British Association of Dermatologists and British Photodermatology Group Guidelines for the Safe and Effective Use of Psoralen–Ultraviolet A Therapy 2015

T.C. Ling; T.H. Clayton; J. Crawley; L.S. Exton; V. Goulden; S. Ibbotson; K. McKenna; M.F. Mohd Mustapa; L.E. Rhodes; R. Sarkany; R.S. Dawe

Disclosures

The British Journal of Dermatology. 2016;174(1):24-55. 

In This Article

Pretreatment Assessment

Risk Assessment and Patient Counselling

Prior to phototherapy, a formal risk assessment, which can be made by a nurse or a doctor, should include assessment of skin cancer risk, use of concomitant topical and systemic drugs, drug allergies, photosensitivity, liver or kidney disease, and history of cataracts.

All patients who have had > 150–200 exposures of PUVA should be offered annual assessment for any premalignant or malignant skin lesions.

Advice should be given on eye protection to be worn for 12–24 h after oral PUVA, and considered for bath PUVA for widespread dermatoses, and for 24 h in high-risk individuals, for example patients with atopic eczema, children or those with pre-existing cataracts or who are aphakic. Eye protection should be worn when outdoors, when exposed to sunlight transmitting through window glass and if exposed to indoor lighting capable of emitting UVA (including 'energy saving' compact fluorescent lamps).

Advice should be given on photoprotection following each PUVA session, especially over the 12 h after each treatment.

Informed consent should be taken and appropriate patient information leaflet provided.

Some examples of patient information leaflets can be viewed at the following websites: http://www.bad.org.uk/shared/get-file.ashx?itemtype=document&id=1644 (pp. 35–8); http://www.phototherapysupport.net/view-document.asp?FileID=40 (Appendix 2, pp. 44–9); http://www.photonet.scot.nhs.uk/professionals-area/patient-information-sheets/.

Baseline Investigations

In view of the minimal risk of hepatotoxicity, routine liver function tests are unnecessary, but should be performed to establish baseline levels in cases where there is known or suspected pre-existing liver dysfunction.

There is no definite evidence that lupus can be induced or exacerbated by PUVA. The routine checking of antinuclear antibodies is unnecessary unless there is history of photosensitivity.

If the patient is at an increased risk of cataracts (e.g. children with atopic eczema), a baseline assessment by an ophthalmologist should be considered.

The MPD should be established to avoid phototoxicity and also, importantly, to ensure sufficient psoralen in the skin at the correct time.[377]

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