PUVA Treatment

PUVA is a photo chemotherapy that involves a topical or oral application of psoralen plus followed by a measured dose of ultraviolet radiation. Psoralen plus is found in many plants and contains a chemical 8-methoxypsoralen or 8 MOP - sensitive to ultraviolet rays. It enhances the effect of the ultraviolet rays on the skin by making the skin photosensitive. Prior to its application in alopecia areata PUVA was used for treating skin disorders such as psoriasis, vitiligo, atopic dermatitis and pruritis or itching.
Choosing the proper dose for PUVA is similar to the procedure followed with UVB. The physician can choose a dose based on the patient's skin type. It often happens that a small area of the patient's skin will be exposed to UVA after ingestion of psoralen. The dose of UVA that produces redness 72 hours later - called the minimum phototoxic dose (MPD), becomes the starting dose for treatment. PUVA therapy has shown the following effects:
- It reduces the fraction of circulating helper T-cells in psoriatic patients. - It depresses the number of circulating E rosette forming cells in psoriatic patients and controls. - It may prevent attack on the hair follicles by the immune system by depleting the number of Langerhan's cells. - It induces suppressor T cells in mice. - It has been to known to stimulate the dopa negative melanocytes in the outer root sheath to divide and multiply.
By its photo immunologic effect on T cells, PUVA may be a good alopecia therapy. Increasing evidence indicates an important role of melanocytes in alopecia areata. A typical PUVA session consists of an oral or topical administration of psoralen plus and two hours later, irradiation to UVA rays. UVA is a broad spectrum, high intensity artificially sourced radiation. Significant finding of the studies was the high relapse rate of 30% to 40% cases when PUVA treatment was discontinued. The reason for high relapse rates is not known, the current belief being that the new hair growth prevents the UVA rays penetrating the skin. Technical improvements such as comb emitting UVA failed to show any significantly better response.
Several studies showed that there was no significant difference in response between patients having different types of alopecia areata. Due to UVA irradiation, side effect posing the greatest risk to PUVA patients is the threat of various types of skin cancer, especially, potentially fatal melanoma. That's the reason why post treatment monitoring of PUVA patients is very important. Nausea is the most prominent side effect reported, but there are others as well: skin darkening, sunburns called photoxic erythema, skin ageing, headache and dizziness, itching and redness of the skin.
PUVA is unsuitable for long-term therapy, because of the risk of cancer. Several studies have cast a doubt on their long-term efficacy. However, PUVA may have a role in alopecia areata management.
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