PUVA therapy

About: PUVA therapy is a research topic. Over the lifetime, 1672 publications have been published within this topic receiving 50656 citations. The topic is also known as: PUVA & photochemotherapy.

The Validity and Practicality of Sun-Reactive Skin Types I Through VI

Abstract: The concept of sun-reactive "skin typing" was created in 19751for a specific need: to be able to classify personswith white skinin order to select the correct initial doses of ultraviolet A (UVA) (in joules per cubic centimeter) in the application of the then newly developed technique for the treatment of psoriasis—oral methoxsalen photochemotherapy (PUVA).2The need arose as a result of experience with several patients who were a "dark" phenotype (brown or even black hair, and some with brown eyes) but, to our surprise, developed severe phototoxic reactions following oral ingestion of 0.6 mg/kg of methoxsalen and then, two hours later, were exposed to 4 to 6 J/cm2. These initial doses were obviously too high, and it was then understood that the estimation of the white-skinned person's tolerance level to oral PUVA could not be based solely on the phenotype (hair and eye color).

Photochemotherapy of psoriasis with oral methoxsalen and longwave ultraviolet light.

Abstract: Oral administration of a photoactive drug, 8-methoxypsoralen (methoxsalen), followed by exposure to a high-intensity, longwave ultraviolet-light system resulted in complete clearing of generalized psoriasis in 21 patients. In 16 of these cases, a paired comparison showed methoxsalen followed by longwave ultraviolet light to be more effective than conventional ultraviolet light. 8-Methoxypsoralen followed by exposure to longwave ultraviolet light has previously been shown to inhibit epidermal DNA synthesis; this may be its mechanism of action in psoriasis, a disorder characterized by an accelerated cell cycle and rate of DNA synthesis. The term photochemotherapy is used to emphasize the point that the effect on epidermal proliferation and the therapeutic response require the interaction of light and drug. (N Engl J Med 291:1207–1211, 1974)

Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics

Abstract: Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In this first of 5 sections of the guidelines of care for psoriasis, we discuss the classification of psoriasis; associated comorbidities including autoimmune diseases, cardiovascular risk, psychiatric/psychologic issues, and cancer risk; along with assessment tools for skin disease and quality-of-life issues. Finally, we will discuss the safety and efficacy of the biologic treatments used to treat patients with psoriasis.

Influence of a Mindfulness Meditation-Based Stress Reduction Intervention on Rates of Skin Clearing in Patients With Moderate to Severe Psoriasis Undergoing Phototherapy (UVB) and Photochemotherapy (PUVA)

Abstract: Objective: This study tests the hypothesis that stress reduction methods based on mindfulness meditation can positively influence the rate at which psoriasis clears in patients undergoing phototherapy or photochemotherapy treatment. Methods: Thirty-seven patients with psoriasis about to undergo ultraviolet phototherapy (UVB) or photochemotherapy (PUVA) were randomly assigned to one of two conditions: a mindfulness meditation-based stress reduction intervention guided by audiotaped instructions during light treatments, or a control condition consisting of the light treatments alone with no taped instructions. Psoriasis status was assessed in three ways: direct inspection by unblinded clinic nurses; direct inspection by physicians blinded to the patient's study condition (tape or no-tape); and blinded physician evaluation of photographs of psoriasis lesions. Four sequential indicators of skin status were monitored during the study: a First Response Point, a Turning Point, a Halfway Point, and a Clearing Point. Results: Cox-proportional hazards regression analysis showed that subjects in the tape groups reached the Halfway Point [p — .013) and the Clearing Point (p = .033) significantly more rapidly than those in the no-tape condition, for both UVB and PUVA treatments. Conclusions: A brief mindfulness meditation-based stress reduction intervention delivered by audiotape during ultraviolet light

European S3-guidelines on the systemic treatment of psoriasis vulgaris

Abstract: Of the 131 studies on monotherapy or combination therapy assessed, 56 studies on the different forms of phototherapy fulfilled the criteria for inclusion in the guidelines. Approximately three-quarters of all patients treated with phototherapy attained at least a PASI 75 response after 4 to 6 weeks, and clearance was frequently achieved (levels of evidence 2 and 3). Phototherapy represents a safe and very effective treatment option for moderate to severe forms of psoriasis vulgaris. The onset of clinical effects occurs within 2 weeks. Of the unwanted side effects, UV erythema from overexposure is by far the most common and is observed frequently. With repeated or long-term use, the consequences of high, cumulative UV doses (such as premature aging of the skin) must be taken into consideration. In addition, carcinogenic risk is associated with oral PUVA and is probable for local PUVA and UVB. The practicability of the therapy is limited by spatial, financial, human, and time constraints on the part of the physician, as well as by the amount of time required by the patient. From the perspective of the cost-bearing institution, phototherapy has a good cost-benefit ratio. However, the potentially significant costs for, and time required of, the patient must be considered.