A clinical study of PUVA-induced complications in vitiligo patients

Background: Oral of topical psoralen photochemotherapy is the most popular and efficacious treatment available for repigmentation of vitiliginous patches. However this therapy is often used for prolonged periods and various types of pigmentary changes can be observed and sometimes, may be carcinogenic. The safety of PUVA therapy has been an issue of debate. Objective: The purpose of the study was to describe in more detail the complications of PUVA treatment and to investigate a possible relation with multiple factors. Patients and Methods: We studied 137 vitiligo patients who received PUVA therapy (using oral 8-MOP) for more than six months in our department between March 1990 and June 1996. Resulte: The results are summarized as follows 1. Among 137 cases of vitiligo, the numbers of male and female patients were 40(29.2%) and 97(70.8%) respectively. The mean age at the start of PUVA was 39 years and the mean duration of treatment was 31 months. There were no patients with skin type I and II. Forty cases had skin type III, 68 skin type IV, 29 skin type V. 2. Acute side effects were nausea(35.8%), pruritus(32:8%), erythema(30.7%), headache(21.2%), dizziness(18.8%), burning sensation(16.8%), fatigue(8.8%) and the Koebner phenomenon(1.5%). These are all reversible and disappear on discontinuation of treatment. 3. PUVA-induced pigmentary changes were PUVA lentigines(39 cases;26.3%), hypopigmented confetti macules(36 cased;26.3%), mottling(31 cases;22.6%), nail pigmentation(8 cases;5.8%) and PUVA keratosis(7 cases;5.1%). 4. The mean cumulative UVA dose was 1833J/cm2 and the mean number of treatments was 171. In the high-dose group and the patients who had the most number of treatments, we observed an increased number of patients with PUVA lentigiens and mottling. However, no relationship was observed between the development of PUVA-induced pigmentary changes and sex or age at the start of PUVA or in relation to skin type. 5. We did not see any patients with melanoma, nonmelanoma skin cancer or systemic cancer. Conclusion: Long term exposure to PUVA significantly increases chronic clinical side effects of PUVA. Therefore careful clinical follow-up of patients who receive long term PUVA therapy in necessary. This risk should be considered in selection of treatment