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PUVA
Therapy for Psoriasis
The word “PUVA” comes from combining
the words “psoralen” and “UVA.” Psoralen is a medicine that makes
the skin more sensitive to UVA light. Using psoralen before stepping
into a UVA light box can be very effective for clearing psoriasis.
PUVA therapy also may be called “photochemotherapy.”
Dermatologists prescribe PUVA therapy when psoriasis does not
respond to other treatments. It also may be prescribed for severe
psoriasis or widespread psoriasis. PUVA can be effective for
generalized psoriasis, a rare and severe form of psoriasis that can
be life threatening.
In the United States, dermatologists tend to prescribe two forms of
psoralen. One form is swallowed, and the other is applied to the
skin. Patients who swallow psoralen will do so between 90 minutes
and 2 hours before stepping into a UVA light box. When applied to
the skin, the psoralen sits on the skin for 30 minutes before the
patient steps into a UVA light box. One type of PUVA called “paint
PUVA” (psoralen applied to the skin like paint) is very effective
for treating psoriasis on the hands and feet.
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Before treatment - Severe
psoriasis made this man eligible for PUVA therapy. |
After treatment -
Combining PUVA therapy with an oral (taken by mouth)
retinoid can reduce possible side effects and decrease
the number of treatments required to clear the skin. |
Photographs used with permission of the Journal
of the American Academy of Dermatology.
All photographs were
published in the Journal of the American Academy of
Dermatology, Vol.
# 45,
Lebwohl M, Ali S.
“Treatment of psoriasis. Part 1. Topical therapy and
phototherapy,” 487-98; quiz 99-502. Copyright Elsevier
(2001). |
Number of treatments / How long
clearing lasts: About 25 treatments within 2 to 3 months are
needed to see clear skin. These treatments are given 2 to 3
times per week. At least 48 hours is needed between treatments.
Studies show that most (about 89%) patients see clear skin.
The clear skin usually lasts 3 to 6 months. Some patients with
aggressive psoriasis receive maintenance PUVA treatments to keep
their skin clear. This requires getting 1 or 2 PUVA treatments
per month.
Some patients have long-lasting clearing without maintenance
therapies. A long-term study conducted in Germany found that on
average 98 patients treated with PUVA therapy saw clear skin for
more than 1 year (64 weeks).
Side effects: Patients undergoing PUVA therapy must be
carefully monitored. Possible side effects can develop on the
skin including redness, itchiness, dryness, a burning sensation,
blisters, and blotchiness.
There also is a risk of severe burns if a patient is not
carefully monitored. For this reason, a patient should never
take, soak in, or apply psoralen and then use a tanning bed.
Using psoralen and then a tanning bed can cause severe,
life-threatening burns.
When taking oral (must be swallowed) psoralen, some people
develop nausea, a headache, or fatigue. The most common side
effect is nausea. All side effects should be reported to the
person monitoring the UVA light box. Side effects can usually be
controlled with some small changes.
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A possible side effect
of long-term PUVA therapy is brown spots on the
skin. Your dermatologist may call these spots “PUVA
lentigines” or “PUVA age spots.” |
Patients who have years
of PUVA therapy may develop other side effects. The
most common is premature aging of the skin caused by
exposure to the UVA light. Some signs of premature
skin aging are sagging skin and blotchiness.
Patients can develop brown to black spots on the
skin called “PUVA age spots.”
Long-term exposure to UVA light also can increase a
person’s risk of developing skin cancer. With
long-term PUVA therapy, men have an increased risk
of developing a type of skin cancer known as
squamous cell carcinoma on their genitals. To
prevent this side effect, men are given protection
for their genitals. |
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All photographs on this page were
used with permission from the Journal
of the American Academy of Dermatology.
All photographs were
published in the Journal of the American Academy
of Dermatology, Vol.
# 45,
Lebwohl M,
Ali S. “Treatment of psoriasis. Part 1. Topical
therapy and phototherapy,” 487-98; quiz 99-502.
Copyright Elsevier (2001). |
PUVA therapy can increase the risk
of developing cataracts. But studies show that when patients
wear the required goggles during UVA exposure and use the
recommended eye protection for the rest of the day after UVA
exposure, patients do not develop cataracts.
References:
Koo J, Lebwohl M. “Duration of remission of psoriasis therapies.”
Journal of the American Academy of Dermatology July 1999; 41:
51-9.
Lebwohl M, Ali S. “Treatment of psoriasis. Part 1. Topical therapy
and phototherapy.” Journal of the American Academy of Dermatology
October 2001; 45: 487-98; quiz 99-502.
Menter A, Korman NJ,
Elmets CA et al. “Guidelines of care for the management of
psoriasis and psoriatic arthritis: Section 5. Guidelines of care for
the treatment of psoriasis with phototherapy and photochemotherapy.”
Journal of the American Academy of Dermatology January
2010; 62: 114-35.
All content solely
developed by the American Academy of Dermatology
For an overview, visit
the AAD pamphlet
Psoriasis and Psoriatic Arthritis.
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You should never take, soak
in, or apply psoralen and then use a tanning bed. This
can cause severe, life-threatening burns. |
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