Pros and Cons of PUVA Therapy in Vitiligo
Benefits and Side Effects of Photochemotherapy
Jul 6, 2009
Vitiligo is a harmless skin disease with cosmetic and psychological implications; hence any treatment for this skin disease with color loss should weigh the benefits against the side effects. PUVA therapy is notorious for its cancer risk, but it is also the best treatment modality available for vitiligo for the last four decades.
What are the Advantages of PUVA or Photochemotherapy?
PUVA or photochemotherapy is the most effective treatment for vitiligo. It is easy to administer and with the PUVASol therapy, the patient can try the treatment at home. If used properly and according to instructions, PUVA therapy can prove to be safe and satisfying for the patients.
What are the Disadvantages of PUVA Therapy?
Following are the disadvantages of PUVA therapy:
- The exposures to UVA in PUVA chambers at the clinics are costly for the average, uninsured, patients.
- Regular visits to the clinic are required for the photochemotherapy.
- PUVA therapy is time consuming compared to other topical and systemic treatments for vitiligo.
- Oral PUVA therapy is not suitable for children below the age of 12.
- Photochemotherapy is not suitable in the fair skinned, as chances of burns and risk of skin cancer is quite high.
- PUVA therapy should be avoided in those with numerous melanocytic nevi, atypical moles or family history of melanoma.
What are the Side Effects of PUVA therapy?
- There is a high risk of cataract in the eye due to UV/solar radiation during the phototherapy.
- Phototoxic reactions and burns may occur during the UVA or sun exposure during PUVA therapy.
- Tanning of the uninvolved skin is common following the UV exposure.
- Nausea and gastric irritation is a common adverse effect in some individuals after ingestions of psoralens.
- Risk of cancer is quite high following photochemotherapy, especially in the skin types of 1-3.
What are the Precautions to be Taken During PUVA Therapy?
- During the UVA/UVB/Sun exposure, UV glasses should be worn to protect the eyes.
- During the entire period of treatment, sunglasses with UV protection should be worn while going out.
- Do not use the PUVA therapy if you are pregnant, breast feeding or suffer from some sun sensitive diseases like porphyria, lupus or xeroderma pigmentosum.
- Never use the photo chemotherapy on consecutive days.
- The uninvolved skin should be protected during the UV radiation with sunscreens or occlusion to avoid the risk of cancer.
- A patient should not receive more than 1000 J/cm2 or 150 UVA exposures in his lifetime. This helps in reducing the cancer risk.
Is PUVA Photo chemotherapy Effective in all Cases of Vitiligo?
No, all vitiligo patients do not respond favorably to PUVA therapy . Usually full repigmentation occurs after around 100 exposures in localized vitiligo and 150-200 exposures in generalized vitiligo. If no repigmentation appears after 3-4 months of treatment, the treatment should be considered ineffective and discontinued. Pigmented hairs in and around the vitiligo patches increase the chances of repigmentation. Presence of white hairs in the white patches is a pointer towards poor response to future treatment.
In some patients, white patches may recur even after successful treatment. Vitiligo recurrence calls for re-treatment with photo chemotherapy or other methods like topical steroids, immune-modulators or surgical methods.
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Related Reading
References
- Various Journals and Text Books of Dermatology
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
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