PUVA Treatment Problems
Short-term Problems of PUVA Treatment
The immediate side-effects which arise during treatment are usually
minor and easily managed.
Erythema
(Redness and Burns)
Tanning
Nausea
Pruritus
(Itching)
Potential Long-Term Problems
of PUVA Treatment
PUVA treatment, just like ultraviolet light in sunlight, can have cumulative
effects on the skin and eyes.
Skin
Cancer
Cataracts
Freckles
Special
Note About Pregnancy
Erythema
(Redness and Burns)
PUVA therapy, if given in sufficient dose, will produce redness of
the skin in much the same way as does excessive exposure to sunlight.
However, the redness from PUVA treatment is delayed and does not appear
until 48 to 72 hours after treatment. In addition, the redness lasts
longer and can persist for a week or more.
The dose of PUVA therapy you are given is selected to produce improvement
in your skin disorder and at most a light pink color in your skin.
The pinkness should not cause you any discomfort. However, the response
of different people to PUVA therapy does vary and about 10% of patients
develop tender redness at some time during a course of treatment. If
you are red, you must not be treated. Bring the problem to the attention
of the nurse and your dose of treatment will be adjusted.
It is important to remember that after taking Oxsoralen your skin gradually
becomes sensitive to UVA light so you are sensitive to sunlight before
you have a treatment. Following your treatment your skin remains sensitive
to UVA light for at least another six hours. If you are exposed to
sunlight before or after your treatment, it is equivalent to having
a second treatment. Therefore, try to avoid exposure to sunlight for
the entire day from the time of taking psoralen.
Everyone has some exposure to sunlight just by coming to have a treatment
but this exposure can be minimized by:
• Wearing slacks and a long-sleeved shirt.
• Using a broad-brimmed hat and gloves.
• Applying a broad-spectrum sunscreen.
Clouds do not screen out UVA light, so take the same precautions on
an overcast day as you would if the sun were shining. Also UVA light
penetrates through window glass, so the same precautions must be taken
in the car or a sunlit room.
Finally, a number of drugs contain photoactive agents and these can
augment the effect of PUVA therapy and result in an erythema. While
on a course of PUVA therapy please inform us of all medications you
are taking. Perfume and cologne also contain photo-active agents so
put them on your clothes and not your skin on the day of treatment.
Tanning
Any person who can suntan will tan as a result of PUVA treatment. Most
people consider this effect to be desirable but some people prefer
not to have a darker skin. The tan produced by PUVA treatment last
for 8 to 12 weeks after stopping the therapy.
Nausea
Oxsoralen Ultra causes nausea in some people. If this occurs eat a
snack, high in fat, immediately after taking the medication. If nausea
still occurs, discuss the problem with the nurse and/or physician.
Pruritus
(Itching)
PUVA therapy dries the skin and
this may cause itching. This is remedied by regular
application of emollients such as hydrated petrolatum,
Eucerin, Aquaphor or U-lactin lotion.
Potential Long-term Problems
of PUVA Treatment
PUVA treatment, just like ultraviolet light in sunlight, can have cumulative
effects on the skin and eyes.
Skin
Cancer
Long-term exposure to PUVA therapy can result in skin cancer of the
same type caused by chronic exposure to sunlight. Certain patients
are at greatest risk:
• Those who have had x-ray treatment for their skin disease.
• Patients who have had skin cancer in the past.
• Fair-skinned individuals.
The risk of skin cancer is mainly a concern in patients who have had
several hundred treatments. Most of the cancers are slow-growing and
can be easily removed by excision. Recently, after about fifteen years
of observation, there has been a increase in frequency of melanoma
which can be lethal. This increase is small and still being evaluated.
There are several precautions every person should take to reduce the
risk of skin cancer:
• Avoid prolonged or excessive sunbathing unless it is a prescribed part
of maintenance treatment.
• Male patients should wear an athletic support during treatment if their
skin disorder does not involve the genital area because skin in this area is
very sensitive to ultraviolet light.
• If your skin disorder does not involve the face, apply a sunscreen to
this area before treatment because facial skin already receives a heavy exposure
to sunlight and it is unwise to increase the exposure.
• Any new lump or bump on the skin should be brought to the attention of
the physician.
• Have a complete examination of your skin by your physician at least
yearly.
Cataracts
Several studies in laboratory animals have shown that PUVA therapy,
just like ultraviolet light from sunlight, can cause cataracts. This
potential problem is completely avoidable by wearing correct eye protection
during therapy. The following precautions must be taken by all patients:
• An eye examination by an ophthalmologist is essential prior to commencing
treatment and this should be repeated yearly.
• UVA-blocking plastic wraparound glasses must be used as eye protection.
• The protective glasses must be worn on the day of treatment from the time
of taking Oxsoralen until sundown when outdoors, while driving a car or while
indoors in a room lit by sunlight through a window.
• If you are treated late in the day, it is advisable to wear protective
glasses if exposed to sunlight outdoors the following morning.
• Shielding of the eyes on the day of treatment is an absolute requirement.
Protective glasses are available from the nurse.
Freckles
Exposure to sunlight causes freckling of the skin and in susceptible
individuals, PUVA-treatment will also produce freckles. Freckles are
small flat brown spots on the skin which usually fade after treatment
has stopped but subsequent exposure to sunlight tends to re-activate
them.
Special
Note About Pregnancy
The use of PUVA therapy has not been associated with any abnormalities
during pregnancy or in children born of mothers who received PUVA therapy
inadvertently while pregnant. However, no planned studies of the effects
of PUVA therapy on pregnancy and developing infants have been conducted
and Oxsoralen is not approved for use in pregnant women.
Therefore:
• No pregnant women will be treated with PUVA therapy.
• If a women becomes pregnant, treatment will be stopped.
• Contraception is essential for women of child-bearing age.
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