Oral PUVA Versus Bath PUVA in Chronic Plaque Psoriasis: A Comparative Study of Efficacy
Introduction: Phototherapy has long been recognized as beneficial for psoriasis treatment, with a favorable risk- -benefit relation. Photochemotherapy comprises the use of psoralen, either orally (oral PUVA) or topically (bath PUVA), prior to UVA irradiation. Oral administration of psoralen may lead to short or long-term side effects. Bath PUVA is particularly useful to minimize systemic toxicity and psoralen side effects. The aim of this study was to compare the effectiveness of these two PUVA modalities.
Material and Methods: A retrospective review of patients with chronic plaque psoriasis treated with PUVA therapy (oral and bath) in our dermatology department, between January 2001 and December 2016.
Results: We performed 81 treatments with oral PUVA and 38 treatments with bath PUVA, in 68 and 26 patients, respectively. The mean age of the patients was 50,6 years. Oral PUVA group achieved PASI 75 in 68 cases (89.5%), and bath PUVA group in 26 (74.3%), with p-value=0 .05. The mean total dose needed to achieve PASI 75 in the oral PUVA group was 113.1 J/cm2 and in the bath PUVA group was 69.8 J/cm2. The mean number of sessions performed to achieve remission in the oral PUVA group was 23.31, and in the bath PUVA group was 17.58.
Conclusion: Despite requiring specialized equipment and being more time consuming, bath PUVA represents one of the most effective therapies available for psoriasis and it should be considered as a treatment option for patients who are not candidates for systemic treatment.
Wong B, Hsu B, Liao M. Phototherapy in psoriasis: a review of mechanisms of action. J Cutan Med Surg. 2012; 17: 6–12.
Almutawa F, Alnomair N, Wang Y, Hamzavi I, Lim HW. Systematic review of UV-based therapy for psoriasis. Am J Clin Dermatol. 2013 ;14:87-109.
Rodríguez-Granados MT, Carrascosa JM, Gárate T, Gómez-Díez S, Guimaraens-Juantorena D. Consensus document on therapy with Bath Psoralen UVA. Actas Dermosifiliogr. 2007;98:164-70.
Hannuksela-Svahn A, Sigurgeirsson B, Pukkala E, Lindelöf B, Berne B, Hannuksela M, et al. Trioxsalen bath PUVA did not increase the risk of squamous cell skin carcinoma and cutaneous malignant melanoma in a joint analysis of 944 Swedish and Finnish patients with psoriasis. Br J
Hannuksela A, Pukkala E, Hannuksela M, Karvonen J. Cancer incidence among Finnish patients with psoriasis treated with trioxsalen bath PUVA. J Am Acad Dermatol. 1996;35: 685-9.
Berneburg M, Herzinger T, Rampf, J, Hoetzenecker W, Guenova E, Meisner C, et al. Efficacy of bath psoralen plus ultraviolet A (PUVA) vs. system PUVA in psoriasis: a prospective, open, randomized, multicentre study. Br J Dermatol. 2013;169:704–8.
Cooper EJ, Herd RM, Priestley GC, Hunter JA. A comparison of bathwater and oral delivery of 8-methoxypsoralen in PUVA therapy for plaque psoriasis. Clin Exp Dermatol. 2000;25:111–114.
Collins P, Rogers S. Bath water compared with oral delivery of 8-methoxypsoralen PUVA therapy for chronic plaque psoriasis. Br J Dermatol. 1992;127:392-5.
Lowe NJ, Weingarten D, Bourget T, Moy LS. PUVA therapy for psoriasis: Comparison of oral and bath-water delivery of 8-methoxypsoralen. J Am Acad Dermatol. 1986;14:754-60
Collins P, Rogers S. 8-Methoxypsoralen bath PUVA clears psoriasis after failure of oral PUVA. Clin Exp Dermatol. 1990;15:320.
Alshiyab D, Chin MF, Edwards C, Anstey AV. An evaluation of the preferences of patients with psoriasis between systemic psoralen plus ultraviolet A and bath psoralen plus ultraviolet A. Br J Dermatol. 2015;172: 1457–8.
Halpern SM, Anstey AV, Dawe RS, Diffey BL, Farr PM, Ferguson J, et al. Guidelines for topical PUVA: a report of a workshop of the British photodermatology group. Br
J Dermatol. 2000;142:22–31.
Copyright (c) 2018 Journal of the Portuguese Society of Dermatology and Venereology
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles in this journal are Open Access and meet the requirements of funding bodies or academic institutions. Each article published in the Journal is published under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0). Articles can be read, downloaded, printed, and shared.
Submission of an article for publication implies the authors’ consent to publication under the applicable Creative Commons license and the terms and conditions of the Publisher’s Licensing Agreement.
It is the author's responsibility to obtain permission to reproduce illustrations, tables, etc. from other publications.
Upon acceptance of an article, authors will be asked to complete a 'Journal Publishing Agreement'. An e-mail will be sent to the corresponding author confirming receipt of the manuscript together with a 'Journal Publishing Agreement' form or a link to the online version of this agreement.
Author rights: As an author you (or your employer or institution) have certain rights to reuse your work.
The Journal reserves the right to use plagiarism detection software on any submitted material.