Effective Use of Psoralen–Ultraviolet A: Review of the Evidence
When Should Patients Be Treated With Psoralen–Ultraviolet A?
For most indications PUVA is a skin-targeted immunosuppressive treatment; other mechanisms of action are also of likely importance. Many conditions that can be treated with PUVA can also be treated with NB-UVB. NB-UVB is a simpler treatment, with fewer side-effects to consider, so PUVA is generally indicated for chronic plaque psoriasis and atopic eczema if NB-UVB has not been effective. In such cases PUVA is often successful; failure to respond adequately to NB-UVB does not predict failure of response to PUVA. For some indications PUVA is the first-line phototherapy (favoured over NB-UVB). These indications include MF beyond patch stage, pustular psoriasis, pompholyx, hand and foot eczema and, probably, adult generalized pityriasis rubra pilaris.[9]
Selection of Oral or Topical Psoralen–Ultraviolet A
In practice, the choice of route of psoralen administration is usually based on patient preference ( Table 1 ). Many patients prefer oral PUVA as it involves less time in the hospital unit, but some choose topical PUVA, in particular to avoid the inconvenience of eye protection.
The British Journal of Dermatology. 2016;174(1):24-55. © 2016 Blackwell Publishing
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