Accidental PUVA burns, vitiligo and atopic diathesis resulting in prurigo nodularis: a logical but undocumented rarity

Abstract

Vitiligo is a dreaded disease in India due to its social and cultural consequences. PUVA and PUVAsol are the main treatment modalities for vitiligo vulgaris. To the best of our knowledge, this is the first case of accidental PUVA burns eventuating in prurigo nodularis lesions to be reported in a female patient who was undergoing home PUVA therapy. The itch is so prominent and disabling that the focus of the patient has shifted from treating her vitiligo to ameliorating the pruritus.

British Association of Dermatologists and British Photodermatology Group guidelines for the safe and effective use of psoralen–ultraviolet A therapy 2015

“…Frank blisters can also occur either owing to UVA overexposure or to psoralen dose, for example as seen if patients stand in a particular way in the cabinet . Particular care is needed in patients with vitiligo; in one atopic patient with vitiligo, accidental PUVA burning resulted in subsequent development of nodular prurigo at affected sites …”

“…197 Particular care is needed in patients with vitiligo; 198 in one atopic patient with vitiligo, accidental PUVA burning resulted in subsequent development of nodular prurigo at affected sites. 199 Thus, depending on the methods for reporting erythema, the incidence of PUVA erythema during treatment is between 10% and 32%, requiring treatment interruption in between 1% and 7% of cases. Patients of lighter skin phototype and those treated with more frequent treatment regimens are at greatest risk of developing erythema during treatment.…”

<p>Amine derivatives of furocoumarin induce melanogenesis by activating Akt/GSK-3&beta;/&beta;-catenin signal pathway</p>

“…Psoralen corylifolia L. is used for repigmentation in traditional Uygur medicine,13–15 and several psoralen compounds that have been isolated from this plant, for instance, 8-methoxypsoralen (8-MOP) and 5-methoxypsoralen (5-MOP),16 are used with ultraviolet radiation in repigmentation therapies 17. Although these compounds have good melanogenesis potential, they have several side effects such as increased risk of skin cancer and hepatic steatosis 18,19. It is important therefore to isolate/synthesize novel plant-derived compounds with better melanogenesis activity and lower toxicity.…”