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.

before PUVA therapy

after PUVA therapy

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.
 

PUVA age spots

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.

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.

 

 

You should never take, soak in, or apply psoralen and then use a tanning bed. This can cause severe, life-threatening burns.

 
 

 

 

 

     © American Academy of Dermatology, 2011  All rights reserved.
 

Page last updated 2/17/10

Disclaimer        Copyright Information