Guidelines for topical PUVA: a report of a workshop of the British Photodermatology Group

Abstract

Psoralen photochemotherapy [psoralen ultraviolet A (PUVA)] plays an important part in dermatological therapeutics, being an effective and generally safe treatment for psoriasis and other dermatoses. In order to maintain optimal efficacy and safety, guidelines concerning best practice should be available to operators and supervisors. The British Photodermatology Group (BPG) have previously published recommendations on PUVA, including UVA dosimetry and calibration, patient pretreatment assessment, indications and contraindications, and the management of adverse reactions.1 While most current knowledge relates to oral PUVA, the use of topical PUVA regimens is also popular and presents a number of questions peculiar to this modality, including the choice of psoralen, formulation, method of application, optimal timing of treatment, UVA regimens and relative benefits or risks as compared with oral PUVA. Bath PUVA, i.e. generalized immersion, is the most frequently used modality of topical treatment, practised by about 100 centres in the U.K., while other topical preparations tend to be used for localized diseases such as those affecting the hands and feet. This paper is the product of a recent workshop of the BPG and includes guidelines for bath, local immersion and other topical PUVA. These recommendations are based, where possible, on the results of controlled studies, or otherwise on the consensus view on current practice.

Current Approach to Phototherapy Applications in Dermatology Practice: Part 1. History, Lamps, Ultraviolet Radiation Levels Measurement and Phototherapy Modalities

“…Sabit doz artışı, deri tipi 1 ve 2 için 0,5; 3 ve 4 için 1,0; 5 ve 6 için 1,5 J/ cm 2 şeklinde olabilir (20). Emülsiyon/jel PUVA'da, 8-MOP tedavi edilmek istenen bölgeye sürüldükten 15 dakika sonra, MFD'nin %40'ı ya da 0,5-1 J/cm 2 UVA ile tedaviye başlanır, 0,5-2 J/cm 2 dozunda artış yapılır (38).…”

“…Topikal PUVA'nın en sık görülen yan etkisi fototoksisitedir, bu nedenle, uygulama sonrası fotokorunma gereklidir (38). Hem topikal psoralenin pigmentasyona yol açma potansiyeli, hem de sağlam derinin psoriatik lezyonlara oranla UV'ye daha duyarlı olması nedeniyle, psoralenin sadece lezyonlu alana uygulanması ve çevre derinin dikkatle korunması uygun olacaktır.…”

Mittel-Dosis-UVA-1- und lokale PUVA-Therapie beim dyshidrosiformen Handekzem - eine prospektive randomisierte Studie

“…Therapeu− tisch stehen neben allgemeinen Hautschutzmaß− nahmen v. a. symptomatisch wirksame Lokalbe− handlungen mit Glukokortikosteroiden im Vor− dergrund. Das Behandlungsspektrum umfasst weiterhin eine Vielzahl lichttherapeutischer Ver− fahren, die Pinsel−PUVA− [5], Bade−PUVA− [2,18], Creme−PUVA− [2,14], UVB− [1] und die UVA−1− Therapie [14,15,19]. Die Pinsel−PUVA−Therapie hat das Risiko unerwünschter phototoxischer Re− aktionen beim Abtropfen der Lösung.…”

Practical Aspects in Topical PUVAsol in Dermatology: An Experience in a Teaching Hospital

“…It is widely practiced in the treatment of psoriasis, vitiligo, atopic eczema, certain skin cancers, photosensitivity dermatoses, alopecia areata, graft-versus-host disease and morphea. [1][2][3] In presence of UVA, psoralen intercalates between the DNA base pairs forming functional adducts, free radicals and reactive oxygen species thus causing cross linking of DNA strands, protein conjugation and cytotoxic effects.…”