Dermatology (Skin)

Whole body PUVA treatment using topical psoralen

Information for patients

View or download this information as a pdf.
Information:

Your doctor has referred you for a course of PUVA phototherapy, for your skin condition. This information explains this treatment in detail, including its risks and benefits. If you have any questions or concerns, please to speak to the doctor or nurse caring for you.

Topical PUVA

Is a treatment, which requires a solution containing a medication called Psoralen (P) to be applied to affected skin. When the whole body is to be treated, this is usually performed by soaking in a bath containing the solution for 15 minutes. The skin is then exposed to UVA light. This is a type of ultraviolet light and is one of the types of ultraviolet rays 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.

Important advice:

What does PUVA involve?

  • PUVA therapy must be carried out in hospital under medical supervision. It will be necessary for you to attend 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 8 weeks.
  • You will need to soak in a bath containing the psoralen solution, mixed with water for 15 minutes. Light exposure will then take place in a specially designed unit containing fluorescent tubes. Each machine is screened off to make sure your treatment is given in private.
  • The time of exposure for your first treatment is decided by your reaction to test doses on a small area of your skin, usually on your back. Following this, increasing doses of light will be given at each visit, depending on the reaction of your skin. Men must wear genital protection. The practical aspects of this will be discussed with you by the nursing staff.
  • To make sure all the affected areas of your skin receive the UVA treatment, we will give you specific instructions on how to stand in the machine to ensure that all of your skin is exposed evenly each time. If you choose to wear underwear, please make sure it covers the same areas of skin on each visit. If an area of skin, which has previously been covered is exposed to the PUVA treatment, it may burn.
  • Psoralen solution can be absorbed into the body and makes both the skin and the eyes sensitive to light for 12 hours. It is, therefore, most important that you wear protective glasses for 12 hours after your treatment, outdoors or indoors during daylight and near fluorescent light at night. You will also need to wear eye protection during the treatment itself. This protects your eyes against damage from PUVA.
Back to top

Things to be aware of

Avoid

  • Throughout the course of treatment, you should not sunbathe or use a sunbed at any time. On the day of treatment, you should avoid unnecessary exposure to direct sunlight (even through window glass). Cover up with loose-fitting, long-sleeved clothes.

Do

  • Use a sunscreen with an SPF factor of at least 30 that protects against UVA and UVB rays. Re-apply it regularly.
  • You may also want to wear a hat after your treatments on sunny days, particularly if you don’t have a lot of scalp hair.

Avoid

  • Wearing perfumes, deodorants, aftershave lotions or other cosmetic products before your treatment. Some of these contain substances, which make your skin more sensitive to light and can cause patchy discolouration of the skin, which may take some months to fade. You can, however, use these after treatment.

Do

  • For the same reason, let us know if you start any new oral medications or creams during the course of treatment as some can make your skin more sensitive to light.
  • For the phototherapy to be effective, you must also use the skin treatment prescribed by the supervising doctor. The use of a moisturizing cream is particularly important. If you are not sure which moisturising creams to use, please ask a member of the Phototherapy Unit staff.


Although there is no clear evidence that PUVA can damage a developing foetus, for the absolute safety of the baby, you should not become pregnant during treatment.

What are the possible side-effects?

  1. 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), although the risk of these effects are minimised by careful selection by the staff of the appropriate UVA dose for you. The risk of this can also be reduced by making sure that the same areas of your skin 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.
  2. Some tanning of your skin is likely.
  3. Very occasionally, patients develop polymorphic light eruption, which is an itchy rash due to sunlight. Some patients can also develop a rash called folliculitis (inflammation around hair follicles).
  4. Occasionally, your skin condition could temporarily worsen in the early stages of treatment.
  5. 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.
  6. Skin dryness. This can be helped with liberal use of moisturising creams. It is important that you use all the topical treatment (creams and ointments) recommended by the department during the course of treatment.
  7. If you do not wear the eye protection in the Unit and glasses for 12 hours after your treatment, you risk developing sunburn like reaction to your eyes within a few hours of exposure. In the long-term, there is also an increased risk of developing cataracts if you do not wear the recommended eye protection.
  8. 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

What are the practical points?

  • It is important that, in general, no clothing is worn whilst undergoing treatment in the light cubicle (except for male patients who need to wear genital protection).
  • The eye protection used during light exposures in the cabinet should on no account be removed. Protective glasses must then be worn for 12 hours after your treatment, indoors and outdoors during daylight. Sunglasses or prescription glasses supplied by your optician with a special UV filter coating are suitable. These can be checked in the Unit. Many manufacturers of sunglasses label their products as UV400 protection and these are particularly suitable. The Unit can also supply suitably protective glasses.
  • Throughout the course of your treatment, you should not sunbathe or use a sunbed at any time. During bright sunny days, a sun cream may be required on exposed sites e.g. face, neck and hands etc. Care should be taken when working in the garden, taking long walks or working outdoors, especially on a day of treatment. Protective clothing such as a hat, gloves and long-sleeved garments are advised.
  • 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 two treatments without telephoning with a reason, your treatment time will be given to another patient and you will be discharged back to the care of your GP or consultant.
  • All of your valuables are your own responsibility.
  • Alcohol MUST be avoided before your PUVA treatment.

Storage of results

We will record the information about your treatment on a secure database for audit proposes, in accordance with good medical practice. The anonymised data may also be used for research.

What do you think of your care?

Please click on the link below to give us your hospital experience.
Your views matter.

Leave Your Friends & Family Test Feedback Here
Back to top
  • LN: 004442
  • Edition number: 2 version 1
  • Developed by: Dr Victoria Goulden, Consultant Dermatologist and Honorary Senior Clinical Lecturer • Reviewed by: Bev Mousa, Senior Sister (May 2024)
    • Page last reviewed:
    • Next review date: