• Reference Number: HEY1339-2024
• Departments: Dermatology
• Last Updated: 1 January 2024

Introduction

This leaflet has been produced to give you general information.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is PUVA therapy?

PUVA therapy is an ultraviolet treatment for skin disease.  The P stands for Psoralen which sensitizes the skin to Ultra Violet A (UVA) radiation.  UVA exposure takes place in a specially designed booth containing fluorescent tubes.

PUVA therapy has been found to successfully treat many skin conditions including psoriasis and atopic eczema.

PUVA therapy must be carried out under medical supervision/Senior Phototherapy Nurse.

It will be necessary for you to attend the department twice weekly during your course of treatment.

The length of course will vary from one patient to another.  An average treatment for psoriasis would be 10 to 15 weeks.

How is the treatment administered?

Bath PUVA

You will need to attend the Dermatology Department twice weekly on Monday and Thursday or Tuesday and Friday.  You will be asked to soak in a bath which contains Psoralen Solution, a clear liquid, for 15 minutes prior to exposure to UVA.  You will need to bring a towel with you at each attendance and dressing gown or suitable clothing for use whilst moving from the bath to the PUVA booth.  You will be responsible for your possessions and valuables so please carry these with you at all times.

On days attending for PUVA treatment you should only apply recommended emollients/moisturisers prior to treatment.  Use of prescribed medications for use post PUVA will be discussed at your assessment.

Can there be any complications or risks?

Psoralen makes both the skin and eyes sensitive to light for 24 hours after your PUVA treatment.  There is a theoretical possibility of psoralen causing problems with your eyes (cataracts) if they are unprotected, therefore you must wear protective glasses for 24 hours post treatment.  The nurse will discuss this with you during your assessment.

Please see the section at the end of this leaflet for more information about these glasses.

Although Psoralen activated PUVA is not definitely associated with damage to unborn babies it is advisable for both females and males to maintain good contraceptive practice whilst receiving PUVA.  However, if pregnancy does occur please tell the PUVA nurse.

Up to 30% of patients may develop mild to moderate sunburn at some point after a treatment; this is especially likely on the infrequently exposed areas.  A few people may have more severe sunburn although this is very uncommon and we try to minimize the risk.

Many patients experience dryness and itching of the skin which can be treated with a simple emollient/moisturising cream, in some cases patients may experience prickling of the skin ‘prickly heat’, occasionally bad enough to necessitate stopping treatment for a period of time.  The nurse will give you guidance about appropriate creams to use if this occurs.

Do report any burning or excessive discomfort as soon as possible by telephoning the Phototherapy room on tel: 01482 624192 or Reception on tel: 01482 623006.

It is common in some patients who have had PUVA therapy for many years to show premature ageing of the skin, eg dryness, freckling and wrinkling.  There is also a small risk with prolonged exposure to PUVA that skin cancers may develop.  The people most at risk are those receiving prolonged continuous PUVA.  To minimize the risks, it is important that you have the shortest effective course of treatment as you require.

It is advisable to share the information contained in this leaflet with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are helping or taking care of you following this treatment.

Assessment

During your assessment a medical history will be taken so please bring with you details of any tablets and creams you are presently using.

The do’s and don’ts along with risks and benefits will be covered at the time of your assessment.

Please ask any questions that you need answering during this time. If any further questions occur during the course of your treatment please ask the nurse delivering your treatment.

What will happen?

Treatment

PUVA therapy is carried out in the department under medical and CNS supervision.  It is necessary you will need to attend twice a week on a Monday and Thursday or Tuesday and Friday; this ensures a 72 hour gap which is required between each treatment.

The length of course will vary from patient to another.  On average this would be 10 to 15 weeks. Your agreed allocated time slot will be the same on both days of attendance throughout the course.

Your course of treatment will be monitored carefully by the nurse at each attendance and any problems referred to the Phototherapy Clinical Nurse Specialist or medical staff.  You will also be reviewed by the Senior Phototherapy Nurse after 20 treatments.

If you fail to attend for more than two treatments without informing us, you will be discharged back to the care of your GP and your appointment slot will be given to another patient.

During your treatment

Each time you attend for treatment, you will be asked your name and date of birth, to confirm your identity, even when the nurse knows you.  You will also need to tell us of any problems with your skin since your previous treatment, eg has your skin been hot or sore, pink or red in areas.

During your course of treatment the dose of UVA and time to deliver this will gradually increase depending on the reaction of your skin.

A sun barrier may be applied to existing moles to protect these areas from exposure.

Your eyes will be protected with goggles and your face may also be protected by a mask/visor during treatment.

Male patients must protect the genital area from exposure, preferably by wearing a black sock (not provided by the department).  This minimizes the chance of experiencing any burning that can occur on jock strap lines, if not worn in exactly the same position, for each treatment.

A jock strap can be worn if preferred and these will be provided.

Only apply agreed emollients prior to attending for PUVA and post treatment topical treatment will be discussed during the assessment.

No alcohol to be consumed prior to attendance for light therapy.

Do not miss treatments unless absolutely unavoidable as your progress depends on regular attendance.

If you are unable to attend please contact the PUVA nurse on tel: 01482 624192 to discuss this.

What happens afterwards?

During the course of your treatment extra care should be taken when working outdoors, gardening and taking long walks.  Wear a high factor sunscreen to protect exposed skin, long sleeves, legged clothes and a broad brimmed hat.  This is to minimize further exposure to UVA and UVB which may increase your short term risk of burning and long term risk of developing skin cancers.

For your own protection if you arrive for treatment wearing scanty clothing the nurse will not treat you.

Do not sunbathe or use a sun bed at any time during your course of treatment.

Avoid putting cosmetics, perfumed substances or aftershave lotion on your skin before UVA treatment as these may make your skin more sensitive to the ultra violet radiation.

You MUST PROTECT YOUR EYES FOR 24 HOURS POST TREATMENT WITH UVA.  This applies to all types of weather conditions – there is still UVA present during the dullest of days and frequently in lighting.

The labelling of commercially available sunglasses may indicate total block to UV radiation though in many cases the specification for these glasses is NOT adequate for your requirements.  Please bring your own glasses as we have the facilities to test these for suitability in our department.

Protective glasses can be loaned from the Dermatology Department.  Alternatively, it is possible to have your own spectacles specially treated by your own Optician.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.