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

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.

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