Name of the Procedure:

Photochemotherapy; Psoralens and Ultraviolet A (PUVA)

Summary

Photochemotherapy, commonly known as PUVA therapy, combines the use of a photosensitizing medication called psoralen with exposure to ultraviolet A (UVA) light to effectively treat various skin conditions. Patients take the medication orally, apply it topically, or soak in a psoralen bath before undergoing controlled UVA light exposure.

Purpose

PUVA therapy addresses chronic skin problems like psoriasis, vitiligo, and eczema. The goal is to reduce skin abnormalities and improve skin appearance by slowing down cell proliferation and promoting repigmentation.

Indications

• Moderate to severe psoriasis
• Vitiligo
• Severe atopic dermatitis (eczema)
• Cutaneous T-cell lymphoma (CTCL)
• Other skin conditions unresponsive to standard treatments

Preparation

• Avoid sunlight for 24 hours before and after the procedure
• Take the oral psoralen 1-2 hours before UVA exposure or follow instructions for topical applications
• Wear protective eyewear during and after the procedure to prevent UV-related eye damage
• Undergo a skin examination and possibly a biopsy to determine suitability

Procedure Description

1. Psoralen Administration: Patient takes psoralen orally, applies it topically, or bathes in a psoralen solution.
2. UVA Exposure: Using a specialized lightbox, the patient is exposed to controlled doses of UVA light.
3. Monitoring: Skin response is monitored regularly to adjust UVA doses and minimize risks.
4. Duration and Frequency: Treatment sessions typically last 15-30 minutes and occur 2-3 times a week for several weeks.

Duration

Each session lasts around 15-30 minutes.

Setting

Usually performed in dermatology clinics or specialized outpatient centers.

Personnel

• Dermatologist
• Trained nurses or technicians

Risks and Complications

• Short-term: Redness, itching, dryness, and tenderness of the skin
• Long-term: Increased risk of skin aging and skin cancers
• Rare: Eye damage if protective eyewear isn't used

Benefits

• Improvement in skin condition, often noticeable within a few weeks
• Long-term remission of symptoms
• Reduced need for systemic medications

Recovery

• Mild skin irritation may occur, managed with moisturizers
• Avoid direct sunlight for at least 24 hours post-treatment
• Regular follow-up appointments to monitor progress and adjust treatment

Alternatives

• Topical treatments (steroids, retinoids)
• Systemic medications (biologics, methotrexate)
• Other light therapies (UVB, excimer laser)

Pros and Cons of Alternatives

• Topicals: Less invasive but may not be effective for severe cases.
• Systemics: Effective for severe conditions but with more systemic side effects.
• Other light therapies: May have similar benefits with different risk profiles.

Patient Experience

• During the procedure: Minimal discomfort but time-consuming.
• After the procedure: Possible mild sunburn-like symptoms; moisturizers and mild pain relievers can enhance comfort.
• Ongoing photosensitivity requires vigilant sun protection.