PUVA treatment of alopecia areata

Abstract

Twenty-three patients with alopecia areata were treated with photochemotherapy combining oral or topical methoxsalen and UV-A irradiation of the scalp or of the whole body. Eleven of 17 patients with multiple plaques of alopecia areata, alopecia totalis, and alopecia universalis, who were treated with oral methoxsalen and total body irradiation, had complete or more than 90% hair regrowth. Three patients had a relapse. The mean energy required was 505 joules/sq cm. In six cases, topical applications of methoxsalen or oral methoxsalen combined with local irradiation of the scalp were treatment failures. In the patients responding to treatment, the result did not seem to depend on the age of onset or the extent or duration of disease. However, patients with long-lasting alopecia had a higher risk of recurrence notwithstanding a good initial regrowth of hair. Few side effects of psoralens and UV-A (PUVA) treatment were noted. The mean follow-up period was 18.6 months after the completion of treatment. We discuss the possible mechanisms of action of PUVA in the treatment of alopecia areata.

Alopecia areata

“…Photochemotherapy with all types of PUVA (oral or topical psoralen, local or whole body UVA irradiation) claim success rates of up to 60–65% for alopecia areata in uncontrolled studies 175–177 , but results are inconsistent. Retrospective reviews reported low response rates 178 or response similar to natural course of the disease 179 .…”

A Comparison of the Efficacy, Relapse Rate and Side Effects among Three Modalities of Systemic Corticosteroid Therapy for Alopecia Areata

“…There have been several uncontrolled studies of PUVA treatment for AA, using all types of PUVA (oral or topical psoralen, local or whole body UVA irradiation [15,16,17]), claiming success rates of up to 60–65%. Two retrospective reviews have reported low response rates [18] or suggested that the response was no better than the natural course of the disease [19], although these observations were also uncontrolled.…”

PUVA Treatment for Alopecia areata

“…PUVA therapy has been advocated for severe AA [10, 11, 12, 13]. Its use is based on the concept that the peribulbar and perifollicular mononuclear cell infiltrates may play a direct pathogenic role and that PUVA therapy may eradicate this inflammatory cell infiltrate [13]. …”

“…Regarding various background factors, such as age, sex, duration of the disease or time from start of AA to PUVA treatment, there are different conclusions from different studies [4, 11, 12, 13, 14, 15]. According to Healy and Rogers [11]and Mitchell and Douglass [15], the age at the time of the treatment was the most significant parameter which correlated with efficacy of PUVA.…”

“…Systemic psoralen with ultraviolet A (PUVA) has been suggested first by Weismann et al [12]as an alternative treatment modality for resistant, diffuse AA. Since this report there have been many publications regarding its efficacy [4, 13, 14, 15]. In this study, we analyzed the results of PUVA treatment in patients with extensive AA, AA totalis and AA universalis resistant to prior treatments.…”