PUVA uses ultraviolet radiation to treat skin affected by serious skin diseases. It may be used for patients suffering from psoriasis, dermatitis, light sensitivity disorder, vitiligo and other conditions.
PUVA has been used in its present form since 1976. The acronym PUVA comes from the two things that make up the treatment: psoralens (P) and long-wave ultraviolet (UVA) radiation. Psoralens are compounds found in many plants which make the skin more sensitive to the UVA radiation.
How it works
Treatment begins with the administration of the psoralens. A patient will take methoxsalen capsules two hours prior to exposure to UVA. If only a small area is being treated, the patient may soak in a dilute solution of methoxsalen for 30 minutes instead of taking the capsules. He or she would then be exposed to the UVA radiation immediately.
In some cases, the patient will apply a lotion to the affected areas about 10 minutes prior to treatment.
The number and the frequency of PUVA treatments will depend on the condition being treated and individual factors.
Typical PUVA treatment for various skin conditions
PUVA is usually reserved for older patients and those with severe cases of psoriasis. It will clear psoriasis in about 90 percent of cases. It also can often prevent psoriasis from returning if treatment is continued. PUVA does not work as well for psoriasis in areas that are shielded from light, such as the scalp.
Expect treatments two or three times per week, with short UVA exposure sessions (five minutes or less) at first, increasing gradually as needed.
Most patients will have their psoriasis cleared or much improved after 12 to 24 treatments. At this point, treatments may be reduced to once a week or less. Even without continued treatment, the skin may remain clear for months. However, the psoriasis may later flare up again, and further PUVA treatments may be necessary.
Those few cases of psoriasis which appear to be resistant to PUVA may still be helped by combining PUVA with other treatments (e.g. ointments or tablets).
- Eczema or dermatitis
PUVA is occasionally used for severe cases of dermatitis. Frequency and dosage of treatment is similar to that used for psoriasis. However, the course of treatment may take longer than with psoriasis.
- Mycosis fungoides
For this rare skin condition, PUVA is usually given twice a week at first, using very brief exposures. Once the skin is clear, treatment frequency is reduced. If PUVA is stopped, the patient will sometimes have a relapse of the condition.
Polymorphic light eruption (PMLE) is a common light sensitivity disorder. A six-week course of PUVA in the spring or early summer usually gives patients good protection for the remainder of the summer.
The protection given by PUVA treatment is temporary. Additional treatment will be needed to provide protection for subsequent years.
For some PMLE patients, PUVA may be unsuitable. It may be possible to use UVB (short-wave radiation) instead.
Patients with vitiligo have areas of completely white skin. PUVA can bring about some repigmentation, particularly for vitiligo of the face and for vitiligo in dark-skinned patients. Results for other body sites and white-skinned patients are usually not as good.
PUVA treatment for vitiligo is usually administered twice a week for two years. Even then, complete repigmentation cannot be guaranteed and relapse is possible.
How to prepare for treatment
If you are receiving PUVA therapy, follow the directions of the phototherapy nurse and your dermatologist. Some general advice:
- Keep all of your scheduled appointments. Allow time to change clothes before treatment.
- Tell Family Dermatology about any health problems you may have, including eye disease. Be sure the doctor is aware of any mediations you are taking.
- Do not apply any ointments or cosmetics (especially perfumes and coal tar products) except as directed by your doctor or phototherapist.
- Schedule treatments at the same time of day whenever possible.
- Always take the prescribed capsules at exactly the same interval before the UVA exposure. Ideally, take the capsules two hours after a meal.
- Keep alcohol consumption to a minimum.
- Avoid sun exposure.
- Apply broad spectrum sunscreen to your face and hands before treatment.
- Cover male genitalia during treatment - this area must not be exposed to UVA.
- Remember, the methoxsalen tablets will increase your sensitivity to sunlight. Protect your skin and eyes from natural sunlight for twelve hours after taking methoxsalen tablets.
- Wear the special goggles provided to protect your eyes during treatment.
- Wear wrap-around, ultraviolet-protective sunglasses both indoors and outdoors, from the moment you take the methoxsalen tablets until nightfall on the treatment day.
- After dark, you should continue to wear protective sunglasses if you are in fluorescent lighting. They are not necessary outside after dark or inside with incandescent lamps.
- In some circumstances, you may be able to wear polarized or prescription glasses may be suitable; however, they must cut out all UV radiation. You can use clear perspex glasses indoors.
- Wear fully covering clothing (e.g. hats, long sleeves and long skirts or trousers) when you are outdoors or if you are near a window indoors.
- Apply sunscreen to all uncovered skin after treatment.
- Arrange to see your dermatologist regularly to chart your progress.
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