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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/05/22 00:52:21」(JST)

PUVA is a psoralen + UVA treatment for eczema, psoriasis, graft-versus-host disease, vitiligo, mycosis fungoides, large-plaque parapsoriasis and cutaneous T-cell lymphoma.^[1]^:686^[2]^[3] The psoralen is applied or taken orally to sensitize the skin, then the skin is exposed to UVA.

Photodynamic therapy is the general use of nontoxic light-sensitive compounds that are exposed selectively to light, whereupon they become toxic to targeted malignant and other diseased cells. Still, PUVA therapy is often classified as a separate technique from photodynamic therapy.^[4]^[5]

Procedure

Psoralens are photosensitizing agents found in plants. Psoralens are taken systemically or can be applied directly to the skin. The psoralens allow a relatively lower dose of UVA to be used. When they are combined with exposure to UVA in PUVA, they are highly effective at clearing psoriasis and vitiligo. Like UVB light treatments, the reason remains unclear, though investigators speculate there may be similar effects on cell turnover and the skin's immune response.

Choosing the proper dose for PUVA is similar to the procedure followed with UVB. The physician can choose a dose based on the patient's skin type. The dose will increase in every treatment until the skin starts to respond.

Some clinics test the skin before the treatments, by exposing a small area of the patient's skin to UVA, after ingestion of psoralen. The dose of UVA that produces uniform redness 72 hours later, called the minimum phototoxic dose (MPD), becomes the starting dose for treatment.

At the very least for vitiligo, narrowband ultraviolet B (UVB) phototherapy is now used more commonly than PUVA since it does not require the use of the Psoralen. As with PUVA, treatment is carried out twice weekly in a clinic or every day at home, and there is no need to use psoralen.^[6]

Narrowband UVB does not cure the legs and hands, compared to the face and neck. To the hands and legs PUVA may be more effective. The reason can be because UVA penetrates deeper in the skin, and the melanocytes in the skin of the hands and legs is deeper in the skin. The Narrowband UVB does not reach the melanocytes.

Side effects and complications

Some patients experience nausea and itching after ingesting the psoralen compound. For these patients PUVA bath therapy may be a good option.

Long term use of PUVA therapy has been associated with higher rates of skin cancer.^[7]

The most significant complication of PUVA therapy for psoriasis is squamous cell skin cancer. Two carcinogenic components of the therapy include the nonionizing radiation of UVA light as well as the psoralen intercalation with DNA. Both processes negatively impact overall genome_instability.

History

Psoralens have been known since ancient Egypt but have only been available in a chemically synthesized form since the 1970s.

References

^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
^ Domínguez MA, Membrillo VG, Ramos GA (2004). "Large plaque parapsoriasis and PUVA-therapy. A case report".
^ MacMillan Cancer Support Group. "Cutaneous T-cell lymphoma (CTCL)".
^ Finlan, L. E.; Kernohan, N. M.; Thomson, G.; Beattie, P. E.; Hupp, T. R.; Ibbotson, S. H. (2005). "Differential effects of 5-aminolaevulinic acid photodynamic therapy and psoralen + ultraviolet a therapy on p53 phosphorylation in normal human skin in vivo". British Journal of Dermatology 153 (5): 1001–1010. doi:10.1111/j.1365-2133.2005.06922.x. PMID 16225614. edit
^ Champva Policy Manual, Chapter: 2, Section: 30.11, Title: PDT (Photodynamic Therapy) and PUVA (Photochemotherapy) at U.S. Department of Veterans Affairs. Date: 12/23/2011
^ What are the treatment options for vitiligo?
^ Melissa Conrad Stöppler, MD. "Psoriasis PUVA Treatment Can Increase Melanoma Risk".

External links

Phototherapy Course, New Zealand Dermatological Society
PUVA Therapy Description at Oxsoralen-Ultra Indications

PUVA Therapy Guideline at Blue Cross and Blue Shield Association of North Carolina

UpToDate Contents

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1. ソラレン・紫外線A（PUVA）光化学療法 psoralen plus ultraviolet a puva photochemotherapy
2. セザリー症候群の治療 treatment of sezary syndrome
3. 進行期（ステージIIB～IV）の菌状息肉症の治療 treatment of advanced stage iib to iv mycosis fungoides
4. 急性心臓同種移植拒絶反応：治療 acute cardiac allograft rejection treatment
5. 重症難治性アトピー性皮膚炎（湿疹）のマネージメント management of severe refractory atopic dermatitis eczema

English Journal

Assessment of DNA interstrand crosslinks using the modified alkaline comet assay.

Wu JH, Jones NJ.SourceDepartment of Biochemistry and Cell Biology, Institute of Integrative Biology, University of Liverpool, Liverpool, UK.
Methods in molecular biology (Clifton, N.J.).Methods Mol Biol.2012;817:165-81.
The single cell gel electrophoresis (SCGE) assay, more commonly known as the comet assay, due to the "comet-like" appearance of the cells, was originally developed as a technique to measure the presence of DNA single-strand breaks. The assay is performed on single cells embedded in agar and placed i
PMID 22147573

[Information letter on PUVA phototherapy].

Groupe de recherche sur le psoriasis de la Société française de dermatologie, mai 2011.
Annales de dermatologie et de vénéréologie.Ann Dermatol Venereol.2011 Dec;138(12):859-60. Epub 2011 Nov 8.
PMID 22137630

Japanese Journal

PUVAバス療法にて奏効した膿疱性乾癬の3例 (特集乾癬)

青山正子,森田明理
皮膚科の臨床 54(10), 1331-1335, 2012-10-00
NAID 40019458349

ジアフェニルスルホンとBath PUVA療法が奏効した急性痘瘡状苔癬状粃糠疹の1例 (特集角化症・炎症性角化症)

角田真弘,西島千博,竹内明子 [他]
皮膚科の臨床 54(6), 825-828, 2012-06-00
NAID 40019345975

PUVAバス療法が奏効した毛孔性紅色粃糠疹の1例 (特集角化症・炎症性角化症)

青山正子,山本あい,森田明理
皮膚科の臨床 54(6), 813-816, 2012-06-00
NAID 40019345954

Related Pictures

★リンクテーブル★

リンク元	「乾癬」「ソラレン」「UVA」
拡張検索	「PUVA療法」「PUVA therapy」

「乾癬」

PUVA therapy
	Intervention
MeSH	D011701

　　[★]

英: psoriasis
関: 角化症

概念

慢性再発性難治性の炎症性角化症
代表的炎症性疾患のひとつで原因は不明：遺伝因子＋環境因子(生活習慣、気候、薬物)　→　HLA-B27と関連していることからautoimmune diseaseとも考えられている。
青年から中年に好発。厚い銀白色の麟屑を伴った紅斑・丘疹が出没、表皮の炎症と表皮細胞のターンオーバーの亢進を認める。