PUVA therapy

There is a bath PUVA and an oral PUVA. Bath PUVA therapies involve soaking in a bath of psoralens liquid for 15 minutes prior to UVA treatment. Oral PUVA involves taking an oral psoralens capsule the day prior to a UVA treatment. Oral psoralens such as methoxsalen cause nausea in many patients. Other adverse effects of PUVA include photosensitivity, which necessitates the use of eye protection and UVA-blocking sunscreen for 24 hours after a PUVA treatment macular melanosis at exposed sites (PUVA lentigines) and increased risk of skin cancers, especially squamous cell carcinoma.21... 

PUVA is most useful for the treatment of severe psoriasis. Early (patch and plaque) stage cutaneous T-cell lymphoma (CTCL) also responds to PUVA therapy. In addition, patients in advanced stages of CTCL have been treated with a modification of PUVA known as extracorporeal photopheresis. In this therapy, blood from a CTCL patient who has taken psoralen is exposed to UVA light and returned to the patient. Lymphocytes are altered or destroyed by the treatment, and theoretically, the return of these abnormal cells triggers an immune response directed against certain lymphocyte surface antigens. The effectiveness of this modality appears to be variable. 

DNA (intercalation) (photosensitive yielding crosslinks) [dermatitic, mutagenic, phototoxic, PUVA therapy for leucoderma psoriasis]... 

PTPases, P-Tyr phosphatases PUVA therapy, psoralen with ultraviolet A light therapy PYK, pyruvate kinase... 

See JA,WeUer P. Ocular compUcations of PUVA therapy. Australas J Dermatol 1993 34 1-4. 

Bullous pemphigoid frusemide (and other sulphonamide-related drugs), ACE inhibitors, penicillamine, penicillin, PUVA therapy. 

Morison WL, Baughman RD, Day RM, Forbes PD, Hoenigsmann H, Krueger GG, Lebwohl M, Lew R, Naldi L, Parrish JA, Piepkorn M, Stern RS, Weinstein GD, Whitmore SE. Consensus workshop on the toxic effects of long-term PUVA therapy. Arch Dermatol 1998 134(5) 595-8. 

Guidelines for topical PUVA therapy, including bath and local immersion PUVA therapy, have been published by the British Photodermatology Group (6). 

A rise in ambient temperature can have cardiovascular effects. In high-risk conditions, cardiovascular monitoring during treatment has been advised (SEDA-6, 148), although patients with cardiovascular disease and hypertension are also reported to tolerate PUVA therapy without evidence of cardiovascular stress (7). 

Concerns that PUVA therapy can cause systemic lupus erythematosus (SLE) and other connective tissue diseases, such as giant cell arteritis (SEDA-6, 147), have been raised by several reports (SED-12, 336) (30), (SEDA-15, 139) (SEDA-17, 183). There have been several studies of the incidence of serum antinuclear antibodies in patients who have received PUVA, with both... 

Although PUVA therapy should not be begun during pregnancy or lactation, the theoretical mutagenic and teratogenic effect of PUVA does not carry any significant risk of abnormal delivery (42,43). 

Lerman S, Megaw J, Willis I. Potential ocular complications from PUVA therapy and their prevention. J Invest Dermatol 1980 74(4) 197-9. 

Fenton DA, Wilkinson JD. Dose-related visual-field defects in patients receiving PUVA therapy. Lancet 1983 1(8333) 1106. 

Agren-Jonsson S, Tegner E. PUVA therapy for palmo-plantar pustulosis. Acta Derm Venereol 1985 65(6) 531-5. 

Bjellerup M, Bruze M, Hansson A, Krook G, Ljunggren B. Liver injury following administration of 8-methoxypsoralen during PUVA therapy. Acta Dermatol Venereol 1979 59(4) 371-2. 

White SI, Friedmann PS, Moss C, Simpson JM. Recovery of cutaneous immune responsiveness after PUVA therapy. Br J Dermatol 1988 118(3) 403-7. 

Staberg B, Hueg B. Interaction between 8-methoxypsoralen and phenytoin. Consequence for PUVA therapy. Acta Dermatol Venereol 1985 65(6) 553-5. 

Photochemotherapy is an efficient way to treat hyperproliferative diseases. Especially the so-called PUVA therapy (psoralen + UVA light) is very common in which the psoralen is irradiated with UVA light to give rise to a covalent adduct with the pyrimidine bases of DNA by means of a photoaddition reaction. There are several undesired side effects for the patients as a result of this therapy, so the synthesis and photobiological evaluation of novel benzosporalen derivatives was undertaken by the research team of L.D. Via. The key step in their synthetic sequence was the von Pechman reaction of 2-methoxyresorcinol with ethyl 2-oxocyclohexanecarboxylate. 

Exposure of animals to large doses of PUVA without eye protection has produced cataracts and 8-methoxypsoralen enhances this effect however, in patients receiving PUVA therapy who use appropriate eye protection, there is no evidence for an increased risk of cataract formation. Prior to the initiation of PUVA therapy and yearly thereafter, patients should have an ophthalmologic examination because of the cataractogenic potential of psoralens. 

Many of the acute symptoms of psoralen toxicity can be avoided by simply avoiding UV light. Severely exposed patients should be kept in a darkened room for 8-48 h depending on which psoralen is involved. Treatment of burns after PUVA therapy is symptomatic and supportive. UV absorbing wrap should be used around sunglasses for 24 h after 8-methoxypsor-alen ingestions to decrease the potential for cataract formation. The body should be shielded from sunlight for at least 48 h after 8-methoxypsoralen exposure. 

PUVA is used most commonly in the treatment of psoriasis, vitiligo, and cutaneous T-cell lymphoma. However, up to 30 other skin diseases have been reported to be responsive to PUVA therapy. The most common of these include palmarplantar pustulosis, polymorphous light eruption, dishydrotic eczema, atopic dermatitis, allergic contact dermatitis, actinic reticuloid, solar urticaria, pityriasis lichenoides, and graft versus host disease. 

The most common short-term side effects of PUVA are pruritus and transient nausea. Up to 25% of patients experience pruritus, which is UV dose-related and is associated with dryness of the skin. Usually, the pruritus responds well to emollients and antihistamines. Transient nausea affects 12% of patients taking 8-MOP and can be minimized by taking the medication with food or using antiemetics. PUVA pain is a rare, intermittent, severe burning pain that occurs 4—8 weeks after the onset of PUVA therapy. Because the pain worsens with ongoing therapy, PUVA must be discontinued and the pain usually resolves spontaneously in a few weeks. Other reported adverse effects include erythema and burning, maculopapular rash, exacerbation of photodermatoses, increased incidence of herpes simplex, and hepatotoxicity. 

Chronic PUVA exposure in humans results in premature skin aging, PUVA keratoses, PUVA lentigines, and nonmelanoma skin cancer (NMSC) typically in a dose-dependent fashion. The incidence of cataracts may also be higher among PUVA treated patients. Cardiovascular disease, noncutaneous neoplasms and teratogenic effects have not been shown to be associated with PUVA therapy. 

Sulfonamides, penicillins, diclofenac, oxyphenbutazone, piroxicam, phenytoin, carbamazepine (Same as for erythema multiforme) penicillamine, captopril, piroxicam, penicillins, rifampicin Frusemide, penicillamine, penicillin, PUVA therapy Immunosuppressants, mexiletine, thioridazine, penicillamine, moduretic , atenolol, quinacrine... 

Martens-Lobenhoffer J, Jens RM, Losche D, Gollnick H. Long term stability of 8-methoxypsoralen in ointments for topical PUVA therapy ("Cream-PUVA"). Skin Pharmacol Appl Skiir Physiol 1999 12 266-270. 

Candidates for PUVA therapy usually have moderate to severe, incapacitating psoriasis unresponsive to conventional topical and systemic therapies. A recent comparison of PUVA and NB-UVB involved 100 patients, 51 treated with NB-UVB and 49 receiving PUVA, with the results clearly favoring PUVA. Of these patients, 84% cleared with 16 PUVA treatments, whereas 63% cleared with 25 treatments of NB-UVB. °... 

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