Is PUVA Light Therapy Effective for Vitiligo?
Vitiligo is a condition of the skin that causes patches of the skin to have all pigmentation removed. Vitiligo is an autoimmune condition commonly treated with two different forms of light therapy. Learn about one form of therapy, PUVA, and its effectiveness for vitiligo below.
If you suffer from vitiligo, you know how scary it can be for entire patches of skin to lose all pigmentation. Medical experts are not sure what causes vitiligo or precisely what makes pigmentation return. However, targeted UV exposure (sometimes combined with medication or supplements) has been found to improve symptoms of vitiligo.
Currently, both PUVA and NB-UVB treatments are used to repigment the skin in vitiligo patients. Although UVB narrowband light treatment is the current preferred method for treating vitiligo, there are some patients who still undergo PUVA treatment because they are unable to go through UVB treatment or have not responded to other treatment types.
Find out more about the effects of UVA light therapy on vitiligo below and whether it could be a viable treatment option for your skin condition:
PUVA is an acronym for the term Psoralen UltraViolet A radiation, which is the solar spectrum between 320 and 400 wavelengths in nanometers. A psoralen is a plant chemical that boosts the absorption of UV light, boosting how much UV light is absorbed by the skin. The chemicals mix with your DNA and inhibit the multiplication of the cells that contribute to skin pigment loss. PUVA is a combination therapy that is used to treat vitiligo that is not responsive to other treatment types.
Currently, UVB treatment is preferred in patients with vitiligo because it has a similar effectiveness rating with fewer side effects, but some patients may still respond better to PUVA therapy.
The standard form of the therapy has patients take an oral supplement of the psoralen (usually 8-methoxypsoralen) and then exposes them to UVA light for several minutes about an hour after the patient takes the supplement. In some cases, a psoralen cream is applied to areas of the skin that lack pigmentation. Patients may also soak in a tub of medicated liquid before undergoing PUVA treatment.
The biggest advantage to PUVA treatment is that the medication used does not affect anything other than the skin. It also can be used to treat large areas of the skin, which is beneficial in patients who have lost a lot of pigment to vitiligo. The drug is only activated when the skin is exposed to UVA light, further minimizing the risk of drug therapy.
Patients cannot administer PUVA therapy on their own. They must visit a medical professional for treatment. In some cases, when PUVA therapy is stopped, vitiligo returns. In these cases, treatment would have to continue indefinitely to maintain proper skin pigmentation. The risks of side effects are high when compared with UVB therapy for vitiligo.
In a 2012 study published in the International Journal of Dermatology, patients who had UVB therapy had side effects in about 7 percent of cases, but patients who had PUVA therapy had side effects in 57 percent of cases. Two of these cases were so severe that the patients discontinued treatment.
According to several studies, PUVA has several side effects, the biggest of which is an increased risk for skin cancer. The more UVA treatments are administered, the higher the risk for skin cancer. Skin aging (sometimes known as leathery skin) is also increased with PUVA therapy. In some cases, the treatment can cause skin burns, nausea, and dizziness.
According to numerous studies, repigmentation occurs in about 70 to 80 percent of all patients who try PUVA therapy. Complete repigmentation is seen in about 20 percent of cases. After two years, about 75 percent of patients relapse either a small amount or completely. It takes between six and 24 months for full results to be seen with PUVA therapy.
According to studies, darker skin responds best to PUVA treatments. When applied topically, PUVA therapy is even more effective and requires less exposure to UVA light. However, topical PUVA therapy is more likely to result in advanced skin aging, blisters, burns, and hyperpigmentation.
In most cases, the patient with vitiligo takes an oral supplement of psoralen about one hour before light therapy. If a topical cream is used, it is applied 30 minutes before sun exposure. The patient is then exposed to UVA lights for a specified length of time depending on severity of vitiligo. In most cases, a patient is placed inside a box that looks similar to a tanning bed and precise amounts of UVA radiation are targeted onto the areas of the body with pigmentation loss. It takes about 15 treatment sessions before significant pigmentation is seen.
Treatments are usually spread at least 48 hours apart to prevent sunburns. Energy levels are adjusted based on the patient’s acceptance to the UVA radiation. It can take up to two years for full effects of the treatment to take place. Usually, patients decide whether to continue treatment after about 30 sessions. If improvements are not seen within 30 sessions, PUVA therapy is not effective for that patient.
In most cases, medical professionals prefer UVB treatment to PUVA as side effects are generally more mild with UVB treatments. Although the 2012 study comparing the two types of UV therapy for vitiligo showed similar effectiveness in skin pigmentation, recovery time, and relapse rate; patients who completed UVB therapy showed better tolerance for the treatment. Additionally, the patients in the UVB group had a better response group overall, had fewer side effects, and had better color matching than the UVA group.
For this reason, if UVB treatment is available, patients should start with that treatment method first before moving on to PUVA therapy.
Some research suggests that the effectiveness of PUVA therapy (and UVB therapy) can be boosted with a variety of lifestyle and diet changes. If you are considering a light therapy for vitiligo, also consider making these lifestyle changes at the same time to boost the effectiveness of your treatment. According to some clinical trials, certain vitamins and nutrient levels are low in patients with vitiligo.
Often, vitiligo patients are low in vitamin B6, B12, and B9, which are used to support the pigmentation of the skin as well as regulate energy and the function of the nervous system. Research suggests that a few other supplements can also boost the effectiveness of light therapy for vitiligo patients.
Picrorhiza is an immune-system booster that can help prevent autoimmune conditions like vitiligo. Some researchers believe that vitiligo is caused by the skin mistakenly attacking skin pigment in an overactive autoimmune response.
Khellin is another common supplement to take in combination with light therapy. According to some studies, when patients take khellin the effectiveness of their treatment increases. Khellin works similarly to psoralen by making the skin more receptive to UV light. For this reason, it is important to make sure you don’t get too much sun exposure outside of targeted light therapy if you are taking khellin or psoralen medication.
Another supplement that has been shown to boost the effectiveness of light therapy in vitiligo patients is L-phenylalanine. L-phenylalanine is an amino acid that helps repigment skin. In one study, a combination of L-phenylalanine, UVA light and 0.025% clobetasol proprionate was able to treat vitiligo on the face without side effects. When combined with khellin, 63 percent of patients had 75-100 repigmentation on the face within 12 months.
If you suffer from vitiligo, there is still hope. According to numerous studies, both UVB and PUVA treatments are effective in treating vitiligo symptoms and restoring pigmentation to the skin. When possible, and when the patient responds to UVB treatment, it is the preferred method as it has fewer side effects and generally better effectiveness overall.
However, in some cases, patients may not respond well to UVB treatment or require additional light therapy. In this case, PUVA treatment can be a viable option for restoring pigmentation to the skin. All light therapy benefits from additional boosting with supplements and vitamin intake. Make sure your vitamin intake is high when completing any light therapy treatment with vitiligo to increase your effectiveness results.
Camacho F, Mazuecos J. Oral and topical L-phenylalanine, clobetasol propionate, and UVA/sunlight--a new study for the treatment of vitiligo. J Drugs Dermatol 2002 Sep;1(2):127-31.
De Leeuw J et al. A case study to evaluate the treatment of vitiligo with khellin encapsulated in L-phenylalanin stabilized phosphatidylcholine liposomes in combination with ultraviolet light therapy. Eur J Dermatol 2003 Sep-Oct;13(5):474-7.
Montes LF et al. Folic acid and vitamin B12 in vitiligo: a nutritional approach. Cutis 1992 Jul;50(1):39-42.
Don P et al. Treatment of vitiligo with broadband ultraviolet B and vitamins. Int J Dermatol 2006 Jan;45(1):63-5. Picrorhiza kurroa. Alt Med Rev 2001 6(3):319-321.
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*Callumae is a Vitiligo Remedy designed to help get rid of white spots on your skin. Use in conjunction with light therapy (or natural sun light) to help get the most repigmentation to your skin.