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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