Your doctor has referred you for a course of PUVA treatment for your skin condition. This leaflet explains this treatment in detail, including its risks and benefits. If you have any questions or concerns, please speak to a doctor or nurse caring for you.
What is PUVA?
Topical PUVA is a treatment in which a solution of a medication called Psoralen (P) is applied to affected skin. The skin is then exposed to UVA light. This is a type of ultraviolet light and is part of the various types of ultraviolet light given off by the sun. The purpose of the Psoralen is to make the skin more sensitive to healing by the light. It achieves this in a number of ways including reducing the activity of immune cells in the skin, which are overactive in many skin conditions. Since 1974, PUVA has widely been used in this country, the USA and Europe for the treatment of a number of skin conditions including psoriasis and eczema.
Local topical PUVA is used to treat localised areas of skin such as the hands, feet and lower legs. PUVA therapy must be carried out in hospital under medical supervision. It will be necessary for you to attend the department twice weekly during the course of treatment. The length of the treatment course will vary from one patient to another. An average course is usually between 8 – 10 weeks.
Treatment with the Psoralen solution will be carried out in the department. Your hands or / and feet are soaked in the Psoralen solution for 15 minutes. After a 30 minute period, light exposure with UVA will take place with a specially designed Unit containing fluorescent tubes. If only the backs of hands or the top of feet require treatment, this will be carried out immediately after soaking. Increasing doses will be given at each visit, depending on the reaction of your skin.
You will need to wear a protective visor during the treatment itself.
Things to avoid
Throughout the course of treatment, you should not sunbathe or use a sun bed at any time. On the day of treatment, you should avoid unnecessary exposure of the treated area of your skin to direct sunlight (even through window glass). Use a sunscreen to the treated areas with an SPF factor of at least 30 that protects against UVA and UVB rays. Re-apply it regularly.
Please let us know if you start any new medications or creams during treatment as some can make your skin more sensitive to light.
Do not apply perfumed products to your hands and / or feet before treatment. Some of these contain substances which make the skin more sensitive to ultraviolet light and can cause patchy discoloration, which may take some months to fade.
Alcohol must be avoided before PUVA treatment.
What are the possible side-effects?
- There is a small risk that your skin may burn, with redness and soreness and very rarely blistering (particularly in patients with a fair complexion). These effects are minimised by careful selection by the nursing staff of the UVA dose, which they will give you. The risk of this can also be reduced by making sure that the exact same areas of your hands and / or your feet are exposed to the light at each treatment. If you should develop excessive redness of your skin following treatment, please contact the nursing staff in the Dermatology department on 0113 3924349.
- Some tanning of your skin is likely.
- Very occasionally, patients develop polymorphic light eruption, which is an itchy rash due to sunlight.
- PUVA pain / PUVA itch. This is a very rare side-effect where patients develop a painful itching sensation of the skin. If this side-effect occurs, treatment needs to be stopped.
- Skin dryness. This can be helped with liberal use of moisturising creams. It is important that you use the topical (creams and ointments) therapy recommended by the department during the course of treatment.
- Long-term use of PUVA (PUVA therapy over many years) causes premature ageing in the skin (dryness, freckling and wrinkling) and increases the risk of developing skin cancer. It is, therefore, our policy to restrict the total amount of PUVA treatments that you can have. Present evidence suggests that you should not receive more than 150 treatments over a lifetime.
Practical points
- The protective visor used during light exposures on the Hand and Foot Unit should on no account be removed.
- Throughout the course of your treatment, you should not sunbathe or use a sun bed at any time. During bright sunny days, sun block may be required on the treated sites
e.g. hands or feet etc. Care should be taken when working in the garden, taking long walks and working outdoors, especially on a day of treatment. - For the phototherapy to be effective, you must also use the skin treatment prescribed by the supervising doctor. If you are not sure which moisturising creams you can use, please ask a member of the Phototherapy Unit staff.
For your treatment to be effective, it is essential to attend regularly. If you are unable to attend for treatment, you should telephone the nursing staff in the Dermatology department on 0113 3924349 with an acceptable reason for cancelling. If you fail to attend for more than 3 treatments without telephoning with a reason, your treatment time will be given to another patient.
Storage of results
We will record the information about your treatment in an anonymised form on a secure database for audit purposes in accordance with good medical practice. The anonymised data may also be used for research.
To help the smooth running of the Unit and our endeavour to give a high standard of care, we would appreciate your co-operation in all of the above points.
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