Psoralen Plus UVA Therapy Research Articles

Psoralen Plus UVA Protocol for Compositae Photosensitivity

Background: Patients allergic to sesquiterpene lactones found in Compositae plants may develop severe photosensitivity, which can result in persistent light reaction. Treatment of these exquisitely photosensitive individuals can be very difficult, often requiring hospitalization. Although some treatment regimens have used psoralen plus UVA (PUVA) therapy, no specific outpatient protocol has been established. Objective: The purpose of this study was to develop an effective PUVA outpatient regimen to treat Compositae photosensitivity. Methods: A prednisone-assisted PUVA protocol was established in which the prednisone dose was decreased weekly, and the PUVA dose was increased during the same time interval. Results: Both patients enrolled in the study experienced dramatic improvement in their previously unresponsive eruptions. Conclusions: Two men aged 66 and 80 years were subjected to this protocol. Both men had chronic photodistributed dermatitis that resolved with this treatment and in one instance has remained clear for 18 months without needing further PUVA therapy.

Vitiligo Treatment With a Combination of PUVA Therapy and Epidermal Autografts

<h3>REPORT OF A CASE</h3> A 20-year-old woman of Indian descent presented with a 6-month history of progressive vitiligo. Small lesions were present on the ventral aspect of the right wrist (diameter, 2 cm); the left popliteal fossa (diameter, 1.5 cm); and adjacent to the right thumbnail (1×0.5 cm). A larger lesion (4×6 cm) was present on the dorsum of the left foot (<b>Figure</b>, left). A routine course of psoralen plus UV-A (PUVA) using oral methoxsalen (0.4 mg/kg) (Oxsoralen Ultra, ICN Pharmaceuticals, Costa Mesa, Calif) and wholebody exposure to UV-A commenced.¹The initial dose of UV-A radiation was 1.0 J/cm², and this was increased by 0.5 J/cm²in each treatment until a light pink erythema was induced in the areas of vitiligo; subsequent increases were aimed at maintaining this color. Perifollicular repigmentation plus hyperpigmentation of the border was seen in all of the small lesions, commencing at treatment

Photoprotection due to pigmentation and epidermal thickness after repeated exposure to ultraviolet light and psoralen plus ultraviolet A therapy.

Tanning and thickening of the epidermis are cardinal defensive responses of human skin to ultraviolet (UV) radiation that lead to increased photoprotection. Earlier studies have shown that skin pigmentation can be used to predict minimal erythema dose and minimal phototoxic dose. In this study it was calculated how much of the increase in photoprotection after 4 weeks of repeated exposure to suberythemogenic doses of either UVA or UVB radiation sources or psoralen plus UVA (PUVA) therapy that was attributable to melanogenesis. The backs of 12 volunteers were exposed to 6 different UVA and UVB radiation sources 9 times during 4 weeks. Skin pigmentation was assessed by skin reflectance measuring. Photoprotection was determined from the minimal erythema dose. Melanogenesis accounted for 63-95% of the increase in photoprotection after 4 weeks of exposure to UVA radiation. Exposure to two UVB sources induced a significant increase in photoprotection but not in pigmentation. Melanogenesis accounted only for 6-11% of the increase in photoprotection after 4 weeks of UVB exposure. The pigmentary and photoprotective responses to PUVA therapy were followed in 14 patients. After 2 weeks of exposure, the increase in photoprotection was significantly higher than predicted from the increase in skin pigmentation. After 4 weeks, melanogenesis accounted for only 36% of the increase in photoprotection. This study shows that melanogenesis accounts for the increased photoprotection after 2 weeks of exposure to UVA radiation, but after 4 weeks other protective mechanisms occur. During suberythemal UVB exposure and during PUVA therapy the importance of skin pigmentation in the overall photoprotection gradually decreases during a 4-week irradiation period.

PUVA-Bath Photochemotherapy of Lichen Planus

Lichen planus (LP) is a common inflammatory skin disease, accounting for approximately 1% of all diagnoses seen in patients seeking dermatologic care. In some patients, therapy remains difficult, and systemic application of glucocorticosteroids, cyclosporine, systemic photochemotherapy with psoralen plus UV-A (PUVA), and acitretin have been used with limited success.¹To circumvent the problems of oral PUVA therapy, methoxsalen (8-methoxypsoralen) in a dilute bathwater solution may be applied to the skin before UV-A.²A PUVA-bath photochemotherapy regimen has been shown to be an elegant alternative in the treatment of psoria- sis.^2,3We describe our first four patients with LP who received PUVA-bath photochemotherapy. <h3>Patients and Methods.</h3> Four patients (age range, 42 to 76 years) with histopathologically proven LP received PUVA-bath photochemotherapy (<b>Table</b>). All had a history of LP for 14 to 24 months and had received topical or systemic glucocorticosteroids, oral PUVA (one patient), and acitretin (one patient),