PUVA THERAPY

What is "PUVA"?

"PUVA" is the name of this treatment used for certain skin diseases and stands for the use of Psoralen drug (Oxsoralen) in combination with Ultraviolet A light.

What is Oxsoralen (Methoxsalen)?

Oxsoralen (methoxsalen) is a drug which has been shown to be effective in the treatment of certain skin diseases when combined with exposure to a very specific kind of light.  In the treatment of skin disease, the use of the drug must be combined with exposure to the special light to produce effective therapy.

What is light treatment?

Light is classified into many different parts.  One part is known as ultraviolet light, which is a normal component of sunlight.  Artificial or man-made light sources can also produce the special part of light (ultraviolet "A") necessary for the most effective therapy.

What should I do before PUVA therapy?

Certain other medicines can increase the skin's sensitivity to PUVA therapy.  In addition, certain other medical conditions can be aggravated by this treatment.  Before starting therapy it is important to tell your doctor if you have experienced any of the following:

1.      Had a severe reaction to Oxsoralen

2.      Had recent radiation treatments or are planning any.

3.      Have or ever have had skin cancer.

4.      Have a history of melanoma or blistering disorders in the family.

5.      Have or ever have had any eye problems such as cataracts or loss of the lens of the eye.

6.      Have or ever have had liver problems.

7.      Have or ever have had heart or blood pressure problems.

8.      Have any medical condition that requires you stay out of the sun, such as lupus erythematosus.

9.      Are taking any drugs (either prescription or nonprescription).  Some drugs can increase your sensitivity to ultraviolet light either from the sun or man-made sources.  Examples of such drugs include: major tranquilizers, sulfa drugs, antibiotics or drugs used for the treatment of infection, medications for the treatment of diabetes, tetracycline antibiotics, griseofulvin products, thiazide-containing diuretics (blood pressure or water-elimination drugs) and certain antibacterial or deodorant soaps.

         If you begin any new medications or re-start any medications that you used to take, please be sure to inform the phototherapy staff.

10.    You should also tell your doctor if your skin sunburns very easily, if there is a chance that you are pregnant, or if you are attempting to become pregnant, if you have taken medicines containing arsenic in the past, or if you have problems with your immune system.

How Should I take Oxsoralen?

1. The number of capsules recommended by your doctor should be taken 1 hour before your treatment.  For maximum absorption, Oxsoralen should be taken on an empty stomach.  Some individuals may experience nausea with this medication.  If this occurs, Oxsoralen may be taken after eating a light low-fat snack.  Large amounts of food, or foods high in fat should be strictly avoided, since they absorb the medication and minimize the drug's effectiveness.  For persistent nausea, ginger 1500 mg. (available at health food stores) may be taken thirty minutes prior to your Oxsoralen dosage.  For more severe cases of nausea, your physician may prescribe an anti-nausea medication.
2. Oxsoralen is a potent drug.  Never take more than is prescribed since it may result in severe burning and/or blistering of your skin after exposure to ultraviolet light.
3. Oxsoralen should be taken as directed only on treatment days.  There is no therapeutic benefit to taking Oxsoralen alone; it must be combined with UVA light to be beneficial.

What Precautions should be taken during and after PUVA therapy?

1. Eye Protection - Make sure that you wear special wrap-around sunglasses that totally block or absorb ultraviolet light.  Put them on immediately after taking Oxsoralen and continue wearing them for the rest of the day while you are outdoors, this includes rainy or cloudy days.  In addition, the glasses should be worn with indirect light as well, such as reflection or through window glass.  Ordinary sunglasses are not adequate.  Eye protection must also be worn during treatment.
2. Males are required to shield the genital area during treatment.
3. It is very important that you stand in the same position during each treatment, since sudden exposure of skin that was not exposed during previous treatments can result in a sunburn-like reaction.
4. It is very important that you inform the phototherapy staff if you experience redness or tenderness of your skin (such as a sunburn) following any light treatment.
5. Skin and Lip Protection – Do not allow exposure of your skin and lips to sunlight for 8 hours after treatment.  In addition do not expose your skin to either sunlight or sunlamps within 24 hours of the scheduled treatment.  It is advisable to wear protective clothing (hat, gloves) to cover as much of your body as possible after treatment as well as using a sunscreen product having a protection factor of at least 15 (only use after treatment, never before treatment).

What are the problems associated with pregnancy): or breast-feeding?

1. Birth control methods should be employed since the effects of PUVA therapy on the unborn child are not known.  If you become pregnant inform your doctor so that he/she can determine whether it is necessary for you to temporarily stop therapy.
2. Since it is not known whether Oxsoralen passes into mother's milk it is safer not to breast feed while taking this drug.

What are the long-term risks of PUVA therapy?

1. Premature skin aging may result from prolonged PUVA therapy, especially in those individuals who tan poorly.  This problem is similar to excessive exposure to sunlight.
2. There is an increased risk of developing skin cancer, especially for those individuals who have had many treatments or who fall into the following categories:
1. Fair skin that burns rather than tans.
2. Have had prior treatment with radiation, grenz rays, or arsenic.
3. Have had coal tar and Ultraviolet B (UVB) treatment.

Even though your doctor will be examining you, you should routinely and completely examine yourself for small growths on your skin or skin sores that will not heal.  Immediately report such observations to your doctor.

3. Since studies have shown that animals with unprotected eyes have developed cataracts after PUVA therapy, you should have your eyes examined by an ophthalmologist before starting PUVA therapy and yearly thereafter.  It is important that you wear wrap around style eye protection as directed on treatment days.

What are the possible immediate side effects?

1.      The most common side effects of PUV A therapy are nausea, itching, and redness of the skin.  The use of low fat snacks, or ginger may prevent the nausea.  The use of moisturizers and mild soaps may help itching and dryness of the skin.

2. Tenderness or blistering of the skin may occur, but these symptoms can be helped by the use of skin products recommended by your doctor or phototherapy staff.
3. Pigmentary changes such as tanning or freckling may occur.  These changes usually diminish or fade over time, once treatment had been discontinued.
4. Less frequent side effects include depression, dizziness, headache, swelling, rash, or leg cramps.