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P
hototherapy
with
PUVA: V
ersatility
and
efficacy
in
dermatoses
R
ev
A
ssoc
M
ed
B
ras
2017; 63(5):393-396
393
SPECIAL ISSUE
Phototherapy with PUVA: Versatility and efficacy in dermatoses
T
atiana
F
erreira
F
rança
1
*, A
lessandra
V
ieira
D
iniz
1
, I
vanete
L
opes
da
S
ilva
1
, R
afaella
R
êllo
P
into
C
oelho
C
arvalho
1
,
V
anessa
K
nauf
L
opes
1
, V
irgínia
V
inha
Z
anuncio
2
1
Medical Student, Universidade Federal de Viçosa (UFV), Viçosa, MG, Brazil
2
Assistant Professor of Dermatology, Department of Medicine and Nursing, UFV, Viçosa, MG, Brazil
Study conducted at Department of Medicine and Nursing, Universidade Federal de Viçosa (UFV), Viçosa, MG, Brazil
Article received:
11/4/2016
Accepted for publication:
11/20/2016
*Correspondence:
Address: Rua Feijó Bhering, 53, apto. 604
Viçosa, MG – Brazil
Postal code: 36570-000
tatif.franca@hotmail.com http://dx.doi.org/10.1590/1806-9282.63.05.393I
ntroduction
Phototherapy is used in the treatment of several derma-
toses, many with high prevalence and chronic progres-
sion.
1,2
Its classification is made according to the type of
irradiation: ultraviolet A (UVA – between 320 and 400 nm
wavelength) or ultraviolet B (UVB – between 290 and 320
nm).
1
The range of UVB between 311-312 nm is called
narrow-band.
The immunological basis of phototherapy is the ac-
tivation of immune-modulating cascades caused by the
absorption of UV rays by chromophores of the skin. Cell
membrane and DNA damage
3
occur due to photochem-
ical reactions that have anti-inflammatory, immunosup-
pressive and antiproliferative effects.
1,4
In order to determine the time and intensity of the
sessions, a minimal erythematous dose (DEM), which is
the minimum energy required to produce a uniform ery-
thematous response within 24 hours, is calculated. Treat-
ment is started with 75 to 90% of this dose. The energy is
gradually increased to minimize adverse reactions and
potentiate the treatment.
1
PUVA treatment uses oral or topical psoralen followed
by exposure to UVA irradiation.
4
Psoralens are tricyclic
furocoumarins derived from plants and activated by UV
rays.
4,5
The PUVA procedure with oral psoralens should
be preceded by ophthalmologic evaluation and serum
dosage of ALT, AST, gamma-glutamyltransferase (gamma
GT), alkaline phosphatase, urea, creatinine, BHCG for
women of childbearing age and antinuclear antibodies
(ANA) to detect potential sensitivity to R-UVA. Topical
PUVA, in turn, is indicated primarily for patients with
hepatic or gastrointestinal dysfunction, cataract, drug
interactions, and for children.
4,5
The absolute contraindications for PUVA are xero-
derma pigmentosum, some genodermatoses, systemic
lupus erythematosus, dermatomyositis, previous history
of melanoma and trichothiodystrophy. Relative contrain-
dications include age less than 10 years, previous or current
history of non-melanoma skin cancer, immunosuppressive
treatment, gestation, cataracts, severe hepatic dysfunction,
and history of systemic malignant tumors.
2
Adverse effects include increased risk of melanoma
and non-melanoma skin cancer, gastrointestinal chang-
es, erythema, burns and pruritus. There may be conjunc-
tival changes and early cataract, justifying ocular protec-
tion with sunglasses for at least eight hours after
ingestion of psoralens. As a late manifestation there is
photoaging.
1,4,6
Medical supervision and periodic labora-
tory evaluation are fundamental, as well as avoiding sun
exposure with the use of physical and chemical barriers
during treatment.
2
This article aims to report three clinical cases, one of
psoriasis, one of vitiligo and one of pityriasis alba, treated
with PUVA with excellent response and, thus, show the
diversity of dermatoses that can be treated with this the-
rapeutic option. All the patients authorized in writing the
use of their images as illustration of the cases by signing
Free and Informed Consent Terms (FIC) forms.