|
1. Can you explain a PUVA treatment in detail?
|
|
PUVA therapy involves the ingestion of Oxsoralen-Ultra® (Methoxsalen Capsules, USP, 10mg) 1.5 to 2 hours prior to exposure to UVA light. The dose of Oxsoralen-Ultra® capsules you take is held constant and is determined by your weight. The interval between taking Oxsoralen-Ultra® capsules and being exposed to light is also held constant because peak levels of psoralen are usually reached in the skin between 1 to 2 hours after ingestion.4
|
|
The variable in PUVA therapy is the dose of UVA light you are given. The initial dose is low and may be determined by your past history of sunburning and suntanning, or by testing your response to PUVA. The dose of UVA light is gradually increased in subsequent treatments as your tolerance to the treatment increases.4
|
|
The dose of UVA light delivered during PUVA therapy is measured in joules per square centimeter (a measure of energy) and is translated into a given number of minutes of treatment. The output of the treatment units varies over time and different units emit different amounts of energy. Therefore, even if your dose of UVA light is constant, your treatment times may vary. Treatments will be required two to four times each week until your skin disease has cleared. Less frequent treatment is necessary to maintain a clear state.4
|
|
2. Will I get a suntan? Can I burn?
|
|
Most patients develop a tan or deepening of their normal skin pigmentation from PUVA therapy. The tanning may be uneven at first, with skin color lighter in areas affected by psoriasis. Some patients also develop freckles - particularly dark freckles - in areas affected by psoriasis.9
|
|
Burning from light treatment is a potential serious side effect of PUVA therapy. Regardless of how carefully light treatment is administered, some redness is likely to occur, especially at the beginning of therapy. If you experience any degree of redness or burning following treatment, be sure to alert your medical provider. The light dose may need to be lowered or you may need to skip a treatment.9
|
|
3. What are the side effects of PUVA therapy?
|
|
MOST COMMON SIDE EFFECTS
|
Skin Burning. Serious burns from either UVA or sunlight (even through a window glass) can result if the recommended dosage of the drug and/or exposure schedules are exceeded.3,9
Sunburn. Some redness is likely to occur in the skin at the beginning of PUVA therapy.3,9
Pigmentation. Many patients observe pigmentation or tanning of their skin.9
Nausea. Nausea may occur after taking the Oxsoralen-Ultra® (Methoxsalen Capsules, USP, 10mg) capsules. This may be avoided or lessened by taking the medication with milk or low-fat food.3,9
Itching. Itching commonly occurs as a result of light treatment. Numerous ointments are available to soothe mild itching. It is important to tell your medical provider if you have any itching. With severe itching, it may be necessary to lower the light dose or skip a treatment. Call your medical provider before taking your capsules if itching is severe.3,9
Dry skin. If PUVA therapy leads to dry skin, apply a moisturizing lotion while your skin is still damp after showering or bathing. If the moisturizer does not relieve your dry skin, ask your medical provider for other recommendations.9
Friction blisters. Blisters are a fairly common occurrence, particularly on the hands and feet.9,14
|
|
LESS COMMON SIDE EFFECTS
|
Central nervous system disturbance. Symptoms reported by some patients include headache, dizziness, light-headedness and insomnia.13,14
Bronchoconstriction. In rare cases, asthmatic bronchoconstriction has occurred after ingestion of psoralen medication.14
Nail changes. A small number of patients develop a painful brown, white or yellow discoloration in the nails, indicating phototoxicity in the nail beds.14
Aggravation of skin disease. PUVA can sometimes aggravate and worsen the skin disease.14
Increased hair growth. Hypertrichosis, or an increased growth of hair, particularly on the face, is an occasional side effect.14
Ankle edema. A small number of patients develop swelling of the ankles as the first sign of phototoxicity.14
|
|
4. How many treatments will I need?
|
|
The total number of treatments depends on your diagnosis. In the beginning, treatments will be necessary two to three times per week. Eventually, the number decreases to a maintenance schedule or reaches a point at which you can stop completely if your skin remains clear.9
Your treatment must be spaced so that at least 48 hours elapse between sessions.9
The average course of treatment lasts approximately 12 weeks.9
|
|
TYPICAL COURSE OF PUVA TREATMENT IN THE U.S.9
|
|
|
FREQUENCY
|
EXPOSURES
|
DURATION
|
|
Clearance Phase
|
Two to three times per week
|
Under 30 treatments
|
Approximately 12 weeks
|
|
Maintenance Phase
|
Once a week to once a month
|
From one to four per month
|
Three months or longer
|
|
|
5. Is it possible to eliminate my psoriasis completely?
|
|
PUVA therapy clears or dramatically improves psoriasis in 84% of patients and can lead to extended remissions.1
|
|
The "Guidelines of Care for Psoriasis" from the American Academy of Dermatology states that with PUVA therapy, total clearing and remission lasting from months to years can be achieved for some patients.12
|
|
6. What can I expect in terms of remission?
|
|
A long-term study of 98 psoriatic patients, who were treated with PUVA therapy, with an average follow-up period of 7 years showed that the patients, on average, were without recurrence for 64 weeks. The remission rate can be further improved by a maintenance PUVA regimen.5
|
|
7. Will I need maintenance treatments if my psoriasis clears completely?
|
|
Once your skin has cleared, you may continue PUVA therapy on a maintenance schedule of once a week, and then gradually decrease your treatments to one per month if your skin remains clear. If it is still clear after three to four months of maintenance therapy, you may discontinue PUVA therapy. If you experience a flare-up, therapy will be reinstated two to three times a week.9 It is important that you discuss your personalized treatment with your physician.
|
|
8. What are the potential long-term effects associated with PUVA therapy?
|
|
Skin cancer. Some people are at a higher risk than the normal population for developing skin cancer, including people who have had previous non-melanoma skin cancer, arsenic therapy or X-ray therapy to the skin, as well as individuals with extremely light complexions which always burn and never tan. In general, these patients are not considered for PUVA therapy unless strong extenuating circumstances exist in favor of it. For all other patients, there may be a minimally higher incidence of skin cancer. Because it is impossible to know exactly how much light a patient needs in order to produce a skin cancer, your skin should frequently be examined for abnormal growths throughout your PUVA therapy.9
|
|
Cataracts. Animal studies show that cataracts may be produced as a result of excess PUVA therapy when no eye protection is used. If a patient undergoing PUVA therapy does not carefully protect his or her eyes by wearing appropriate protective sunglasses, there may be a risk of developing cataracts. To date, very few eye problems have been experienced with patients since most are conscientious about following the simple instructions for eye protection during and following PUVA therapy. Pre-treatment eye exams and yearly followup exams are also required.9
|
|
9. What precautions must I take before and after PUVA therapy?
|
BEFORE TREATMENT
Take Oxsoralen-Ultra® (Methoxsalen Capsules, USP, 10mg) capsules 1.5 to 2 hours prior to your scheduled treatment. After taking the capsules, stay out of the sun and wear UVA-blocking glasses. Avoiding the sun prevents overexposing the skin to UVA rays, which could lead to a sunburn. The glasses prevent UVA rays from entering the eyes and potentially causing cataracts. If you must travel in the sun, wear clothing that covers your arms and legs as well as a hat to protect your head and face.9
|
AFTER TREATMENT
Since your eyes and skin will remain sensitive to UVA light for up to 24 hours after taking Oxsoralen-Ultra® capsules, you must observe the following steps to protect your skin and eyes from the harmful effects of both direct and indirect sun exposure. Remember, UVA from the sun passes through glass and some plastic. If you are indoors and near windows, the following precautions still apply.9
|
|
Eye protection. Shielding the eyes after Oxsoralen-Ultra® capsule ingestion and for 24 hours thereafter during daylight hours is an absolute requirement. Make sure you wear special wraparound sunglasses that absorb ultraviolet light or block it entirely. These special sunglasses should be worn when you are outdoors, riding in a car or sitting near a window. Do not attempt to drive in dim light while wearing dark glasses. On non-treatment days, you should routinely wear either plastic wraparound or UVA-blocking sunglasses. Prescription sunglasses should be checked for their ability to block UVA light. This check may be performed at the phototherapy unit by your phototherapist.9
|
|
Skin protection. Do not allow your skin or lips to be exposed to sunlight for eight hours after treatment. In addition, do not expose your skin to either sunlight or sunlamps within 24 hours of treatment. It is advisable to wear protective clothing (i.e., hat, gloves, long sleeves) to cover as much of your body as possible, and to use a UVA-blocking sunscreen product with a sun protection factor (SPF) of at least 15. You must not sunbathe for 24 hours before and after PUVA therapy.9
|
|
10. Do I need a prescription in order to undergo PUVA therapy?
|
|
Yes. If your physician finds that you are a good candidate for PUVA therapy, he or she will write you a prescription for Oxsoralen-Ultra® in conjunction with exposure to UVA light.3
|
|
11. Will my insurance cover PUVA therapy?
|
|
Most private insurers do cover it as a treatment for severe, recalcitrant, disabling psoriasis. You will likely be required to remit a standard copay amount as determined by your medical insurance company. Check with your insurer for coverage details and copay amounts. Medicare also covers a portion of PUVA therapy for psoriasis treatment.10
|
|
12. What is the difference between PUVA therapy and UVB treatment?
|
|
PUVA therapy involves treatment with UVA light while UVB therapy involves treatment with Ultraviolet B light.
UVA light penetrates through a greater depth of tissue than UVB light.6,11
|
|
13. What are the success rates of PUVA therapy?
|
|
Studies show that PUVA therapy clears psoriasis in 84% of the patients who undergo it and that it induces long remission times, even without maintenance therapy.1,5
|
