Puva therapy, systemic

Synonym(s)

oral; oral PUVA therapy; peroral PUVA therapy; PUVA Therapy

Definition
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UVA irradiation after oral application of methoxsalene as photosensitizer. The main advantage over PUVA bath therapy is the possibility to treat the face and capillitium as well (see Table 1). The peroral PUVA treatment is therefore often used as light-hardening for photodermatoses.

Indication
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S.u. PUVA therapy.

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Implementation
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Intake of Methoxsalen (Meladinine Tbl.) 0,5-0,8 mg/kg KG p.o. (plasma level 50-250 ng/ml). Irradiation with UVA at intervals of 1-3 h. The initial dose is 50% of the MPD or 0.5-1 J/cm2 (depending on skin type). Increase of the dose after 72 hours at the earliest. (delayed phototoxicity! MPD is lowest after 72 hours at the earliest!) Usually increase by 0.3-0.5 J/cm2 after every 3rd irradiation. Frequency of irradiation 3-4 times/week.

Protective measures: Fitting of PUVA glasses by the ophthalmologist is absolutely necessary (cataract prophylaxis!), e.g. Clairless, Fa. Zeiss. Aluminium foil/cloth to cover the male genital. Even if there is no infestation of the face or the capillitium, these locations should also be covered.
Education: Patients must be well informed about increased light sensitivity in the treated areas! Written information and declaration of consent are required.
Accompanying: Regular ophthalmological check-ups before therapy and every 6 weeks during therapy are necessary. No additional sun exposure during ongoing photochemotherapy.
Cave! Immunosuppressive accompanying medication! These are suspected of promoting the development of carcinoma!

Undesirable effects
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S.u. PUVA therapy.

Contraindication
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S.u. PUVA therapy.

Tables
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Advantages and disadvantages of systemic and PUVA bath therapies in daily practice

	Systemic PUVA Therapy	PUVA Bath Therapy
Advantages	Co-treatment of the capillitium and face is possible (photodermatoses)	No systemic absorption (no systemic NW)
		Significantly lower cumulative UVA dose required than with peroral therapy (probably lower risk of carcinoma!)
		No protective goggles necessary (no risk of cataract)
		Only short photosensitization (max. 2-3 hours)
		Applicable in case of reduced liver and kidney function
		Applicable in cases where no additional internal medication is possible

Disadvantages	Systemic NW like nausea, vomiting (up to 21%)	High water temperature is not cardio-pulmonary compatible for all patients
	Not applicable in case of reduced liver and kidney function	Increased photosensitivity immediately after the psoralen bath (careful UVA dosimetry!)
	Permanent wearing of UV-protective glasses is necessary	High organisational and equipment costs
	Increased generalized photosensitivity for at least 12 hours
	Head and hands must also be strictly protected from sunlight