Oral PUVA

http://www.benohanian.com/puva_en.html

The acronym, PUVA, stands for Psoralen + Ultra Violet rays type A. The source of
ultraviolet radiation UV could be natural (the sun) or artificial. Psoralen is a
prescription medication that is very photosensitizing, i.e. a normally harmless
quantity of UV rays could cause severe reactions of sunburn type. The severity of
the reaction would also be expected to be due to the medication dosage as well
as the amount of UV rays administered. Psoralen is much more phototoxic when
applied to the skin than it is after oral administration.
Oral PUVA consists of administering UVA rays in
special irradiation chambers an hour or two after
ingesting the drug psoralen. PUVA treatments are given
once every two or more days, two to three times a
week. After taking psoralen, skin reactions, such as
sunburn, can occur when exposed to an otherwise
harmless quantity of light. Thus, ingestion of such a
photosensitizing medication requires protection of the
skin and the eyes until it has been totally eliminated
from the body. The time interval between the ingestion
of the medication and exposure to UVA light is one to two hours, depending on
the brand of psoralen taken. If you anticipate taking any other photosensitizing
medications or even large amounts of photosensitizing foods during PUVA
treatments, tell your doctor in order to avoid any undesirable side effects.
Examples of photosensitizing foods are limes, figs, parsley, parsnips, mustard,
carrots and celery. Some examples of photosensitizing medications include
antidepressants [Elavil,Tofranil], antihistamines [Periactin, Benadryl],
antimicrobial [Tetracyclines, Bactrim, Septra], antipsychotic drugs [Largactil,
Moditen, Mellaril], diuretics [Lasix, Hydrodiuril, hypoglycemics [Diabinese,
Mobenol], anti-inflammatory drugs [Naprosyn, Feldene, Clinoril] and others
[Capoten, Tegretol, Quinidine sulfate]. All these medications are much less
phototoxic than psoralen.
EYE PROTECTION: Eye protection is crucial when taking UVA treatment. We
face ultraviolet rays when we are exposed to daylight or to artificial sources of
ultraviolet rays such as in the PUVA chambers. This exposure to daylight could
also happen even through a window because window glass does not stop the
penetration of ultraviolet rays. Eye protection is not required after sunset nor
during exposure to fluorescent or incandescent lamps. Eye protection should
start immediately following the ingestion of the psoralen medication and
continue for 6 to 8 hours until all traces of the medication are totally eliminated
from the eyes. Eyes must be protected by UV-blocking wraparound Glasses.
Sunglasses available on the market do not all block out ultraviolet rays and ,
even if they do, they do not offer lateral protection to the eyes. Some
dermatologists allow their patients to wear UV opaque contact lenses. As these
lenses do not totally block UV rays, it is advisable to wear UV opaque sunglasses,
particularly when outdoors. Furthermore, a pair of goggles, totally opaque to UV
rays, should be worn during the treatment. To avoid contracting and transmitting
infections, please have you own pair of goggles. Fortunately, patients undergoing
PUVA treatments for the last 20 years failed to show an increased incidence of
cataracts compared to the general population as was expected to happen from
the animal models. However, this does not mean that we should neglect eye
protection.
PROTECTION OF THE SKIN: Sun exposure must be avoided on the day of the
treatment. If you have to go into the sun, use sunscreens and wear appropriate
clothing. Sunbathing should be avoided 24 hours before and 48 hours after the
treatments. Avoid perfumes and perfumed products and use nothing but the
products recommended by your dermatologist. Because the face and male
genital organs are the most prevalent sites for the development of skin cancer,
we recommend you cover these areas during therapy sessions.
SIDE EFFECTS: Stomachache, one of the short term side effects that may occur,
can be alleviated by taking psoralen with a glass of milk or food. It would also be
helpful to take half the dosage one half hour before the time the medication is
supposed to be taken and the other half on time. If still uncomfortable with oral
psoralen, ask your doctor to take psoralen suppositories instead which are
available at certain pharmacies. Itching and dryness could be easily improved by
emollients such as vaseline, glaxal base and moisturel.
Should any swelling and/or redness develop, you must inform your doctor
immediately. Premature aging of the skin, elevated risk of non melanoma skin
cancers (Basal cell epithelioma and Squamous cell epithelioma) and even,
according to one study, melanoma skin cancers are possible if PUVA therapy is
continued for extended periods of time. It is rather reassuring to find that after
more than 20 years, the incidence of cataract in humans has not been increased
as predicted on the animal studies. That does not mean of course that eye
protection should be neglected.
In spite of all these side effects PUVA remains the systemic treatment of choice
compared to the other systemic agents used to control severe psoriasis. 95% of
psoriasis cases clear within 30 treatment sessions.
Some diseases that respond to oral PUVA therapy: Psoriasis vulgaris,
Polymorphous light eruption, Palmoplantar pustulosis, Pityriasis lichenoides,
Mycosis Fungoides (early, stages IA, IB), Solar urticaria.
Some diseases that could respond to oral PUVA therapy: Vitiligo, Lichen
Planus, generalized Alopecia Areata, Atopic eczema, Pityriasis rubra pilaris,
generalized Granuloma annulare, Dyshidrotic czema, Hydroa vacciniforme,
Transient Acantholytic Dermatoses, Lymphomatoid Papulsis, Urticaria
Pigmentosa, Erythropeitic protoporphyria.
 UVB PHOTOTHERAPY (Broad band and narrow band: TL01)

Phototherapy: means the treatment of skin diseases, by ultraviolet rays coming

either from the sun or artificial sources. Many diseases spontaneously improve or
disappear during the summer months. Solar radiation reaching the earth
contains 48% of visible light, 42% of infrared and 6% of ultraviolet rays, mainly
UVA's & UVB's. The UVA's are 10 to 100 times more than the UVB's. This is
mainly due to seasonal variations, the condition of the ozone layer, the latitude,
the altitude, the clouds, the fog, the pollution and so on. The new UVB lamps
TL01 emitting a narrow band UVB’s (311nm) are more effective in treating
psoriasis and vitiligo although they invelve a higher risk of developing side
effects like erythema and itching..

Skin Phototypes:
SKIN TYPES
Type I Always burn, never tan Type IV Rarely burn,always tan
Type II Always burn, sometimes tan Type V Brown (Asians)
Type III Sometimes burn, always tan Type IV Black (Africans)

Some diseases that would benefit from UVB phototherapy:

Psoriasis vulgaris, vitiligo, eczema, folliculitis, furunculosis, pityriasis rosea,
pityriasis lichenoïdes chronica, parapsoriasis en plaques, mycosis fungoides,
idiopathic pruritus, pruritus of renal failure, acne. UVB phototherapy could also
be combined with other treatment modalities like: anthralin, steroid creams,
calcipotriol, PUVA, retinoid, methotrexate and cyclosporin when indicated to
control more severe types of psoriasis.
Side effects of sunlight and UVB rays:
On the short run: redness, itching, dryness of the skin and inflammation of the
cornea.
On the long run: the risk of photoaging, skin cancers and cataracts becomes
elevated specially in skin types I & II. However, therapeutically effective doses of
UVB radiation, given under careful supervision to treat psoriasis, are relatively
safe and very effective.
The combination treatment of Tar & UVB:
The patient applies a tar preparation twice a day, followed by an oil bath to
remove the excess of the tar. Following the bath the patient is exposed to a UVB
dose that causes a mild redness to the skin. Recently, it was discovered that a
lower dosage of UVB rays, not enough to cause redness to the skin, are also
effective to clear psoriasis. This would be the ideal treatment for persons of skin
type I or II. The frequency of UVB exposures varies from 3 to 5 times per week.
Psoriasis clears within 6 to 8 weeks in 80% of the treated patients. If the broad
band and narrow band UVB rays fail to clear psoriasis, then, PUVA (Psoralen and
UltraViolet rays type A) should be considered.
Ocular protection: Ultraviolet blocking glasses should be worn whenever
exposure to ultraviolet radiation is anticipated in order to prevent acute
inflammation of the eyes on the short run and cataracts on the long run. Patients
are also advised to wear their own goggles during their phototherapy sessions to
avoid catching or transmitting any diseases.
Contraindications: Phototherapy should be avoided in patients who are
sensitive to the sun. Also patients with a previous history of skin cancer or those
who have been treated with radiotherapy are preferably excluded from this kind
of therapy.
Caution: Certain medications like thiazides, certain antibiotics like tetracyclines
and also other medications like the antidepressants could cause a sunburn-like
reaction when exposed to a normally harmless amount of UVB or sunlight. The
use of perfume or perfumed products could also initiate such a reaction. They
should be avoided during the treatments. TL01 treatments are given once every
two or more days, two to three times a week.