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Effectiveness and Safety of Topical Phototherapy in the Treatment of Dermatological Diseases

G. Delrosso,P. Savoia

Published 2017 in Unknown venue

ABSTRACT

Phototherapy consists in the use of ultraviolet (UV) radiation from artificial sources for therapeutic purposes. Despite the introduction of new and powerful drugs (including biological and target therapies), phototherapy remains an established, lower cost, and effective option for the treatment of many common skin diseases. In systemic photochemotherapy or PUVA, photosensitizing agents of the family of Psoralens are used in combination with UVA, i.e. with long wave ultraviolet radiation . Psoralens strongly enhance the effect of UVA alone, as they interact with biological macromolecules, causing the production of oxygen free radicals within the photoacti‐ vated cells. However, systemic administration of psoralens can be problematic, causing possible negative interactions with other drugs and the onset of serious side effects. To counteract these limitations, it has been developed the bath‐PUVA therapy, which consists in the topical administration of psoralens by bathing the whole body surface in an alcoholic solution of 8‐methoxypsoralen (8‐MOP); immediately afterwards this pre‐ treatment, the patient is UVA‐irradiated. This technique has several advantages over conventional PUVA, including the use of a reduced UVA dosage, thus resulting in minimal skin damage with complete elimination of skin photosensitivity within three hours after the treatment; furthermore, it virtually eliminates systemic side effects and drug interference due to the very limited percutaneous absorption of psoralens. Bath‐ PUVA is indicated and effective in the treatment of many chronic inflammatory dermatoses (including psoriasis, atopic and allergic dermatitis, lichen ruber planus, chronic urticaria, and mastocitosis), autoimmune skin diseases (including vitiligo, and alopecia aerata), and premalignant/malignant systemic absorption of the psoralen. Ultraviolet A (UVA) irradiation is administered by cabins or partial devices according to the extension of the body areas to be treated. Gel‐ PUVA has produced its best responses in morfea, palmo‐plantar psoriasis, contact dermatitis and vitiligo. The purpose of this chapter is to provide a detailed description of the various phototherapy techniques and discuss their possible applications to the treatment of specific acute and chronic skin diseases.

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