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Introduction to dermatological treatment
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
UVA radiation (320–400 nm) is ineffective on its own. Sunbeds bought commercially produce mainly UVA although a low dose of UVB is also emitted which probably produces the tan. The addition of a psoralen followed by UVA (PUVA therapy) has been found to be an effective treatment for several conditions (Table 2.04).
Pharmacology of Therapeutic Agents in Photomedicine
Published in Henry W. Lim, Nicholas A. Soter, Clinical Photomedicine, 2018
Ira C. Davis, Matthew J. Stiller, Jerome L. Shupack
Adverse effects of PUVA therapy may be classified into acute and chronic effects. Acute side effects include erythema, vesicles, pruritus, and nausea. Less commonly, headache and dizziness can occur. Drug fever due to PUVA therapy and to 8-MOP alone has been noted.
Determination
Published in David Woolley, Adam Woolley, Practical Toxicology, 2017
Phototoxicity is also a potential problem; for instance, the presence in celery of psoralens has been associated in celery pickers with extensive skin reactions brought about by sunlight-induced reaction of the psoralens with DNA, inhibiting DNA repair. Treatment of psoriasis with so-called psoralen and UVA (PUVA) therapy–8-methoxypsoralen and UV light–was associated with the induction of cancer. Certain cosmetic ingredients have also been associated with phototoxicity and with more mundane forms of dermatitis. It is worth pointing out that there is a distinction to be drawn between phototoxicity and photoallergy and vice versa. Phototoxicity is likely to occur on first exposure; it is dose related and may be seen after systemic or topical exposure. The mechanism is usually one of photoexcitation, leading to the generation of oxygen or other free radicals. Psoralens intercalate with DNA-producing adducts and inhibition of DNA synthesis. Photoallergy is a delayed type IV hypersensitivity reaction, which–as with other routes of sensitization–requires prior sensitization. Following induction, small amounts of exposure can lead to a reaction. Photoallergy induced by topical exposure is known as photocontact dermatitis and by systemic exposure as systemic photoallergy.
Safety considerations when using drugs to treat pruritus
Published in Expert Opinion on Drug Safety, 2020
Kayla Fourzali, Gil Yosipovitch
Phototherapy using various wavelengths, particularly narrow-band ultraviolet (UV)-B, has been shown to be effective in treatment of pruritus and can be useful alone or in combination with other therapies [61,62]. Phototherapy, in general, is considered a safe and well-tolerated treatment and is especially beneficial for those with generalized pruritus who are avoiding systemic medications due to intolerance of adverse effects or drug–drug interactions. Adverse effects common to all modalities of phototherapy include sunburn, photodamage, skin aging, xerosis, erythema, and tenderness. While exposure to all UV types is known to increase the risk of skin cancer, therapy using UV-B and narrow-band UV-B has not been shown to significantly increase the risk for non-melanoma or melanoma skin cancer [91,92]. In contrast, long-term use of oral psoralen and UV-A therapy (PUVA) has been associated with a dose-related elevated incidence of non-melanoma skin cancer, particularly squamous cell carcinoma, and a less well-defined increase in the risk of melanoma [93]. These risks are of particular importance in patients who may be concurrently using photosensitizing medications or in those with fair skin. Because of the increased risks associated with PUVA therapy, the majority of patients now receive UV-B-based therapy.
Classification and recommended treatment options for folliculotropic mycosis fungoides
Published in Expert Opinion on Orphan Drugs, 2018
Suzanne van Santen, Maarten H. Vermeer, Rein Willemze
PUVA monotherapy, is also frequently used in patients with FMF [20,22,32]. In a recent study, PUVA therapy in 40 patients with early-stage FMF, resulted in CR and OR rates of 30 and 88%, respectively [32]. Eighteen percent of these 40 patients remained in long lasting remission (median duration 116 months). However, in patients with advanced plaque-stage FMF PUVA was less effective [22,32]. Common short-term side effects of PUVA include nausea and abdominal pain from oral psoralen intake, erythema and pruritus, while long-term PUVA therapy is associated with an increased risk of non-melanoma skin cancer [39,40]. Bath PUVA is sometimes used to prevent oral PUVA-related side effects. Although one study reported high efficacy of bath PUVA in 14 patients with early-stage FMF presenting with superficial and keratosis pilaris-like skin lesions[41], bath PUVA is generally not useful in patients with FMF, since skin lesions are commonly localized in the head and neck area.
Biologic therapies for plaque type psoriasis in patients with previous malignant cancer: long-term safety in a single- center real-life population
Published in Journal of Dermatological Treatment, 2022
M. Valenti, G. Pavia, L. Gargiulo, P. Facheris, F. Sanna, R. G. Borroni, A. Costanzo, A. Narcisi
This association is partially related to common risk factors, as obesity, metabolic syndrome and smoking. Also, some approved psoriasis treatments have been linked to an increased risk of malignancies. In particular, is well demonstrated the relationship between psoralen UVA (PUVA) therapy, cyclosporine and MTX and the risk of developing non melanoma skin cancers (14). Cyclosporine has an established associated risk of causing lymphoproliferative disorders, Kaposi’s Sarcoma and NMSC in patients treated with a long-term regimen at high dosage after transplantation (15). For MTX, there is a confirmed role in increasing NMSCs incidence. A possible association with lymphoproliferative disorders in patients with long-term treatments is just anecdotal.