Dermatology - Hand and Foot PUVA Phototherapy

Phototherapy Unit
Ground Floor, Turnberg Building
Salford Royal Hospital
Northern Care Alliance NHS Foundation Trust

For new patient appointments: 0161 206 4226

To cancel/change subsequent appointments: 0161 206 1343
https://www.northerncarealliance.nhs.uk/patient-information/ your-appointment

For any queries/emergencies related to treatment
Monday - Saturday (7:45am – 4pm): 0161 206 0226
Outside these hours: 0161 206 4012 (Ward M3)

This leaflet aims to answer the most asked questions, but please feel free to ask your nurse or doctor if you are unsure of anything.

What is Hand and Foot PUVA?

Topical PUVA therapy is a treatment in which a medication called psoralen (P) is either taken internally as tablets or applied to the skin before exposure of the skin to special wavelengths of light called Ultraviolet A (UVA). Psoralen applied to the skin can be administered either by soaking in a basin of psoralen solution, or by applying psoralen gel directly on the affected areas. The psoralen reacts in your skin with the UVA to cause effects that help in a variety of skin conditions and makes you more sensitive to sunlight. We will discuss with you the most suitable method of treatment for you.

Which conditions are treated with Hand and Foot PUVA?

Psoriasis, eczema, vitiligo and many other skin conditions.

Where do I have Hand and Foot PUVA?

Hand and Foot PUVA treatment is carried out in the Phototherapy Unit in the ground floor of the Turnberg Building, near the main outpatient department. You may attend here as an outpatient or inpatient for your treatment. The Unit staff includes doctors, nurses and technicians.

What happens when I get there?

The phototherapy nurse will first go through the phototherapy dos and don’ts, and consent procedure. You will then be shown around the Unit before starting the treatment.

How long will I have Hand and Foot PUVA treatment?

This varies from person to person, but a course may last between 6-15 weeks. Treatments are usually given twice a week, for up to 30 sessions. Each individual visit may take up to an hour. The staff will assess you at each visit. If required a doctor will see you.
 
For patients having Hand and Foot oral PUVA, oral psoralen (8- MOP or 5-MOP tablets) needs to be taken by mouth two hours prior to each treatment session, before commencing UVA treatment.

For patients having Hand and Foot PUVA soaks in psoralen solution, you will be required to soak your hands and/or feet in a basin of psoralen solution for 15 minutes, then wait in the department for a further 30 minutes to allow psoralen to penetrate, before commencing UVA treatment.

For patients having Hand and Foot PUVA with psoralen gel, this will be applied to localised areas. You will then wait in the department for a further 15 minutes before UVA treatment.

Dos and Don’ts

• Do bring a list of your creams and medications on your first visit
• If you take psoralen tablets, do take the prescribed number of tablets two hours before attending for treatment. They should NOT be taken on an empty stomach but with a small amount of food; however, avoid any fatty food such as milk or butter as they inhibit absorption
• If you have been prescribed Acitretin tablets, do take it every day. You will still need to take oral psoralen tablets, only on the PUVA treatment days
• Do inform the staff of any change in your medications (tablets and creams) as this may interfere with the treatment. For patients on oral PUVA (8-MOP or 5-MOP) and taking Warfarin, this should be monitored closely during the course of treatment
• Do continue to use moisturisers during your course of treatment. If you use any other treatment creams the nursing staff will tell you if you should carry on using them 
• If you are on Protopic ointment (Tacrolimus) or Elidel cream (Pimecrolimus), please stop using this two weeks before starting phototherapy (unless directed otherwise by your photodermatologist)
• Do not use salicylic acid preparations or any moisturiser containing soft yellow paraffin before treatment as this can act like a sunscreen and stop the treatment working
• Do not use sunbeds or sunbathe throughout the course of treatment
• The psoralen preparation makes the skin sensitive to sunlight; do take extra caution during exposure to sunlight. UVA can penetrate through glass therefore care needs to be taken both indoors and while outside during daylight hours
• Avoid eating or handling large quantities of celery, parsnips, carrots, citrus fruits, figs and parsley as they may make your skin more sensitive to the light
• Avoid alcohol prior to your treatment

Unwanted side effects that can happen to hands/feet during a course of Hand and Foot PUVA

• You may get a mild sunburn reaction during your course
• You may get a spotty, itchy rash during your course
• You may develop a dark tan
• Your skin may become dry
• You may get a prickling/painful sensation of the skin

If you develop any of these or any other side effects which you think may be PUVA-related, please discuss with the nursing staff.

Unwanted side effects that can happen to hands/feet after a course of Hand and Foot PUVA

Skin Cancer

People who have a lot of sunlight exposure have an increased risk of skin cancer to the treated areas.

If you have more than 200 PUVA treatments, you can expect to have 5 times the risk of developing a skin cancer on the treated areas.

Photoageing

It is also possible if you need a lot of treatment that you will develop sunlight-induced skin changes on the treated areas, with wrinkling and skin discolouration, like that of the ageing process or produced by cigarette smoking.

Final points

• Please inform staff if you are unable to attend
• Valuables are your responsibility
• If you have questions about any aspect of your treatment, please ask any member of staff while you are having your treatment