Topical Psoralen-Ultraviolet A Therapy for Palmoplantar Dermatoses: Experience With 35 Consecutive Patients

Abstract

To report the effectiveness of topical psoralen-ultraviolet A (PUVA) therapy for palmoplantar dermatoses and to describe our method of administration of this treatment modality. We conducted a retrospective study of 35 patients, 27 to 66 years of age, who received topical hand and foot PUVA therapy. Ten patients had psoriasis vulgaris, 8 had pustular psoriasis, 5 had dyshidrotic eczema, and 12 had other types of dermatitis. The affected area was soaked in a psoralen solution, 0.0005% methoxsalen (10 mg of methoxsalen in 2 L of warm water), for 30 minutes and then exposed to incremental amounts of ultraviolet A light three times weekly until the dermatosis subsided or cleared. Treatment frequency was then reduced and ultimately discontinued. Time to maximal improvement of the hands and feet was defined as the period from the beginning of PUVA treatment to the point at which the frequency of treatment was reduced from three times weekly to twice weekly. Fourteen patients (40%) had clearing of their disease, and 14 others (40%) had improvement of their conditions. The mean time to clearing was 2.8 months (range, 2 weeks to 7 months), and the mean number of treatments was 27.3 (range, 10 to 55). The mean total dose of ultraviolet A received was 140 J/cm2 (range, 9 to 530). Two patients (6%) had no response to treatment. Mild localized ultraviolet-related erythema developed in 16 patients (46%). Five patients "dropped out" of treatment, and nine other patients discontinued treatment during maintenance therapy. The principal reason cited was inconvenience. Topical PUVA therapy is an effective and safe treatment option for recalcitrant dermatoses affecting the palms and soles.