Dermatology - Oral 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 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 PUVA?

PUVA therapy is a treatment in which a medication called Psoralen (P) is taken by mouth 2 hours before exposure of the skin to special wavelengths of light called Ultraviolet A (UVA). The number of tablets you will take depends on your weight and you will be given this medication from the hospital pharmacist.

The Psoralen reacts in the skin with the UVA to cause effects that help improve or clear a variety of skin conditions. It also makes your skin temporarily more sensitive to sunlight.

Which conditions are treated with PUVA?

Psoriasis, eczema, cutaneous T-Cell lymphoma, granuloma annulare and many other skin conditions.

Where do I have PUVA?

UVA treatment is caried out in the Phototherapy Unit in the Brooke Building, near Ward M3 (Dermatology ward).

You may attend 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 the consent procedure. You will then be shown around the unit before starting the treatment.

How long will I have PUVA treatment for?

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 session may last a few minutes, with the total visit taking up to half an hour. The staff will assess you at each visit. If required, a doctor will see you.

Dos and Don’ts

• Do bring a list of your creams and medications at your fist visit
• Do take the prescribed number of tablets 2 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 these inhibit absorption
• If you have been prescribed Acitretin tablets, do take it every day. You will still need to take oral psoralen tablets on the PUVA treatment days
• Do not wear any clothing during the treatment
• Male patients must wear a sock for genital protection - so please bring a clean, dark sock for this purpose
• Do wear the close fitting goggles and face visor provided while you are in the phototherapy cubicle (unless otherwise specified)
• Do inform the staff of any change in your medications (tablets and creams) as this may interfere with the treatment. If you are taking Warfarin this should be closely monitored during your 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 continue 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)
• On the day of treatment, do not use perfumed products such as cosmetics, perfumes or aftershaves as these can make your skin more sensitive to the light
• 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
• Avoid severe haircuts during your course of treatment
• 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
• If you have a history of cold sores, do apply total sunblock to the affected area prior to each treatment
• Female patients should avoid pregnancy during PUVA treatment. If pregnancy does occur, do inform the staff

Eye protection

Psoralen tablets make both the skin and the eyes sensitive to light for some hours. It is therefore most important that protective glasses MUST be worn during daylight exposure for 24 hours after you take your tablets (not while sleeping or driving at night!) to avoid increasing the risk of cataracts. Suitable protection glasses may be clear or tinted (i.e. sunglasses). We can test your glasses or sunglasses to check if they are suitable.

Sunglasses

You should look for sunglasses which are marked UV400. Boots the chemist, and many other retailers will carry this. Glasses conforming with British Standard BS2724 is not necessarily adequate protection. Lenses should be large enough, being adequate to cover the whole eye, preferably with ‘wrap-around’ side protection.

Prescription Lenses

If you normally wear prescription spectacles with plastic lenses, you can have them coated with a clear material which is protective against UV light. You should ask your optician for a UV coating.

You must also wear the protective goggles and face visor provided during treatment unless otherwise stated by your doctor.

Extra care should be taken throughout the course of PUVA treatment to protect the skin from sunlight.

UVA light can penetrate through glass therefore care needs to be taken both indoors and while outside during daylight hours.

Unwanted side effects that can happen during a course of PUVA

• You may get a sunburn reaction during your course, which in severe cases could blister
• You may get a spotty, itchy rash during your course (about 2 in 10 people do)
• You may develop a dark tan
• Your skin may become dry
• You may get a prickling/painful sensation of the skin
• You may get queasiness/indigestion due to the psoralen tablets

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 after a course of PUVA

Skin Cancer

• People who have a lot of sunlight exposure have an increased risk of skin cancer. In Scotland, approximately one out of 10 will develop a skin cancer. (It is worth noting that 8 out of 10 Australians have a skin cancer at some time in their lives)
• If you have more than 200 PUVA treatments, you can expect to have 5 times the risk of developing a skin cancer

Photoaging

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

Important points

Take your Psoralen tablets 2 hours before each treatment. Wear protective glasses for 24 hours after taking Psoralen tablets.

Review

You will be asked to attend for a specific skin cancer review once you have received more than 200 PUVA treatments.

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.