Psoralen and Ultraviolet A Phototherapy (PUVA)
This
psoriasis treatment combines oral or topical administration of a medicine called psoralen with exposure to ultraviolet A (UVA) light. UVA has a long wavelength that penetrates deeper into the skin than UVB. Psoralen makes the skin more sensitive to this light. PUVA is normally used when more than 10 percent of the skin is affected or when the disease interferes with a person's occupation (for example, when a teacher's face or a salesperson's hands are involved).
Compared with broadband UVB psoriasis treatment, PUVA treatment taken two to three times a week clears psoriasis more consistently and in fewer treatments.
However, it is associated with more short-term side effects, including nausea, headache, fatigue, burning, and itching. Care must be taken to avoid sunlight after ingesting psoralen to avoid severe sunburns, and the eyes must be protected for one to two days with UVA-absorbing glasses. Long-term treatment is associated with an increased risk of squamous-cell and, possibly,
melanoma skin cancers. Simultaneous use of drugs that suppress the immune system, such as cyclosporine, have little beneficial effect and increase the risk of cancer.
Light Psoriasis Treatment Combined With Other Therapies
Studies have shown that combining ultraviolet light treatment for psoriasis and a retinoid, like acitretin, adds to the effectiveness of UV light. For this reason, if patients are not responding to light therapy, retinoids may be added. UVB phototherapy, for example, may be combined with retinoids and other psoriasis treatments.
One combined therapy program, referred to as the Ingram regime, involves a coal tar bath, UVB phototherapy, and application of an anthralin-salicylic acid paste that is left on the skin for 6 to 24 hours. A similar regime, the Goeckerman treatment, combines coal tar ointment with UVB phototherapy. Also, PUVA can be combined with some oral psoriasis medications (such as retinoids) to increase its effectiveness.
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