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Topical and Oral Psoralen Photochemotherapy for Vitiligo

Topical Psoralen Photochemotherapy
Topical psoralen photochemotherapy is often used for people with a small number of depigmented patches (affecting less than 20 percent of the body). This vitiligo treatment is also used for children 2 years old and older who have localized patches of vitiligo. Treatments are done in a doctor's office under artificial UVA light once or twice a week. The doctor or nurse applies a thin coat of psoralen to the patient's depigmented patches about 30 minutes before UVA light exposure. The patient is then exposed to an amount of UVA light that turns the affected area pink. The doctor usually increases the dose of UVA light slowly over many weeks. Eventually, the pink areas fade and a more normal skin color appears. After each treatment, the patient washes the skin with soap and water and applies a sunscreen before leaving the doctor's office.
 
There are two major potential side effects of topical PUVA therapy:
 
  • Severe sunburn and blistering

 

  • Too much repigmentation or darkening of the treated patches or the normal skin surrounding the vitiligo (hyperpigmentation).
 
Patients can minimize their chances of sunburn if they avoid exposure to direct sunlight after each treatment. Hyperpigmentation is usually a temporary problem and eventually disappears when treatment is stopped.
 
Oral Psoralen Photochemotherapy
Oral PUVA therapy is used for people with more extensive vitiligo (affecting more than 20 percent of the body) or for people who do not respond to topical PUVA therapy. This vitiligo treatment is not recommended for children under 10 years of age because of an increased risk of damage to the eyes, such as cataracts. For oral PUVA therapy, the patient takes a prescribed dose of psoralen by mouth about two hours before exposure to artificial UVA light or sunlight. The doctor adjusts the dose of light until the skin areas being treated become pink. Treatment is usually given two or three times a week, but never two days in a row.
 
For people who cannot go to a PUVA facility, the doctor may prescribe psoralen to be used with natural sunlight exposure. The doctor will give careful instructions on carrying out treatment at home and monitor the patient during scheduled checkups.
 
Known side effects of oral psoralen include:
 
  • Sunburn
  • Nausea and vomiting
  • Itching
  • Abnormal hair growth
  • Hyperpigmentation.
 
Oral psoralen photochemotherapy may increase the risk of skin cancer. To avoid sunburn and reduce the risk of skin cancer, patients undergoing oral PUVA therapy should apply sunscreen and avoid direct sunlight for 24 to 48 hours after each treatment.
 
Patients should also wear protective UVA sunglasses for 18 to 24 hours after each treatment to avoid eye damage, particularly cataracts.

Vitiligo Skin Disorder

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