• Reference Number: HEY1343-2024
• Departments: Dermatology
• Last Updated: 1 January 2024

Introduction

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is PUVA Therapy?

PUVA Therapy is an ultraviolet treatment for skin disease.  The P stands for Psoralen which sensitizes the skin to Ultra Violet A (PUVA) radiation.  UVA exposure for hands and feet, uses a small portable unit. (You will be shown this during your assessment).  This treatment has been found to be successful for skin conditions including psoriasis and eczema.

It will be necessary for you to attend the department twice weekly during your course of treatment. The length of course will vary from one patient to another.  An average treatment would be over 10 to 15 weeks.

You will be under the supervision of Senior Phototherapy Nurse or medical staff.

How is the Treatment Administered?

Gel Soak

You will need to attend the Dermatology Department twice weekly. You will submerge your hands/feet in a Psoralen Solution, clear liquid, for 15 minutes prior to exposure to UVA.

The areas are then dried and exposed to UVA within 15 minutes.  After treatment areas are washed and you are then advised to apply your emollient/moisturiser to the affected areas. Please bring along your emollient/moisturiser.

On the days you are attending for UVA treatment only apply recommended emollients prior to UVA exposure.  Use of medicated topical treatments after PUVA will be discussed at your assessment.

Can there be any complications or risks?

Psoralen makes the skin and possibly the eyes sensitive to light for 24 hours after your PUVA treatment. There is a theoretical possibility of Psoralen causing problems (cataracts) if they are unprotected. Due to the size and areas of treatment on hands and feet, there is little likelihood of complications, so you are NOT required to wear protective glasses after attending for PUVA treatment.  The nurse will discuss this with you during your assessment.

Although Psoralen activated PUVA is not definitely associated with damage to unborn babies it is advisable for both females and males to maintain good contraceptive practice whilst receiving PUVA. However, IF PREGNANCY OCCURS PLEASE TELL YOUR PUVA NURSE.

The following information mostly applies to those patients having PUVA treatment to their body, limbs and scalp:

Up to 30% of patients may develop mild to moderate sunburn at some point after treatment.  A few people may have more severe sunburn although this is very uncommon and we try to minimize the risk.

Many patients experience dryness and itching of the skin. This is treated with a simple emollient/moisturising cream, and in some cases, if severe, your treatment will be omitted for several sessions.  Some patients may occasionally experience ‘prickly heat’, bad enough to stop treatment, mostly for a short period of time.

Do report any burning or excessive discomfort as soon as possible.

You may telephone the Phototherapy room on tel: 01482 624192 or reception on tel: 01482 623006.  The PUVA nurse will give guidance on use of creams.

It is common in some patients who have had PUVA therapy for many years to show premature ageing of the skin, eg dryness, freckling and wrinkling.  There is also a small risk, with prolonged exposure to PUVA, that skin cancers may develop.  The people most at risk are those receiving prolonged continuous PUVA.  It is therefore, important that you have the shortest effective course of treatment as you require.

It is advisable to share the information contained in this leaflet with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are helping or taking care of you following this treatment.

Assessment

During your assessment a medical history will be taken so PLEASE BRING DETAILS OF ANY TABLETS AND CREAMS YOU ARE PRESENTLY USING.  The do’s and don’t’s, along with risks and benefits will be discussed at the time of your assessment. Please ask any questions that you need answering during this time. If any further questions occur during the course of your treatment, please ask the nurse delivering your treatment.

What will happen?

Treatment

You will need to attend twice weekly on a Monday and Thursday or Tuesday and Friday. This ensures the required minimum 72 hour between each treatment. The length of course will vary from one patient to another.  On average this would be 10 to 15 weeks. Your agreed allocated time slot will be the same on both days of attendance throughout the course.  The effect of treatment will be monitored carefully by the nurse at each attendance and any problems referred to the Phototherapy Nurse Specialist or medical staff.

You will also be reviewed by the Clinical Nurse Specialist or your Dermatologist after 20 treatments in the Dermatology Outpatient Clinic.

If you fail to attend for more than two treatments without informing us, you will be discharged back to the care of your GP and your appointment slot will be given to another patient.

During your Treatment

Each time you attend for treatment, you will be asked your name and date of birth to confirm your identity even when the nurses know you. You will also need to tell us of any problems with your skin since previous treatment e.g. has your skin been hot or sore, pink or red in areas.

During your course of treatment the dose of UVA and time required to deliver this will gradually increase, depending on the reaction of your skin.

Your eyes will be protected with goggles and your face will be protected by a mask/visor during treatment.

Do avoid alcohol of any kind before your PUVA treatment.

Do not miss treatments unless absolutely unavoidable because your regime depends on regular controlled PUVA exposure.

If you are unable to attend for treatment please telephone the Phototherapy room on tel: 01482 624192 or reception on tel: 01482 623006 and discuss this with the nursing staff.

Do not apply any new creams which are not prescribed by the dermatology department.  Please inform the PUVA nurse about any medications you are taking for other reasons, including ones you buy yourself from the chemist, this includes supplements and herbal remedies.   If your own GP introduces a new drug, including an antibiotic or any other form of treatment, please tell the nurse prior to your treatment.

Do not sunbathe or use a sun bed at any time during your course of treatment.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.