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Phototherapy: PUVA
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PUVA is a combination of psoralen (P) and long-wave ultraviolet radiation (UVA) that is used to treat psoriasis and some other several severe skin conditions. Psoralen is a drug taken by mouth that makes the skin disease more sensitive to ultraviolet light. This allows the deeply penetrating UVA band of light to work on the skin.

Natural psoralen has been used in combination with sunlight for the treatment of skin disease for centuries. Today, 'Oxsoralen Ultra' is the brand of psoralen used. This is taken one hour before ultraviolet light treatment. Light treatment is given 2-3 times per week for 12-15 weeks. It is never given on two consecutive days. After completion of a PUVA course, maintenance therapy is often required once a week.

Side Effects: (%= percentage of patients receiving treatment)

  • <1% Headache and dizziness
  • 1-2% Skin burn and blistering
  • 4-8% Nausea
  • 4-8% Redness of the skin
  • 10-20% Itching
  • 20% Stinging sensation
  • 100% Tan or darkening of the skin

Nausea from the pills is most common reason for stopping the treatment. Lowering the dose, or taking Ginger capsules (in health food stores), or prescriptions such as Reglan may help. Most of the side effects are temporary. People who have had PUVA have an increased risk of squamous cell skin cancer, which is a common form of skin cancer easily treated by minor surgery. There are recent reports suggesting that PUVA may increase the risk of melanoma skin cancer also, but if this occurs at all, it only happens after at least 150 treatments. PUVA does cause the skin to look older (photo aging), and can also cause white and brown spots to appear on the skin. Unlike sunburn, if the skin becomes red from a treatment, it shows up one to two days after treatment.

PUVA can cause cataracts to form if the eyes are unprotected while receiving treatment. One must wear protective goggles while in the booth, and UVA-absorbing, wrap-around sunglasses for twenty-four hours following a PUVA treatment. These glasses must be worn outside and indoors if any sunlight is coming into the room through a glass window. Sunlight on the skin must be completely avoided for 24 hours after a PUVA treatment.

A typical PUVA session consists of coming into a dermatology office, removing clothes from the affected body areas and standing in a five foot square by seven foot high light box. The lights are then turned on for 1-10 minutes. The length of each session is increased by a small amount over the previous session. Patients must wear groin protection (underwear, a towel or the "male pouch") while in the light box. Some patients wear a bag over their heads to prevent the facial skin from looking older.


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