail.

How is PUVA Therapy Administered?

PUVA can be used for both, the whole body and local (hand and foot) treatments. First, the psoralen is administered orally or is applied to the required part of the skin. In some cases, the patient soaks in a bath that contains psoralen. After approximately 2 hours after the oral intake of the psoralen when the drug has reached the skin, the UVA treatment is administered.

In case of whole body PUVA therapy, the patient stands undressed in a specially designed cabinet containing fluorescent light tubes. When a specific area is treated, only the affected hand or leg is exposed to the radiation. Sensitive body parts such as the face, eyes, breast, and genitals are covered to protect them from the potential carcinogenic effect of the UV radiation.

How Safe is PUVA Therapy?

PUVA is recommended only when other treatments fail to benefit the patient because of its side effects. However, acute treatments given by trained professionals, with accurate dose, duration, and schedule are usually safe and have been beneficial to patients suffering from chronic skin diseases. Minor side effects such as burning, itching, or redness can be managed with topical treatments.

Though it is not clear whether PUVA therapy affects the developing baby during pregnancy, couples are advised to avoid planning a family while on PUVA therapy or stop the therapy immediately if pregnancy is confirmed.

What are the Side Effects of PUVA Therapy?

The side effects of PUVA therapy include the following:

• Skin: Several skin reactions can occur during the treatment. These include:
• Phototoxic erythema, a sunburn-type reaction, which occurs more commonly in fair-skinned patients and 48 to 72 hours after the first two or three treatments. Moisturizers and painkillers are used to reduce the discomfort. The patient is advised to avoid exposure to direct sunlight after taking the psoralen, as it can cause sunburns.
• Dryness of the skin resulting in itching. It is treated with a moisturiser and sometimes an antihistamine
• Tanning of the skin that may last several months
• Premature aging changes such as wrinkles, freckles and lentigines. Long-term treatment can increase the chances of skin cancer especially in Caucasians
• Nausea: Nausea if present, can be treated with medications for vomiting.
• Eye damage: Eye damage can be in the form of keratitis (damage to the cornea) or an increased risk of cataract. The eyes should be protected during the treatment as well as until bedtime at night on the day of the treatment.

Health Tips for those Undergoing PUVA Therapy

• Do not apply any ointments or cosmetics (especially perfumes and coal tar products) on the skin except as directed by your doctor. You may need to apply a moisturizer prescribed by a doctor. Inform your doctor if you need to take any other medication.

• Always take the psoralen capsules at exactly the same interval before the UVA exposure.
• Alcohol consumption should be avoided during the treatment.
• Avoid sun exposure on the treatment and non-treatment days. Cover your body as much as possible when exposed to sunlight. Apply sunscreen to all uncovered parts.
• Follow up with your skin specialist regularly even if you feel fine.

References:

1. PUVA (Photochemotherapy) - (https://www.dermnetnz.org/topics/puva-photochemotherapy/)
2. PUVA Treatment - (http://www.ouh.nhs.uk/patient-guide/leaflets/files/120719puva.pdf)
3. Cutaneous Carcinogenic Risk of Phototherapy: An Updated Comprehensive Review - (https://www.psoriasis.org/content/cutaneous-carcinogenic-risk-phototherapy-updated-comprehensive-review)

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