Topical PUVA Therapy Guidelines

Introduction to Topical PUVA

The American Academy of Dermatology recommends using 0.1% 8-methoxypsoralen (Oxsoralen Ultra brand) in an emollient base for topical PUVA therapy, applied 30 minutes before UVA exposure, starting at 0.25-0.5 J/cm² and treating 2-3 times per week for localized psoriasis of palms and soles in adults 1, 2

The American Academy of Dermatology advises that PUVA therapy should be undertaken with great caution in children due to photocarcinogenicity, and bath PUVA is strongly preferred over topical or oral PUVA in pediatric patients because of lowered systemic absorption 3, 4
The British Journal of Dermatology recommends topical calcineurin inhibitors (tacrolimus 0.1% or pimecrolimus 1%) as first-line therapy instead of PUVA for children with severe psoriasis or vitiligo, with narrowband UVB phototherapy as the preferred phototherapy option when topical treatments fail 5

The American Academy of Dermatology indicates that the primary indication for topical PUVA is psoriasis of palms and soles in adults 1, 2
The American Academy of Dermatology suggests that bath PUVA is an alternative for generalized psoriasis in adults and children (preferred over topical in children) 1, 2

The American Academy of Dermatology recommends using the brand name Oxsoralen Ultra (8-methoxypsoralen) for topical PUVA therapy 1, 2
The American Academy of Dermatology advises using a topical concentration of 0.1% 8-methoxypsoralen in emollient base 1, 2, 6

The American Academy of Dermatology recommends applying 0.1% 8-methoxypsoralen in emollient 30 minutes before UVA exposure 1, 2, 6
The American Academy of Dermatology suggests treating 2-3 times per week 1, 2, 6
The American Academy of Dermatology advises starting with a dose of 0.25-0.5 J/cm² UVA 1, 2, 6
The American Academy of Dermatology recommends increasing the dose by 0.25-0.5 J/cm² at each treatment 1, 2

The American Academy of Dermatology indicates that initial response may take 30 treatments to see noticeable improvement 1, 2, 6
The American Academy of Dermatology suggests that a single course usually consists of 30-40 treatments 1, 2, 6
The American Academy of Dermatology advises that remission duration is 3-12 months after clearance 1, 2, 6

The American Academy of Dermatology states that topical PUVA should never be used in patients with lupus erythematosus, porphyria, or xeroderma pigmentosum 1, 2, 6, 7

The American Academy of Dermatology recommends using topical PUVA with extreme caution in skin types I and II (burn easily) 1, 2, 6, 7
The American Academy of Dermatology advises using topical PUVA with caution in patients with a history of arsenic intake or previous ionizing radiation therapy 1, 2, 6, 7
The American Academy of Dermatology suggests using topical PUVA with caution in patients with a history of melanoma or multiple nonmelanoma skin cancers 1, 2, 6, 7
The American Academy of Dermatology recommends using topical PUVA with caution in pregnancy or nursing (Category C) 1, 2, 6, 7

The American Academy of Dermatology indicates that topical PUVA has a superior safety profile compared to oral PUVA, with no increased risk of skin cancer demonstrated 1, 2, 6
The American Academy of Dermatology advises that psoralen is not detectable in blood when washed off after use in palmoplantar psoriasis 3, 4

The American Academy of Dermatology recommends monitoring for efficacy and burning during topical PUVA therapy 1, 2, 6
The American Academy of Dermatology advises that no routine skin cancer screening is required (unlike oral PUVA which requires annual screening after 150-200 treatments) 1, 2, 6

The American Academy of Dermatology indicates that common acute side effects of topical PUVA include erythema, blistering, and hyperpigmentation 1, 2, 6

The American Academy of Dermatology states that there are no significant drug interactions with topical PUVA 1, 2, 6

The American Academy of Dermatology recommends using topical PUVA with caution in pregnancy (Category C) 1, 2, 6
The American Academy of Dermatology advises that no epidemiologic studies have evaluated congenital anomalies with topical PUVA during pregnancy 3, 4
The American Academy of Dermatology suggests that topical PUVA may be detectable in blood when applied over large surface areas 3, 4

The British Journal of Dermatology recommends never using topical PUVA as first-line therapy in children—use topical calcineurin inhibitors or narrowband UVB instead 5
The American Academy of Dermatology advises never applying topical PUVA over large body surface areas without considering systemic absorption risk 3, 4
The British Journal of Dermatology recommends never combining topical PUVA with cyclosporine due to accelerated skin cancer risk 9, 8
The American Academy of Dermatology states that topical PUVA should never be used in patients with photosensitivity disorders (lupus, porphyria, xeroderma pigmentosum) 1, 2, 6, 7