What diseases does PUVA therapy treat?
What Diseases and Conditions Does PUVA Therapy Treat? There are a number of diseases where PUVA is of proven benefit, including psoriasis (but not psoriatic arthritis ), mycosis fungoides (cutaneous T-cell lymphoma ), graft versus host disease, and vitiligo.
What are the phases of PUVA treatment?
PUVA treatment is administered over the long term in two separate phases: an initial clearing phase and a maintenance phase. For each method of PUVA, during the initial clearing phase, patients will be treated two to three times weekly, with a minimum of 48 h in between each session.
What is the history of PUVA therapy?
In the 1940s, Abdel Monem El Mofty from Cairo University Medical School used crystalline methoxsalen (8-methoxypsoralen, also called xanthotoxin) followed by sunlight exposure to treat vitiligo. This began the development of modern PUVA therapy for the treatment of vitiligo, psoriasis, and other diseases of the skin.
How much does PUVA therapy cost?
The price of PUVA therapy depends on the number and duration of sessions. For an adult, treatment usually costs about $4,000-5,000 per year. Can I do PUVA therapy at home?
What is PUVA treatment used for?
PUVA is usually reserved for patients whose psoriasis is severe or is not responding adequately to other treatments. In most patients PUVA is effective at clearing psoriasis although psoriasis in body areas shielded from light (eg scalp, body folds) may not clear satisfactorily with PUVA.
What are the side effects of PUVA treatment?
What are the side effects and risks of PUVA?Burning. An overdose of PUVA results in a sunburn-like reaction called phototoxic erythema. ... Itching. Temporary mild pricking or itching of the skin is common after treatment. ... Nausea. ... Tanning. ... Eye damage.Skin ageing and skin cancer. ... Pregnancy.Psoriasis.More items...
Is PUVA chemotherapy?
PUVA Therapy Overview PUVA refers to the interaction of long wavelength ultraviolet light (320-400 nm) with a pharmaceutical molecule of plant origin, psoralen, producing a type of "photodynamic chemotherapy." PUVA is useful in treating a number of human diseases.
What does PUVA stand for?
PUVA is the acronym for Psoralen + ultraviolet light A. PUVA is a type of phototherapy used in treatment of psoriasis and other skin conditions. Treatment requires the patient to ingest a light-sensitizing medication called psoralen before being exposed to UVA rays.
How long does PUVA treatment last?
How often will I need to have this treatment? You will have to attend a PUVA treatment session every Monday and Friday for up to ten weeks. The maximum number of treatments per course, except for vitiligo and atopic eczema patients, is 30, unless your doctors advise otherwise.
How effective is PUVA therapy?
PUVA treatment is a very effective and safe treatment option for patients whose psoriasis is not well controlled on topical therapies alone. PUVA may also be a viable option for patients who have failed UVB therapy.
How does PUVA work in psoriasis?
There is also another option called “psoralen plus ultraviolet A” (PUVA) therapy. It involves exposing the skin to UVA light and using a medication known as "psoralen" too. The medication makes the skin more responsive to UVA light, increasing its effect.
What is bath PUVA?
Bathwater PUVA, also called bath-water or balneo-photochemotherapy, is a treatment for skin diseases. It is a type of phototherapy. PUVA is an acronym: 'P' is for psoralen, a medication. It is used in combination with 'UVA', or the ultraviolet radiation of wavelength 320–360 nm.
Does insurance cover light therapy?
Most major insurance companies now authorize or reimburse the purchase of light therapy equipment for Seasonal Affective Disorder (SAD).
What is topical PUVA?
Topical PUVA therapy is a treatment in which a medication called psoralen (P) is applied to the skin before exposure of the skin to ultraviolet A (UVA) wavelengths of light. The psoralen can be applied in a variety of ways: Bathing the whole body in psoralen solution.
How is photochemotherapy done?
Extracorporeal photopheresis (ECPP or systemic photochemotherapy) is a method of delivering PUVA systemically by utilizing an extracorporeal technique. The patient's white blood cells are collected (leukapheresis), exposed to a photoactivating drug, and then irradiated with UVA.
What foods contain psoralens?
Sources of Psoralens Psoralens are natural products found in plants such as limes and lemons, celery, bergamot, parsley, figs, and cloves. Psoralens are an old and effective natural treatment for skin conditions.
What is PUVA used for?
One of the skin diseases for which PUVA is used and for which it was originally developed is psoriasis. The psoralen, 8-methoxypsoralen (8-MOP) ( Oxsoralen ), is used for the treatment of psoriasis along with exposures to ultraviolet light in the UVA spectrum. PUVA is also of benefit in treating vitiligo, mycosis fungoides ...
How many treatments does PUVA have?
After about 30 treatments, a decision is made as to whether to continue treatments. PUVA is not always effective.
Is PUVA effective?
PUVA is not always effective. If there is no improvement after these treatments, it is probably unlikely that continuing this form of treatment is worthwhile. On the other hand, if significant clearing has occurred, it is probably prudent to decrease the frequency of treatments in order to maintain the improvement.
Is PUVA safe for psoriasis?
PUVA is a safe and effective treatment for psoriasis. Recently, a newer treatment has supplanted it to some extent, utilizing a different wavelength of light called "narrow band UVB.". Although a visit to a physician's office is still necessary to administer the light, it is not necessary to take a drug by mouth.
Can PUVA cause skin cancer?
PUVA has a definite potential to cause skin cancer, including melanomas. The risk of developing skin cancer is directly related to the amount of energy administered. PUVA will cause photo- aging (dry and wrinkled with pigment alterations called lentigenes) that is unavoidable.
What is the treatment for PUVA?
As in standard PUVA, the light exposure is gradually increased. Although not strictly PUVA, there is a treatment termed "extracorporeal photophoresis" whereby a patient's white blood cells are extracted from the bloodstream and then exposed to psoralen, followed by UVA, and then added back into the bloodstream.
What is a puva?
PUVA Therapy Overview. PUVA is an acronym for psoralen and ultraviolet A. PUVA refers to the interaction of long wavelength ultraviolet light (320-400 nm) with a pharmaceutical molecule of plant origin, psoralen, producing a type of "photodynamic chemotherapy .". PUVA is useful in treating a number of human diseases.
How long does it take for a puva to work?
What Is PUVA Therapy? About 60-90 minutes after ingesting a weight-adjusted dose the 8-MOP, the patient's skin is exposed to fluorescent bulbs emitting UVA light energy. The precise amount of light exposure is specified by a physician in units of energy.
How long does UVA exposure last?
Initially, exposures generally last about 30 seconds and later can extend to as long as 20 minutes, depending on the patient's pigmentation and tolerance as well as the intensity of the UVA source. Exposures ought to occur no more often than every 48 hours in order to avoid burning.
What are the three types of psoriasis treatments?
There are three basic types of treatments for psoriasis: (1) topical therapy (drugs used on the skin), (2) phototherapy (light therapy), and (3) systemic therapy (drugs taken into the body). All of these treatments may be used alone or in combination.
Does puva damage DNA?
It is hypothesized that PUVA produces reactive oxygen atoms that lethally damage the DNA molecule and/or alters the chemical receptors of skin cells (epidermal cells) and certain immune cells (T-lymphocytes).
Is psoralen FDA approved?
Two forms of the psoralen molecule are currently medically useful: 8-methoxypsoralen ( 8-MOP, Oxsoralen, Methoxsalen) and 5-methoxypsoralen (not FDA approved). 8-MOP is the only psoralen available in the United States by prescription. 8-MOP can be given orally or applied topically.
What is PUVA treatment?
Unsourced material may be challenged and removed. PUVA ( psoralen and ultraviolet A) is an ultraviolet light therapy treatment for skin diseases: eczema, psoriasis, graft-versus-host disease, vitiligo, mycosis fungoides, large plaque parapsoriasis and cutaneous T-cell lymphoma using the sensitizing effects of the drug psoralen.
Why is PUVA more effective?
The reason can be because UVA penetrates deeper in the skin, and the melanocytes in the skin of the hands and legs are positioned deeper in the skin. Narrowband UVB 311 nanometer is blocked by the topmost skin layer, and UVA 365 nanometer reaches the melanocytes that are in the bottom skin layer.
How do psoralens work?
Psoralens are materials that make the skin more sensitive to UV light. They are photosensitizing agents found in plants naturally and manufactured synthetically. Psoralens are taken as pills (systemically) or can be applied directly to the skin, by soaking the skin in a solution that contains the psoralens. They allow UVA energy to be effective at lower doses. When combined with exposure to the UVA in PUVA, psoralens are highly effective at clearing [psoriasis] and [vitiligo]. In the case of vitiligo, they work by increasing the sensitivity of melanocytes, the cells that manufacture skin color, to UV light. Melanocytes have sensors that detect UV light and trigger the manufacture of brown skin color. This color protects the body from the harmful effects of UV light. It can also be connected to the skin's immune response.
What are the complications of PUVA?
The most significant complication of PUVA therapy for psoriasis is squamous cell skin cancer. Two carcinogenic components of the therapy include the nonionizing radiation of UVA light as well as the psoralen intercalation with DNA. Both processes negatively contribute to genome instability.
When was vitiligo treated?
In Egypt around 2000 B.C., the juice of Ammi majus was rubbed on patches of vitiligo after which patients were encouraged to lie in the sun. In the 13th century, vitiligo was treated with a tincture of honey and the powdered seeds of a plant called "aatrillal", which was abundant in the Nile River Valley.
Does vitiligo require psoralen?
At the very least for vitiligo, narrowband ultraviolet B (UVB) nanometer phototherapy is now used more commonly than PUVA since it does not require the use of the psoralen. As with PUVA, treatment is carried out 2–3 times a week in a clinic or every day at home, and there is no need to use psoralen.
Who invented the phototherapy machine?
In the 1890s Niels Ryberg Finsen of Copenhagen developed a bulky phototherapy machine to treat skin diseases using UV light. In 1900, French electrical engineer, Gustave Trouvé miniaturized Finsen’s machine with a series of portable light radiators to heal skin diseases such as lupus and epithelioma.
What is the most commonly used treatment for skin conditions?
Ultraviolet (UV) light therapy is one of the most widely used treatments for skin conditions. Phototherapy is typically used when skin involvement is widespread and/or topical treatments have proven to be ineffective or impractical.
Does puva therapy work?
Many skin diseases are caused by cells of the body’s immune system. They either multiply too quickly or behave abnormally, disrupting the life of the system. PUVA therapy destroys these cells without harm to our immunity. Psoriasis, eczema, lichen planus, alopecia, and mycosis fungoides are just a few of the disease s that are amenable to PUVA therapy.
Does puva help with vitiligo?
Both of these effects reduce sensitivity to sunlight. Thus, treatment with PUVA is beneficial for disorders characterized by hypersensitivity to sunlight, such as vitiligo, polymorphic light rash, and solar urticaria.
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.
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.
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.
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.
References
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What is PUVA treatment?
PUVA treatment is photochemotherapy for psoriasis that combines psoralen with UVA radiation. Although PUVA is a very effective treatment option for psoriasis, there is an absence of patient resources explaining and demonstrating the process of PUVA.
How effective is puva?
PUVA is exceptionally effective. It has been shown to reduce the Psoriasis Area and Severity Index by 75% or more (PASI-75) in 80% of patients, which is comparable to many of the biologic medications available today [7].
How often is puva given?
For each method of PUVA, during the initial clearing phase, patients will be treated two to three times weekly, with a minimum of 48 h in between each session .
Where is the Puva protocol used?
The PUVA treatment protocol used at the University of California—San Francisco Psoriasis and Skin Treatment Center as well as available information from the literature was reviewed to design a comprehensive guide for patients receiving PUVA treatment. Results.
How to care for a PUVA?
Post-phototherapy skin care for PUVA phototherapy. Avoid exposure to sunlight and use sunscreen of SPF 15 or higher for at least 24 h after PUVA. Moisturize skin twice daily and frequently in between treatments. Avoid scrubbing skin hard or tearing off skin.
What supplies do you need for UVA light therapy?
Flow of Treatment. Every patient receiving UVA light therapy will check in at the front desk and gather all necessary supplies, including goggles, a gown, towels, and genital covering for men. Patients receiving hand and foot soak PUVA or bath PUVA should also get a measuring cup and additional towels.
Can PUVA cause melanoma?
PUVA can lead to an increased risk of non-melanoma and melanoma skin cancers, particularly among light-skinned individuals and those who have previously received X-rays or Grenz rays [16]. The risk of genital skin cancer may also be increased, but may be prevented with proper shielding (Table 5) [17]. Table 5.
Overview
PUVA (psoralen and UVA) is an ultraviolet light therapy treatment for skin diseases: eczema, psoriasis, graft-versus-host disease, vitiligo, mycosis fungoides, large plaque parapsoriasis, and cutaneous T-cell lymphoma, using the sensitizing effects of the drug psoralen. The psoralen is applied or taken orally to sensitize the skin, then the skin is exposed to UVA.
Photodynamic therapy is the general use of nontoxic light-sensitive compounds that are expose…
Procedure
Psoralens are materials that make the skin more sensitive to UV light. They are photosensitizing agents found in plants naturally and manufactured synthetically. Psoralens are taken as pills (systemically) or can be applied directly to the skin, by soaking the skin in a solution that contains the psoralens. They allow UVA energy to be effective at lower doses. When combined with exposure to the UVA in PUVA, psoralens are highly effective at clearing psoriasis and vitiligo. In th…
Side effects and complications
For small spots of vitiligo, it is possible to use psoralen as drops, applied only on the spots. This method does not have side effects since the amount is very low.
For larger area, the psoralen is taken as a pill, and the amount is high (10 mg); some patients experience nausea and itching after ingesting the psoralen compound. For these patients PUVA bath therapy may be a good option.
History
In Egypt around 2000 BC, the juice of Ammi majus was rubbed on patches of vitiligo after which patients were encouraged to lie in the sun. In the 13th century, vitiligo was treated with a tincture of honey and the powdered seeds of a plant called "aatrillal", which was abundant in the Nile Valley. The plant has since been identified as A. majus, which contains significant amounts of both bergapten and methoxsalen, two psoralen derivatives well known for their photosensitizing …
See also
• Goeckerman therapy
• PUVA lentigines
External links
• Phototherapy Course, New Zealand Dermatological Society
• PUVA Therapy Description at Oxsoralen-Ultra Indications
• Light Therapy for Dermatologic Conditions at Blue Cross and Blue Shield Association of North Carolina