PUVA Therapy (Photochemotherapy) For Vitiligo


puva therapy for vitiligo

PUVA Therapy For Vitiligo 

What is PUVA?


Vitiligo is an autoimmune skin disease that is common in dark-skinned individuals and usually influences the personal satisfaction of the patient. PUVA therapy for vitiligo has been used for a long extent. Although it is time taker to get benefits yet it is a first-line treatment in many cases whereas many options are available today to take care of Vitiligo.



PUVA (photochemotherapy) is a combination treatment which is a short form of Psoralen ultraviolet A (solar spectrum wavelength).

Psoralens (methoxsalen, methoxy psoralen, and trisoralen) are plant-based compounds that are known to absorb ultraviolet light from the solar spectrum and temporarily make the skin sensitive to UVA.

It generally reacts within the body that produces phototoxicity and extremely supportive in managing various kinds of skin issue including Vitiligo. 


How is PUVA used to deal with Vitiligo?




Mechanism of action of PUVA treatment for vitiligo  - Without the correct wavelength of ultraviolet light, Psoralens are naturally dormant and don't perform well in vitiligo. Generally, skin cells are not sensitive to ultraviolet light alone, but when used with psoralens, the results can be discovered drastically with a skin irritation known as phototoxicity. That is why Psoralens are called photosensitizing agents. 

It is used both topically or orally to sensitize the color giving skin cells named melanocytes and the skin is exposed to UVA subsequently in a phototherapy center. 

 Is PUVA treatment for vitiligo safe?


It is a relatively safe means for the treatment of vitiligo and known to initiate repigmentation of white macules but needs a prolonged treatment following twice or thrice a week. 

However, this therapy is mostly used in widespread vitiligo and is not devoid of side effects. This treatment shows more miraculous effects in people who go to the shelter of PUVA with a positive thought and is well aware of both the benefits and unwanted effects of this therapy. 

It is a long term treatment to take benefits that requires endurance. Long-term treatment often seems boring to patients and due to which sufferers discontinue their treatment after some time which is not right at all.

What are PUVA light therapy side effects?


Skin related disorders - Erythema, friction blisters, pruritus, xerosis, sunburn, hyperpigmentation, acute dryness of skin, skin aging (hypopigmentation, wrinkles, telangiectasia, lentigines, actinic keratosis etc), cutaneous malignancies (squamous cell cancer) basal cell carcinoma, melanoma and skin pain (sometimes there is a mild pain in the skin due to photo-toxic damage to the nerve associated with the skin). 

Excessive darkening effects in dark-skinned patients.

CNS disorders such as anxiety, depression, stress, headache, giddiness, sleeplessness, and hyperactivity.

Relapse of disease named herpes simplex medically.

Gastrointestinal upset - Nausea, and vomiting. 

Bronchoconstriction.

Drug fever.

Photo-onycholysis.

Melanonychia.

Tachycardia.

Ankle edema.

Eye toxicity (Keratitis, cataracts, etc.)



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 Does PUVA therapy for vitiligo works well?



Usually, PUVA therapy for vitiligo results are variable and complete repigmentation is rarely achieved. If you leave the extremities and genital parts, it gives effective outcomes in 70-75% vitiligo cases. 

Typically more than 10% of the white patches on the skin show good results with PUVA treatment in vitiligo. Patients with the localized disease do not respond well with topical PUVA.

However, the patient needs to visit the clinic frequently to get phototherapy because the span of treatment is very long which can usually take from 6 to 24 months. Sometimes the results also prove frustrating and less encouraging. 

Apart from this, relapse is possible. Therefore, we see that the management of vitiligo is quite a challenging task, and for fruitful treatment, the patient needs to take phototherapy according to the doctor without making any interval.

The use of phototherapy relies upon different factors such as the age of the patient, site of lesions, financial status, and psychosocial conditions, etc.

Still, phototherapy is considered well-established in the treatment of vitiligo particularly in the cases of widespread vitiligo.


Some Instructions & Precautions during PUVA treatment in vitiligo  





  • During PUVA therapy for vitiligo, always follow the advice of the photo-therapist.


  • Pregnancy - Evidence of fetal destruction has not been found with this therapy, yet it should be discontinued during pregnancy or suspected pregnancy. 


  • Oral PUVA treatment should be avoided for children under 10 years of age.


  • An extraordinary kind of glasses (UV-blocking goggles) must be used during the therapeutic session. Such glasses are provided to you at the treatment center for eye protection.


UV-blocking goggles

  • If you are already taking any drugs or facing any eye problem then inform the doctor about it. Do not use any cosmetic items without the advice of a photo therapist. 




  • The risk of melanoma after PUVA increases markedly. It is a proven fact that prolonged use of PUVA leads to the occurrence of squamous cell carcinoma in vitiligo patients. So, it always should be performed under the supervision of a photo therapist.


  • If there is no white spot on the face, then broad-spectrum sunscreen (with an SPF of 50+) should be used or use clothes as a barrier during procedure. 


  • Male genitalia should never be kept open during UVA therapy.


  • Before starting therapy, use sun-block lotion on your hands and face. Also, use sunscreen on uncovered skin after the treatment.


  • Stay away from sun presentation for 10-12 hours after taking psoralen (methoxsalen).
  • Also, avoid sun rays to minimize pigmentation. For this reason, cover your body completely before going into the sun.


  • Do not consume too much alcohol and use other addictions sparingly.


  • Visit the dermatologist much of the time.

puva center for vitiligo patient







Indications for PUVA apart from Vitiligo




Apart from vitiligo, PUVA therapy is also used in many other skin disorders such as

Psoriasis

Mycosis fungoides 

Large-plaque parapsoriasis 

Dermatitis

Eczema

Polymorphic light eruption

Cutaneous T-cell lymphoma 


Contraindications (Exclusion criteria) of PUVA



PUVA is always contraindicated during pregnancy and lactation period.

Hypersensitive people with phototherapy.

Recognized HIV infection (AIDS).

Children under 10. (In some special circumstances, this treatment may be given to children under 10 if it is always evaluated their eyes).



Monitoring patients during PUVA therapy in Vitiligo



It has already been told that this therapy demands months and years to get an optimal result. Hence keeping in mind its side effects, the patient should always be monitored. 

opthalmic test during puva therapy


First of all, the liver (liver function tests) and eyes should be examined thoroughly. Periodic screening should also be executed for skin cancer.

Drug interactions are following - 
Phototoxic agents like thiazides, tetracyclines, phenothiazines, sulfonamides, and anthralin or coal-tar (topical use).

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