Photochemotherapy is one of the methods of treatment with light. Another name for this form of treatment is PUVA therapy - Psoralen Ultra-Violet A. When is this method used? What is and how is PUVA treatment performed?
PUVAis an abbreviation of Psoralen Ultra-Violet A. It is one of the methods of light treatment, that isphotochemotherapy . The treatment process uses UVA radiation along with an orally administered chemical that sensitizes the skin to radiation. The method is used to treat dermatological diseases such as
- psoriasis
- vitiligo
- alopecia areata
- acne
PUVA - what is it?
PUVA therapy is the most widely used and most beneficial method of photochemotherapy, from which patients benefit greatly.
The treatment is based on the combined action of ultraviolet (UVA) radiation and compounds with photosensitizing effect, which increases the effectiveness of the treatment.
Among the photosensitizing compounds, the most used are psolarenes - compounds classified as furanocoumarins, which, among others, are increase skin re-pigmentation, which is used in the treatment of leukemia.
PUVA - types of therapy
Several types of PUVA therapies have been developed so far.
- Classic method
Here psolaren are used, which are administered orally because they have a systemic effect. The preparation is taken 1-3 hours before the start of UVA exposure.
- Bath method
These are healing baths to which psolarenes are added. Thanks to this, you can avoid the systemic effects of the substances, which are classified as toxic. For each patient, a bath is prepared with the right dose of a chemical agent. The bath is combined with exposure to ultraviolet rays.
- Soaking
This method is similar to PUVA Bath. The difference is that certain parts of the body are subjected to the bath, e.g. hands, feet.
- Topical
In this form of therapy, the psolarenes are applied directly to the skin and then the illumination begins.
- Sol
Similar methodis up to the classic. The chemical is administered to the patient orally, but sunlight is used for irradiation. However, it is not possible to precisely calculate the radiation dose. Therefore, this method is not currently used.
- RePUVA (Retinoid PUVA)
The treatment combines classic photochemotherapy with oral administration of retinoids. This is advantageous for the patient because lower doses of ultraviolet radiation can be used for irradiation. Lower than in the classical method.
PUVA - indications for treatment
As mentioned in the introduction, PUVA therapy is used to treat dermatological diseases. For many patients who have failed conventional therapies, this is the last chance to change the appearance of diseased skin.
The PUVA method is most often used to treat severe forms of psoriasis, such as:
- pustular psoriasis
- articular psoriasis
- psoriatic erythroderma
The method is perfect for treatment:
- vitiligo
- alopecia areata and total
- severe forms of juvenile acne
- lichen planus
- psoriasis
- limited scleroderma
- pigmentary urticaria
It can also be successfully used to treat eczema (mainly those involving the hands) and atopic dermatitis.
The purposefulness of using this treatment method has also been demonstrated in the treatment of some cutaneous forms of lymphomas - especially in mycosis fungoides and Sezary's syndrome.
This treatment can also be used preventively in patients suffering from light urticaria or various types of light rash (especially multiforme).
PUVA - side effects
Like any other medical treatment, PUVA is at risk of complications, most often related to the intolerance of photosensitizing substances, and less often to the body's reaction to ultraviolet radiation. or a combination of the two. Side effects after using PUVA are divided into two groups:
- Direct complications (sometimes called acute)
formed immediately or shortly after the procedure. The symptoms of an immediate complication are nausea and vomiting resulting from intolerance to oral psolaren. You may also experience dizziness, difficulty sleeping (both excessive sleepiness and difficulty falling asleep), and mood disorders (irritability, sadness).
Observed quite often actionUndesirable use of PUVA may be the worsening of existing or the appearance of new skin lesions. These are erythema-like changes, but there may also be blisters, rashes of non-psoriatic lesions, and intensification of acne lesions.
Extremely troublesome complication is a severe, often paroxysmal itching of the skin, mainly fragments free of lesions. Patients often stress that itching is worse than pain and that it is much more difficult to function in everyday life, and that it causes sleep problems. It can also contribute to concentration disorders.
- Long-term complications are those that appear a long time after the photochemotherapy treatment
The most common long-term complication of PUVA therapy is the acceleration of the skin aging process - it becomes less elastic, wrinkles appear, and the number of discolorations on its surface increases.
The most dangerous but rare complication is an increased risk of skin cancers other than melanoma (squamous cell carcinoma of the skin, basal cell carcinoma of the skin).
PUVA - contraindications
PUVA therapy carries the risk of various side effects, therefore it cannot be used by all people who need such treatment. Contraindication to the use of PUVA is:
- the period of pregnancy and lactation - the mechanism of action of this method of photochemotherapy is not fully understood, therefore it cannot be completely ruled out that it will not adversely affect the developing child
- young age of the patient - treatment is not used in children, especially those who are under 12 years of age
- the occurrence of atypical moles on the skin, the presence of cancer in the past - the use of PUVA therapy increases the risk of developing non-melanoma skin cancers, especially in people already at a certain oncological risk
- eye diseases - cataracts, glaucoma
- hypersensitivity to psolarens
- photosensitivity
- use of photosensitizing substances other than psolaren - (drugs - tetracyclines, sulfonamides, phenothiazines, drugs used in the treatment of depression, some cytostatic drugs, antimalarial drugs, some preparations used in the treatment of cardiac arrhythmias, griseofulvin, agents containing beta -carotene)
- accompanying neurological diseases - including epilepsy
- severe liver damage or kidney damage
- hypertension
Anna Jarosz A journalist who has been involved in popularizing he alth education for over 40 years. Winner of many competitions for journalists dealing with medicine and he alth. She received, among others The "Golden OTIS" Trust Award in the "Media and He alth" category, St. Kamil awarded on the occasion of the World Day of the Sick, twice the "Crystal Pen" in the national competition for journalists promoting he alth, and many awards and distinctions in competitions for the "Medical Journalist of the Year" organized by the Polish Association of Journalists for He alth.