Psoralens are medicines, mainly of plant origin, the use of which makes the human skin more susceptible to sunlight. In addition, these agents stimulate the restoration of pigmentation. Mankind has known about psoralens since ancient Egypt. Four millennia ago in Egypt and India, pigmentation disorders were treated with seed extracts from legumes and umbrella plants. These extracts were applied internally, or they lubricated the skin, after which the patients were placed in open sunlight. Of course, ancient people could not control the dosage of photosensitizers and the patient's exposure to sunlight, so the result was not always positive.
At the end of the 19th century, the Dane Niels Finsen began to study the effectiveness of drugs under the influence of sunlight, and found that ultraviolet rays have more influence on a person than, say, infrared. The scientist began to treat lupus with light. For 50 years he has been treating this disease, and during this time more than 800 people underwent treatment with him, almost half of them completely got rid of the disease.
At the beginning of the 20th century, a scientist from France intercepted the baton for studying the effects of light, and by 1974 a source of intense ultraviolet radiation was developed, 10 years later in America, PUVA therapy was officially approved by the drug control federation.
What it is?
So, PUVA therapy - what is it? PUVA therapy is a physiotherapy method using a photoactive drug. In other words, this is irradiation of the affected skin with ultraviolet radiation.
This technique was developed, as already mentioned, in the middle of the last century, and has been used quite successfully in America and Europe for the treatment of skin pathologies. According to statistics, the success of therapy is 85%.
Mechanism of action
The method (PUVA therapy) is based on a combination of medication and ultraviolet A radiation. At first glance, this is a rather incomprehensible procedure, but its effectiveness is undeniable.
PUVA therapy, what is it and what is the mechanism of its action? The method is based on direct toxic suppression of activated lymphocytes. Psoralen is a group of drugs that, regardless of origin (plant or synthetic), have the ability to absorb light waves. Examples of such agents are Matoxalen, Methoxyporalen, Ammifurin, Trioxalen and others. All these funds are activated only under the influence of sunlight.
Ultraviolet treatment is carried out in medical rooms equipped with tanning booths. Now there are various modifications - both for irradiation of individual parts of the body, and for irradiation of the entire surface. With the help of PUVA therapy, you can get rid of psoriasis, solar urticaria, mycoses, depriving and other ailments.
Observations show that as a result of inattention to the dosage of exposure to rays, patients experience various complications. Therefore, experts do not welcome the implementation of PUVA therapy with the device at home, but, despite this, manufacturers produce portable UV irradiators.
Treatment methods
The most common method of treatment is a systematic approach - the patient takes the drug, and then the problem areas are treated with ultraviolet rays. The exposure time is from 45 minutes to an hour.
Local therapy consists in the fact that a solution of a photosensitizer is applied to a specific area of the skin, and then the surface of the skin is irradiated.
A PV bath is a solution of psoralen that a patient must take, and then a UV lamp is sent to the skin.
The dosage of the drug is calculated based on the weight of the patient, and the time of exposure to the rays depends on the pigmentation of the skin. The darker the skin, the longer the exposure is needed.
Disease treatment
Having figured out what it is - PUVA therapy, you need to find out how the treatment of a disease occurs. The outcome of treatment depends on the correctness of the action.
PUVA therapy for psoriasis is used if the lesion extends to 20-30% of the skin, as well as for the treatment of severe forms of pathology: plaque, pustular, erythrodermic, palmar-plantar and others. Such treatment can be used at any stage of the disease, including with a progressive form. The frequency and frequency of PUVA therapy sessions for psoriasis is selected individually, and depends on the nature and severity of the course of the disease, in addition, the appearance of new rashes is taken into account. On average, spend about 30 sessions with a frequency of 3-4 times a week.
After the main treatment, supportive treatment can be used, the dosage and the number of procedures are less.
PUVA therapy in the treatment of red lichen is carried out through bathtubs. The bath is prescribed for a week or 10 days, the dose of radiation each time increased by 25% of the minimum phototoxic dose. At the same time, “Panavir” at 200 mcg every other day is injected. This method of treatment provides a longer remission of the disease.
Mushroom mycosis of the skin is also successfully treated with PUVA therapy. According to statistics, complete remission occurs in 70% of cases of treatment of the disease in the early stages of the disease.
As for photodermatosis, treatment with PUVA therapy also shows good results. If the disease often recurs, and there is no effect of sunscreens, medium-wave ultraviolet therapy or PUVA therapy is prescribed. In general, the treatment of photodermatosis is quite complicated, but it is still possible to achieve positive results using this method.
Benefits
PUVA therapy has several advantages:
- the ability to provide supportive care;
- a nice addition to using the technique is an even tan;
- convenient treatment conditions;
- no need to take leave for treatment;
- repeated courses give a more effective result;
- the duration of remission from 6 months to several years;
- well tolerated by all patients;
- 80% efficiency;
- the procedures are not addictive;
- after five sessions you can see a noticeable result.
Disadvantages of the method
Like any treatment, PUVA therapy has its drawbacks:
- adverse reactions;
- relapses of pathology are possible;
- the need to visit a health facility often.
Indications
As a rule, PUVA therapy is used to treat psoriasis of the palms of the hands and feet. In addition, the method is used to treat other pathologies.
A very effective method in the treatment of precancerous skin diseases, Bowen's disease. Papillomavirus infection, solar urticaria are also no exception. In addition, this technique is effective for acne and alopecia (pathological hair loss). A noticeable effect is achieved in the treatment of PUVA therapy for lichen planus.
Contraindications
Among the contraindications for PUVA therapy can be identified:
- hypersensitivity to drugs or to ultraviolet radiation;
- diseases that lead to increased sensitivity to light rays - xeroderma pigmentosa, albinism, lupus erythematosus;
- acute infectious diseases;
- renal failure;
- chronic ailments in acute form;
- cardiovascular failure;
- oncology;
- diabetes;
- liver disease
- increased thyroid function;
- tuberculosis;
- cataract;
- pregnancy;
- decompensated diseases of the nervous system.
Side effects
Despite the fact that reviews of PUVA therapy are mostly positive, the patient may encounter the following side effects:
- depression;
- lowering blood pressure;
- headaches and dizziness;
- allergies
- itchy skin;
- discomfort in the epigastric region;
- lack of appetite;
- nausea and vomiting.
Regarding the latter, to stop nausea, doctors recommend:
- reduce the dosage of psoralen to 10 mg, as well as increase the dose of ultraviolet radiation;
- take antiemetics;
- divide the dose into several parts;
- eat fractionally;
- take a photosensitizing agent with milk or food.
Effects
If we talk about the serious consequences of using PUVA therapy, it is necessary to say about the following dangers:
- melanoma;
- squamous cell carcinoma;
- basal skin cancer;
- premature skin aging;
- burns;
- erythema;
- cataract;
- the appearance of unwanted spots.
Preparation for the procedure
Some special preparation for the procedure is not required, only in some cases, to reduce the risk of side effects, it is recommended to take vitamins of group A, as well as Karsil or Essential, on the eve of the procedure.
All necessary preparations before PUVA therapy will be prescribed by a doctor, taking into account their feasibility.
Other photochemotherapy methods
What is it - PUVA therapy, indications, contraindications, possible side effects and complications - all this is already clear. But are there other safer photochemotherapy methods?
Exist:
- BUF phototherapy. In this case, medications are not used, treatment can be carried out both in the clinic and at home.
- Selective phototherapy. Medium-wave ultraviolet rays are used.
- PUVB therapy. Ultraviolet A and ultraviolet B are used. The disadvantage of this method is that penetration into skin cells is not deep enough.
- Re-PUVA therapy. This is a combination of PUVA therapy with retinoids. In this case, the dose of ultraviolet radiation is reduced. In addition, the skin cleansing time is reduced by almost half. This technique is good for fungal skin fungal infections.
Tips for those who plan to undergo treatment with PUVA therapy
Of course, the dermatologist and nurse who will conduct the sessions will give the patient detailed recommendations, only general tips are presented below:
- Be sure to attend all breaded receptions.
- To inform medical personnel about their health problems, as well as which drugs are taken.
- Do not apply cosmetics and creams before the sessions, especially those containing coal tar should be excluded. Only ointments and preparations for external use are recommended, which are recommended by a phototherapist or attending physician.
- If possible, it is recommended that you plan the procedures at the same time.
- Observe the interval between procedures for at least 48 hours.
- Take capsules at regular intervals before the procedure.
- It is best to take pills after two hours of eating.
- It is recommended to take hepatoprotectors to avoid hepatotoxic effect.
- It is also advisable to take antioxidants to prevent the appearance of free radicals, and reduce the overall course of treatment.
- Do not drink alcohol during treatment.
- Avoid exposure to the sun, both on treatment days and on days free of them.
- Before treatment, it is recommended to use a sunscreen.
- The inguinal region in men is not exposed to ultraviolet rays.
- When taking Metoxalen, you need to remember that within 12 hours after taking it, you must protect your eyes from sunlight.
- From the time you take psoralen, you must wear sunglasses until dark. Moreover, in the room you must stay in glasses.
- After dark, sunglasses should continue to be worn in the presence of fluorescent lighting.
- It is necessary to wear clothes with long sleeves, which covers all parts of the body, as well as hats.
Immediately after the procedure, any hydrating cream must be used to prevent the skin from drying out. It is better if the cream will include anti-inflammatory components, vitamins, as well as substances that improve regeneration processes.
As for the cost of the procedure, it may be different in different cities. But on average, one procedure costs from 500 to 700 rubles. As for the course of treatment, it is always negotiated on an individual basis.
Observing all the rules of treatment, with the help of PUVA therapy, you can get rid of ailments without consequences and side effects.
I must say that PUVA therapy cannot be considered a panacea for all patients suffering from dermatological ailments. Unfortunately, there is no remedy that can help any patient. But do not despair, you need to try all the methods available in the arsenal of modern medicine, and among them there is sure to be one that works.