PUVA Phototherapy Dermatology Department Medicine Group This leaflet has been designed to give you important information about your condition / procedure, and to answer some common queries that you may have.
What is PUVA? PUVA stands for psoralen and UVA. VA is a part of natural sunlight. Psoralens are chemicals that are photosensitising ; this means that when they are used on the skin or taken as a tablet they make a person more sensitive to sunlight. Psoralens are found naturally in certain foods such as parsley, figs and parsnips but they can also be manufactured to be combined with UVA light to make treatment more effective. Psoralens can be taken as a tablet or applied topically to the skin as a gel or emulsion. It can also be used as a solution for specific parts of the body such as the hands and feet or to treat the whole body when the solution is added to a bath. After the skin has been exposed to the psoralen it is then treated with UVA either in a cabinet standing up which is usually to the whole body or by small light units that treat smaller areas such as hands and the feet only. Due to the long term effects (see below) a course of treatment is usually given once a year although this is not a strict timescale and treatment can be given more frequently. Occasionally we may give PUVA treatment with an oral drug called Acetretin (Neotigason) for patients with psoriasis. This is called Re PUVA. How does it work? We are not sure of the exact mechanism of how PUVA works but when skin is treated with UVA and psoralen the cells of the immune system responsible for the inflammation and production of psoriasis plaques are affected. Which skin conditions is it used for? PUVA is used for various skin conditions. The most common types are psoriasis and eczema but it can be helpful in many other others including light sensitive skin rashes. How is treatment given? PUVA treatment is usually given every four to five days apart, this is because any side effects such as sun-burn like reaction, for example redness, flushing and the skin feeling tight many take this length of time to develop and settle before the next dose. It is important that you are aware of these symptoms. A mild reaction is normal but more severe reactions may result in problems with treatment or dose. It is therefore important that you inform the nurse if your symptoms are more severe or different in order that we can give you accurate treatment. Before beginning treatment we have to determine a starting dose. This is usually done by carrying out an MPD (minimal phototoxic dose) the nurse will explain how we do this at your first appointment. If you are having topical PUVA treatment such as bath or hands and feet the nurse will explain the procedure at your first appointment. If you are to take tablets with your treatment these must be taken with a snack or light meal two hours before your treatment time. This is because psoralen tablets can sometimes make you feel queasy. If you are having tablet PUVA you will also need to wear glasses that block out UVA light each time you have your treatment. The glasses will need to be worn from the time you take the tablets up to your treatment time
and afterwards for the rest of daylight hours on that particular day. If you are having hand and foot or bath PUVA there is no need for glasses to be worn. It is also very important to prevent exposing the skin to sunlight during your course of treatment. Wearing a wide brimmed hat and light clothing is better particularly to protect the face, try to avoid the mid-day sun between 11am-2pm. Applying sun block regularly is also important. Remember that UVA light is present on a cloudy day and that it also penetrates through window glass such as in a conservatory and car windscreen. It is also important that you regularly check your body for any new or changing moles and report any concerns to the nursing staff during or after treatment especially if you have a personal or family history of skin cancer. Do s and Don ts of Treatment Do make sure you are wearing UVA protective glasses if you are having tablet PUVA Do make sure you take your psoralen tablet two hours before your treatment time Do make sure you have not applied deodorant, perfumes or aftershave before your treatment Do make sure you avoid exposing your body to any other ultraviolet light (sun beds) or the sun whilst having treatment especially if you are having bath or hand and foot PUVA. Cover with light clothing, wear a hat, apply sun creams regularly and avoid the mid-day sun between 11am-2pm Do let staff know if you start any new tablets or creams during your treatment as some drugs can make you more sensitive to sunlight. The medical staff will advise you further Ideally you should avoid having a hair cut during your treatment course. If you do you will need to inform staff so they can advise you with regard to applying sunblock before your next treatment. Please also inform staff if you shave your beard area or body hair Do make sure you always wear goggles in the cabinet Do make sure you do not apply any topical treatments including moisturisers before your treatment you may apply them afterwards and on non-treatment days on a regular basis to prevent the skin becoming dry Benefits The benefits of having ultraviolet light treatment are to clear your skin condition both physically and symptomatically. Although it is important to remember that PUVA is not a long term cure. It will temporarily clear your skin condition. How long your skin will remain clear very much depends on the individual. Some people may only get a few months of remission and others much longer. Possible Side Effects Side effects are short term and long term. Short term Psoralen tablets may make you feel queasy therefore you should take them with a light meal or snack to help reduce this problem. If you are finding it difficult to tolerate it may be
possible to change to a different type which can help. PUVA treatment may cause the skin to itch. This is a recognized symptom of the treatment. Anti-histamine tablets and steroid creams may help, occasionally the treatment has to be postponed or discontinued altogether. Tanning of the skin also occurs with the treatment. Occasionally sun burn type reactions can occur with redness, blistering and itching to the skin. Patients should contact the department treating them first for advice before seeing the GP or going to A&E. Long term UV light causes chronic irreversible changes to the skin such as premature ageing and wrinkling. PUVA treatment can also cause freckling called lentigos. PUVA is known to increase the risks of skin cancer. This is cumulative, meaning that the higher the total dose over a lifetime the greater the risk. PUVA treatment is limited to 150 lifetime treatments. Therefore we will try to keep each treatment course as short as possible but aiming to achieve disease free skin. We also keep an accurate record of all your treatment courses. Alternatives If you decide not to have light treatment you will need to discuss alternative options with a doctor or nurse. The alternative is likely to be to continue with topical treatments as before or discuss systemic treatments which will involve taking tablets. References Guidelines for topical PUVA: a report of a workshop of the British Phototherapy Group SM Halpern et al. Jan 2000 BJD vol 142:1 22-31. Guidelines for dosimetry and calibration in ultraviolet radiation therapy: a report of a British Photodermatology Group workshop. DK Taylor et al. 2002 May: 146: 5 755-762. Contact Details for Further Information If you would like any further information or wish to discuss any details of your care further please contact: Dermatology Department: Scunthorpe General Hospital 01724 282282 extension 5616 Goole District Hospital 01405 720720 extension 4036 Cromwell Primary Care Centre 01472 255693 Phototherapy Nurses: 01472 255629 Concerns and Queries If you have any concerns / queries about any of the services offered by the Trust, in the first instance, please speak to the person providing your care. For Diana, Princess of Wales Hospital Alternatively you can contact the Patient Advice and Liaison Service (PALS) on (01472) 875403 or at the PALS office which is situated near the main entrance. For Scunthorpe General Hospital Alternatively you can contact the Patient Advice and Liaison Service (PALS) on (01724) 290132 or at the PALS office which situated on C Floor. Alternatively you can email: nlg-tr.pals@nhs.net
Northern Lincolnshire and Goole NHS Foundation Trust Diana Princess of Wales Hospital Scartho Road Grimsby DN33 2BA 01472 874111 Scunthorpe General Hospital Cliff Gardens Scunthorpe DN15 7BH 01724 282282 Goole & District Hospital Woodland Avenue Goole DN14 6RX 01405 720720 www.nlg.nhs.uk Date of issue: December, 2016 Review Period: December, 2019 Author: Dermatology Department IFP-635 v1.1 NLGHT 2016