Photochemotherapy (PUVA)

The aim of this page is to provide information about hand and foot photochemotherapy or ’PUVA’. Please ask a member of staff if you have any questions.

What is PUVA?

Photochemotherapy (PUVA) is widely used for a number of skin disorders. The choice of PUVA over the other forms of light treatment depends on a range of factors including age, disease, skin type, previous treatment and current medication. The doctor or nurse will discuss what is best for you.

PUVA is not a long-term cure but it can improve your condition significantly for a period of time.

PUVA therapy can only be given if you can commit to attending all the sessions within the prescribed course. If you cannot attend, PUVA therapy may not be the best treatment for you. If you require more information, please ask the nurse or ring 01724 292 106 or 01482 638 571
(8am-5pm, Mon-Fri).

What is involved in PUVA?

We use hand and foot N-LINEt Modue PUVA machines at the Ironstone centre. The machine has two modules, one for the hands and one for the feet. Each module consists of UVA light emitting tubes. We will show you the machine before you commence your treatment and discuss with you the days and times of your treatment.

Treatment is usually twice a week (Monday and Friday) for up to 40 treatments.

Procedure

Before you start your PUVA treatment, we will apply a light sensitive gel (Psoralen gel) to the affected areas for 15 minutes. After which you will be asked to take a seat in front of the machine and place your hands and/or feet on to the machine.

Goggles will be provided to protect your eyes from the light which can cause cataracts if not protected. You will also wear a face shield to protect your face from unnecessary light exposure.

Initially, treatment starts at 30 seconds and will increase by 30 seconds at each visit reaching a maximum time of five or six minutes. If your skin becomes sore or uncomfortable the treatment may be held at a specific time or postponed until it has settled down. You will be asked to wash any residual psoralen gel from your hands and/or feet after exposure to the light.

Following treatment, it is not unusual to develop a mild skin redness. Please tell the nurse at your next appointment if, a few hours after treatment, the affected areas felt hot, uncomfortable or your skin remains red.

Please remember there is a limit to the amount of PUVA you can have in your lifetime. We keep records to avoid exceeding the recommended amount.

What you need to do during treatment

Some plants, vegetables and fruits ( e.g. Celery, parsnips, figs and limes), have photosensitisers in them. These make you more sensitive to UV light, so please avoid handling them for at least two hours before treatment.

Regular and punctual clinic attendance is important. To avoid inconveniencing other patients, please be on time for your appointment. We may be unable to accommodate late arrivals. If you miss three appointments in a row without notification the treatment will be withdrawn to allow treatments for other patients. If you are unable to attend for treatment you should telephone 01724 292 106 or 01482 638 571 to let the staff know (8.15am-5pm, Mon-Fri).

Repeat prescriptions should be obtained from your GP throughout the course of treatments. It is your responsibility to keep yourself well stocked with the creams you require.

Short-term side effects

1. Redness/burning – should your skin become blistered, hot or uncomfortable (e.g. like sunburn) please report this to the Dermatology service on 01724 292 106 (Mon-Fri, 8.15 am-5 pm). Explain that you have had hand or foot PUVA and describe your symptoms. Treatment is sometimes suspended and the use of specific creams may be advised until symptoms settle.
2. Dry skin – your skin may be unusually dry during treatment and for some time afterwards. Applying an emollient to the affected areas at least twice a day will help keep the skin hydrated and supple.
3. Itching – PUVA can cause itching, articularly during the first two weeks. Emollients and antihistamine tablets may be required to treat this.
4. Cold sores – (Herpes Simplex virus) Those who have had a cold sore in the past may find that they develop cold sores. Apply sunscreen to the lips before every treatment to help prevent this and ensure the visor is worn during treatment.
5. Folliculitis – small pustules and minor inflammation around the hair follicles can occur. This does not cause discomfort, and treatment can go ahead. Applying moisturiser in a downward motion before treatment may help to prevent this.
6. Photosensitivity – if you sometimes develop a rash (e.g. prickly heat), you may suffer a flare of your condition with PUVA treatment. If this happens tell the phototherapy nurse who may be able to treat you to reduce the symptoms.

Long-term side effects

1. Photo-aging – frequent exposure to UV may cause aging changes in the skin, such as freckles and wrinkles.
2. Skin cancer – As with sunlight, there is a risk of skin cancer if you have a lot of PUVA treatment (more than 200 treatments in your lifetime).