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PUVA photochemotherapy

Psoralen + UVA (PUVA) therapy is based on the interaction of UV radiation and a photosensitizing chemical (psoralen) plus ultraviolet A. In the doses used, the radiation alone or the chemical alone would have no significant biologic effect.

There are several available psoralens: 8-methoxypsoralen, 5-methoxypsoralen and 4,5,8-trimethoxypsoralen. These psoralens can be used orally or topically as ointments, creams, lotions and baths. Topical or bath psoralens have the advantage of less gastrointestinal side effects. The photosensitization with topical psoralens also typically persists for a much shorter period of time than oral psoralens.

The safety and efficacy of photochemotherapy (PUVA) in children has not been established so far.

Psoralen ingestion may lead to short- and long-term toxicities as nausea, vomiting, headache, hepatotoxicity, generalized photosensitization requiring 24 hours of photoprotection, ocular toxicity, acute risk of burning, and long-term risk of skin cancer). 

With the use of PUVA, erythema can start 2436 hours after the exposure and peaks 48-72 hours later. PUVA erythema can last for a week or more. It is particularly important if PUVA is used to avoid prolonged sun exposure, wear UVA-absorbing sunglasses outdoors, use a broad spectrum sunscreen and photoprotective clothing the days of the treatments to prevent significant phototoxicity.