Reactions 441 - 6 Mar 1993

The risks of PUVA: from minor tomajor

Psoralens + ultraviolet A radiation (PUVA) is a usefultherapy for many dermatological conditions. However,the risks associated with its use include thedevelopment of certain cancers. PUVA therapy aims toinduce remission of the skin disease by repeated,controlled phototoxic reactions. Nausea can occur in upto 20% of patients as a result of the ingestion of thepsoralen, but this is only a problem in a small percentageof treatments. Erythema and itching can also beexpected from the nature of the treatment. Animalstudies have indicated a possible risk of cataracts withPUVA therapy, but this has not been reported in patientswho use proper eye protection. B Sigurgeirsson statesthat ‘as long as there is uncertainty about the actual risk,it is recommended that appropriate protection is wornduring the entire period of increased photosensitivity’.PUVA has detrimental effects on the dermis andepidermis. Patients develop premature aging of the skinwith wrinkling, dryness and discoloured spots.Immunological abnormalities also occur as leucocytescirculating through the dermis are exposed to UVAradiation There is a decrease in the total number of Tlymphocytes, T suppressor cells and T helper cells,which may be the result of impaired interleukin 2production. There have been several studies whichindicate a definite risk of squamous cell cancer inpatients who receive long term PUVA treatment. Theremay also be an increased risk of genital tumours in menHowever, ‘so far there have been no indications thatthere is increased risk of malignant melanoma in PUVA-treated patients.’Sigurgeirsson B. PUVA treatment and risk of malignancy. Acta Dermato-Venereologica 72 (Suppl. 178): 27-32, 1992 800180687

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Reactions 6 Mar 1993 No. 4410114-9954/10/0441-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved