Response of PUVA Therapy in Vitiligo Patients

Kim, Youn Soo; Suhr, Ki Beom; Lee, Jeung Hoon; Park, Jang Kyu

Abstract

BACKGROUND: Psoralen and UVA(PUVA) are the most common and effective treatments for vitiligo. UVA treatment requires measurement of the minimal phototoxic dose (MPD) in order to determine adequate UVA irradiation for safe and effective photochemotherapy. There have been only a few reports about the efficacy of PUVA therapy in which the exposure dose was determined by the MPD.
OBJECTIVE
The purpose of this study was to measure the MPD on vitiliginous lesions and to evaluate the response of vitiligo patients to photochemotherapy.
METHODS
The minimal phototoxic dose of UVA was measured in 82 vitiligo patients. Thirty two of the 82 patients were treated by PUVA therapy for at least three months. The initial exposure dose was two thirds of the MPD. Subsequently we evaluated the initial exposure dose, the total exposure dose, and the total number of exposures until initial repigmentation appeared. Adverse effects of PUVA therapy were also evaluated.
RESULTS
1. The initial repigmentation rate for systemic PUVA therapy was highest for the trunk (68.4%), followed by the face and neck (33.3%), and the extremities(6.3%). 2. For topical PUVA treatment the mean total exposure dose was 2.3J/cm2, the number of treatments was 5.3, and the duration until initial repigmentaion appeared was 16.5 days. In the case of systemic PUVA treatment the same parameters were 12.0J/cm2, 7.1, 27.3 days, respectively. 3. In the systemic PUVA therapy group the total exposure dose was 21.4+/-15.0J/cm2 for patients with lesions of less than one year duration and 8.7+/-5.1J/cm2 for patients with lesions of longer than one year duration. 4. The adverse effects of topical PUVA therapy were erythema (7 of 11 cases), prickling (3 of 11 cases), pruritus (2 of 11 cases), and desquamation (1 of 11 cases). 5. Side effects in 23 patients with systemic PUVA therapy were erythema (78.3%), pruritus (47.8%), gastrointestinal symptoms (21%), burn (8.7%), and headache (1.9%). There were no side effects in topical and systemic PUVA therapy as much as PUVA therapy discontinued.
Conclusion
: These results indicate that PUVA therapy in cases where the initial exposure dose is determined by MPD, subsequently the exposure dose is determined by visual inspection of vitiliginous lesions and history taking of subjective symptoms on each treatment is safe and effective.