PUVA Therapy Negative Sides

PUVA Therapy Negative Sides

Reasons a Psoriasis Patient Should Not Receive PUVA Therapy
  • history of skin cancer, particularly malignant melanoma
  • systemic lupus erythematosus
  • history of reaction to psoralen
  • pregnant or nursing
  • prior treatment with X-rays
  • use of medication that makes the patient more sensitive to ultraviolet light (check with your doctor)

PUVA Therapy Negative Sides

Sometimes PUVA is the only treatment that works for an individual; however, because it has potential short-term and long-term side effects, it is important to follow your doctor's guidelines:
  • Your doctor will record the amount of PUVA you receive and try to keep it under a certain amount.
  • Eyes, nipples, lips, and genitals must be protected during PUVA treatments.

Before your doctor prescribes PUVA therapy, the following steps will generally occur:
  1. evaluation by your doctor to determine if PUVA therapy would be beneficial
  2. assessment of any reasons you should not have PUVA (contraindications)
  3. full skin examination
  4. eye examination, which will be repeated yearly
  5. recording of any other medications you are taking to make sure no drugs that increase your sensitivity to the sun are being used (photosensitizing medications)
Should your doctor decide that PUVA is right for you, she or he will review PUVA with you and might ask you to sign a consent form (outlining the risks and benefits of treatment) before administering treatment. The PUVA treatment protocol can differ from center to center. The two most common schedules are to administer the therapy two or three times weekly. Your dermatologist will decide how the psoralen is administered (by mouth, bath, or applying psoralen directly to a given area).

If the disease is localized, such as on the hands or feet, a bath or topical PUVA is often used. Instead of taking a pill, patients either soak in a psoralen bath for 10-20 minutes or apply a psoralen cream 2 hours prior to ultraviolet-A exposure.
 
Both these methods have the advantage of avoiding some of the side effects of oral psoralen (e.g., nausea). These side effects are fewer because the medication is not taken orally and therefore does not enter the bloodstream.

In general, the following steps will occur in orally administered PUVA therapy:
  1. An oral dose of psoralen is given 2 hours prior to exposure to UV light.
  2. Genitalia must be covered.
  3. The eyes must be completed shielded by protective goggles.
  4. UVA exposure occurs in a light machine (the dosage is based on your skin type).
  5. UV protective sunglasses must be worn after treatment, especially outdoors. Exposure to sunlight should be minimal.
  6. UVA may be increased (increased time in the light machine with subsequent sessions).
  7. PUVA is given two or three times weekly until the desired effect is obtained.
  8. If your skin reddens, the treatment could be canceled, or if redness is localized, the area can be shielded with clothing or zinc oxide.
  9. Once clear, you may be placed on a maintenance schedule that requires you to return on a less frequent but regular basis.
  10. On nontreatment days, exposure to sunlight should be minimized; outdoor use of sunglasses is also encouraged.
PUVA therapy generally shows improvement in the skin lesions within six to ten treatments. Clearance can often be obtained after twenty to thirty treatments, providing that treatments are not missed and instructions are followed.
 
Combination Therapy with PUVA


 PUVA may be combined with another topical or oral treatment to increase the improvement in psoriasis at the same or lower dose of UVA radiation.


 Acitretin (Retinoid) Plus PUVA (RePUVA)


 Acitretin (Soriatane) is an oral vitamin A analogue, or retinoid (see Chapter 10) that is given in combination with PUVA. Your doctor will usually start you on acitretin ten to fourteen days before beginning PUVA therapy. This therapy can be of particular use to those who have:
  • failed PUVA therapy alone
  • certain types of psoriasis (erythrodermic or generalized pustular)
  • darker complexions
Pregnant women or women planning a pregnancy should not receive acitretin.


 Methotrexate Plus PUVA


 Methotrexate can also be used in combination with PUVA, a therapy that has been successful in certain patients with severe psoriasis and psoriatic arthritis. The patient can begin methotrexate two to three weeks before PUVA therapy. Take methotrexate exactly as directed by your doctor.

 Balneotherapy (Climatotherapy)
 
The use of highly concentrated saltwater (greater than 20 percent) with ultraviolet light is known as balneotherapy. Balneotherapy first emerged as a treatment for various skin disorders in Europe in the 1800s.
 
PUVA Therapy Negative Sides

The Dead Sea in Israel is one place balneotherapy is practiced. The Dead Sea has been known to be of therapeutic benefit for psoriasis patients. There are several scientific reasons for this: The Dead Sea lies 1,312 feet (400 meters) below sea level and UVB rays are largely filtered out, leaving a higher concentration of UVA rays, thereby allowing patients to expose their skin for long periods without burning. Also, the Dead Sea contains both salt (in concentrations ten times higher than ocean water) and a number of other minerals, such as magnesium, calcium, potassium, and bromine. These minerals seem to enhance the beneficial effects of the UVA.
 
Patients typically go to the Dead Sea, bathe in the water, and expose themselves to the sunlight for several weeks. Many return every year for relief of their psoriasis. To find out more, you can check out PUVA Therapy Negative Sides.
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