Psoralen Photochemotherapy and Ultraviolet B Guidance Compliance

Title: Audit of the use of psoralen photochemotherapy (PUVA) and narrowband UVB phototherapy in the treatment of psoriasis.
: Yoness SS, et al.
Publication: J Dermatolog Treat. 2005 Apr;16(2):108-12.

Psoralen photochemotherapy or PUVA was introduced in 1974 and had gained acceptance because of its benefits. This therapy uses the combination of psoralen (a chemical that makes the skin more sensitive to ultraviolet) and long wave ultraviolet (UVA) radiation.

PUVA, however, carries the increased risk of cancer after 150 to 200 exposures. To minimize this effect, a narrowband (311 to 312 nm wavelength) ultraviolet B lamp called TL-01 was introduced in 1984. Except for severe or resistant psoriasis, this has become the preferred photochemotherapy method.

In this study, the authors reviewed 6 months of patient’s hospital notes (from November 2001 to April 2002) to see whether narrowband UVB treatment followed the established British Photodermatology Group guideline for PUVA.

The authors found that 31 patients received PUVA (18 oral, 11 bath and 2 uncertain because of missing notes) and 20 narrowband UVB during this period and that both PUVA and narrowband UVB guidelines were followed relatively closely. There were, however, some exceptions:

  • One PUVA patients received high cumulative exposure after mutual agreement because there was no other suitable therapy
  • Failure to measure minimal phototoxic doses (MPDs) in some PUVA patients
  • Prolonged referral delays, generally due to patient’s choice.

Editor’s Note: Minimal Phototoxic Dose (MPD) refers to the smallest amount of UV dose that can produce a grade E1 erythema (faint pink), 48 hours after exposure.

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