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==Overview==


'''PUVA''' is a [[Psoralen]] + [[UVA]] treatment for [[Eczema]], [[Psoriasis]] and [[Vitiligo]], and [[mycosis fungoides]][http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8507078&dopt=Abstract]. The Psoralen is applied or taken orally to sensitize the skin, then the skin is exposed to UVA. Long term use has been associated with higher rates of skin cancer.[http://www.medicinenet.com/script/main/art.asp?articlekey=548]
'''PUVA''' is a [[psoralen]] + [[Ultraviolet|UVA]] treatment for [[eczema]], [[psoriasis]], [[graft-versus-host disease]], [[vitiligo]], [[mycosis fungoides]], [[large-plaque parapsoriasis]] and [[cutaneous T-cell lymphoma]].<ref name="Andrews">{{cite book |author=James, William D.; Berger, Timothy G.; et al. |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |location= |year=2006 |pages= |isbn=0-7216-2921-0 |oclc= |doi= |accessdate=}}</ref> 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 exposed selectively to light, whereupon they become toxic to targeted malignant and other diseased cells. Still, PUVA therapy is often classified as a separate technique from photodynamic therapy.


Psoralens are photosensitizing agents found in plants. They have been known since ancient Egypt but have only been available in a chemically synthesized form since the 1970s. Psoralens are taken systemically or can be applied directly to the skin. The psoralens allow a relatively lower dose of UVA to be used. When they are combined with exposure to UVA in PUVA, they are highly effective at clearing psoriasis. Like UVB light treatments, the reason remains unclear, though investigators speculate there may be similar effects on cell turnover and the skin's immune response.
==Procedure==
Psoralens are photosensitizing agents found in plants. Psoralens are taken systemically or can be applied directly to the skin. The psoralens allow a relatively lower dose of UVA to be used. When they are combined with exposure to UVA in PUVA, they are highly effective at clearing [[psoriasis]] and [[vitiligo]]. Like [[UVB]] light treatments, the reason remains unclear, though investigators speculate there may be similar effects on cell turnover and the skin's immune response.


Choosing the proper dose for PUVA is similar to the procedure followed with UVB. The physician can choose a dose based on the patient's skin type. Often, however, a small area of the patient's skin will be exposed to UVA after ingestion of psoralen. The dose of UVA that produces uniform redness 72 hours later, called the minimum phototoxic dose (MPD), becomes the starting dose for treatment.
Choosing the proper dose for PUVA is similar to the procedure followed with UVB. The physician can choose a dose based on the patient's skin type. The dose will increase in every treatment until the skin starts to respond.  


Some patients experience nausea and itching after ingesting the psoralen compound. For these patients PUVA bath therapy may be a good option.
Some clinics test the skin before the treatments, by exposing a small area of the patient's skin to UVA, after ingestion of psoralen. The dose of UVA that produces uniform redness 72 hours later, called the minimum phototoxic dose (MPD), becomes the starting dose for treatment.


==See also==
At the very least for vitiligo, narrowband ultraviolet B (UVB) 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 twice weekly in a clinic or every day at home, and there is no need to use psoralen.<ref>[http://www.patient.co.uk/health/Vitiligo.htm What are the treatment options for vitiligo?]</ref>
* [[Psoriasis#Photochemotherapy|Psoriasis Photochemotherapy]]
* [[Light therapy]]


[[Category:Dermatology]]
Narrowband UVB does not cure the legs and hands, compared to the face and neck. To the hands and legs PUVA may be more effective. The reason can be because UVA penetrates deeper in the skin, and the melanocytes in the skin of the hands and legs is deeper in the skin. The Narrowband UVB does not reach the melanocytes.
[[Category:Dermatological preparations]]
<br>
[[de:PUVA]]
[[fr:PUVA-thérapie]]


{{WikiDoc Help Menu}}
==Side effects and complications==
{{WikiDoc Sources}}
Some patients experience nausea and itching after ingesting the psoralen compound. For these patients [[PUVA bath therapy]] may be a good option.
 
Long term use of PUVA therapy has been associated with higher rates of skin cancer.<ref>{{cite web|url=http://www.medicinenet.com/script/main/art.asp?articlekey=548| title=Psoriasis PUVA Treatment Can Increase Melanoma Risk| author=Melissa Conrad Stöppler, MD}}</ref>
 
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 impact overall genome instability.
 
==History==
Psoralens have been known since ancient Egypt but have only been available in a chemically synthesized form since the 1970s.
 
== References ==
{{reflist|2}}
 
==External links==
* [http://dermnetnz.org/doctors/phototherapy/uva.html#act Phototherapy Course, New Zealand Dermatological Society]
* PUVA Therapy Description at [http://www.rxlist.com/oxsoralen-ultra-drug/indications-dosage.htm Oxsoralen-Ultra Indications]
* [http://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/puva_(psoralens_with_ultraviolet_a)_therapy.pdf PUVA Therapy Guideline] at [[Blue Cross Blue Shield Association|Blue Cross and Blue Shield Association]] of North Carolina

Latest revision as of 16:31, 25 June 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

PUVA is a psoralen + UVA treatment for eczema, psoriasis, graft-versus-host disease, vitiligo, mycosis fungoides, large-plaque parapsoriasis and cutaneous T-cell lymphoma.[1] 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 exposed selectively to light, whereupon they become toxic to targeted malignant and other diseased cells. Still, PUVA therapy is often classified as a separate technique from photodynamic therapy.

Procedure

Psoralens are photosensitizing agents found in plants. Psoralens are taken systemically or can be applied directly to the skin. The psoralens allow a relatively lower dose of UVA to be used. When they are combined with exposure to UVA in PUVA, they are highly effective at clearing psoriasis and vitiligo. Like UVB light treatments, the reason remains unclear, though investigators speculate there may be similar effects on cell turnover and the skin's immune response.

Choosing the proper dose for PUVA is similar to the procedure followed with UVB. The physician can choose a dose based on the patient's skin type. The dose will increase in every treatment until the skin starts to respond.

Some clinics test the skin before the treatments, by exposing a small area of the patient's skin to UVA, after ingestion of psoralen. The dose of UVA that produces uniform redness 72 hours later, called the minimum phototoxic dose (MPD), becomes the starting dose for treatment.

At the very least for vitiligo, narrowband ultraviolet B (UVB) 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 twice weekly in a clinic or every day at home, and there is no need to use psoralen.[2]

Narrowband UVB does not cure the legs and hands, compared to the face and neck. To the hands and legs PUVA may be more effective. The reason can be because UVA penetrates deeper in the skin, and the melanocytes in the skin of the hands and legs is deeper in the skin. The Narrowband UVB does not reach the melanocytes.

Side effects and complications

Some patients experience nausea and itching after ingesting the psoralen compound. For these patients PUVA bath therapy may be a good option.

Long term use of PUVA therapy has been associated with higher rates of skin cancer.[3]

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 impact overall genome instability.

History

Psoralens have been known since ancient Egypt but have only been available in a chemically synthesized form since the 1970s.

References

  1. James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
  2. What are the treatment options for vitiligo?
  3. Melissa Conrad Stöppler, MD. "Psoriasis PUVA Treatment Can Increase Melanoma Risk".

External links