PUVA therapy adverse effects

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... 

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. 

Acitretin has shown good results when combined with other psoriatic therapies, including PUVA and UVB, cyclosporine, and methotrexate. The combination of acitretin and PUVA is highly effective and provides faster and more complete clearance, as well as allowing a decrease in the doses of both agents, thereby limiting the risk of adverse effects. ... 

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