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Giornale Italiano di Dermatologia e Venereologia 2004 April;139(2):111-30


language: English, Italian

PUVA photochemotherapy: update 2003

Capezzera R., Sala R., Venturini M., Zane C., Calzavara-Pinton P.

Dipartimento di Dermatologia Azienda ospedaliera Spedali Civili di Brescia, Brescia, Italia


Psoralens are the most widely used sensitizers in dermatological practice and the acronym PUVA (Psoralen plus UVA) is often used as a synonym for photochemotherapy. The biologic effects of photochemotherapy are obtained through a cascade of molecular events triggered by the photo-activation of an exogenous cromophore. According to early studies on skin photosensitivity only broadband UVA sources are used for PUVA. 8-MOP is the most widely used psoralen, but 5-MOP and TMP may be used as well. Topical bath water application of psoralens is another promising advancement of the standard PUVA technique. PUVA is one of most popular regimens for the treatment of psoriasis, atopic dermatitis, vitiligo and cutaneous T cell lymphoma. There is no general agreement on the most effective, safe and practical treatment schedule. Several centers choose the initial UVA dose and further progressive increments on the basis of the skin phototype. Other centers have adopted the determination of each patient’s individual minimal phototoxic dose (MDP) before the first irradiation. With the MPD-based approach, the number of exposures was significantly less for patients with skin types I and II but not III. Another very intriguing use of oral PUVA is photochemioprophylaxis that means prevention of idiopathic photosensitive diseases inducing a progressive tolerance to sunlight. The main long-term side-effect of PUVA therapy with high cumulative UVA doses is the risk of skin tumors and the hazard is much greater for patients who had previous exposure to treatments of known carcinogenicity, or patients who are at risk for skin cancer (phototype I and II, familiarity for skin cancer, outdoor workers, etc.).

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