|Year : 1992 | Volume
| Issue : 4 | Page : 252-254
Puva therapy for psoriasis comparison of oral and bath water delivery of 8-MOP
K Sridhar, CR Srinivas, SD Shenoi
Source of Support: None, Conflict of Interest: None
Exposure to UVA following oral psoralens for the treatment of psoriasis is associated with systemic side effects which are absent if bath water delivery of psoralens is practiced. We have compared the relative therapeutic effectiveness of these 2 modes of drug delivery in skin types IV and V. To date all such studies have been done only in skin types I, II and III. Bath PUVA although relatively expensive is an effective and acceptable mode of drug delivery.
Keywords: Psoriasis, Bath PUVA, Oral PUVA
|How to cite this article:|
Sridhar K, Srinivas C R, Shenoi S D. Puva therapy for psoriasis comparison of oral and bath water delivery of 8-MOP. Indian J Dermatol Venereol Leprol 1992;58:252-4
|How to cite this URL:|
Sridhar K, Srinivas C R, Shenoi S D. Puva therapy for psoriasis comparison of oral and bath water delivery of 8-MOP. Indian J Dermatol Venereol Leprol [serial online] 1992 [cited 2020 Feb 22];58:252-4. Available from: http://www.ijdvl.com/text.asp?1992/58/4/252/3809
| Introduction|| |
Systemic side effects associated with oral psoralens followed by UVA (O-PUVA) do not occur if the drug is delivered by bath (B-PUVA).  Peak level of serum psoralens following oral administration may occur at different times in different individuals,  however it is maximum in the skin immediately after the bath, not so long lasting and the systemic absorption is minimal.  In India the sunlight is the most commonly used source of UVA (PUVASOL). The availability of sunlight after 2 hours of oral drug administration is difficult to predict especially during monsoon whereas bath PUVA can be administered whenever sunlight is present as the treatment can be completed within half an hour. To date no study has been undertaken in skin types IV and V to assess the effectiveness of BPUVA.
| Materials and Methods|| |
Twenty two patients with stable psoriasis involving more than 20% body surface and not on any active treatment for 6 weeks were included in the study. Percentage of body surface involvement and erythema, scaling, and thickness (EST) score in a 3 point scale were recorded over the front and back of truck, right lower and upper extremities, before treatment and after every 5 exposures by a blinded investigator.
Eleven patients selected by using a random table were included in Group A and remaining 11 in group B. Patients in group A received 8 MOP tablets which was followed one and a half hours later by a placebo bath for 15 minutes. The patients were then wiped dry and exposed to UVA. Group B patients were similarly treated but 8-MOP was substituted with colour and size matched placebo tablets and to the bath containing 100 litres of tap water was added 50 ml of 0.75% 8-MOP solution to attain a bath water concentration of 3.75mg/It.
UVA was administered in a total body phototherapy unit obtained from NBC, Ohio. All the patients received an initial dose of 6J/cm 2 followed by alternate day increment of 1J/cm 2. Assessment was discontinued after 15 exposures as many patients were unable to continue due to economic and other practical considerations.
| Results|| |
Twenty patients completed the treatment. One person from each group dropped out. The patient on oral 8-MOP developed icterus whilst the patient on bath PUVA developed tiny haemorrhagic blisters over extremities which subsided after the treatment was withdrawn. The mean UVA doses for 0-PUVA and B-PUVA were 133.25 \ 3.6 J/cm 2 and 131.6 \ 2.8 J/cm 2 respectively. The mean EST score after 5, 10, and 15 exposures is shown in [Table - 1]. The side effects encountered in both groups are shown in [Table - 2].
We found that B-PUVA resulted in earlier clearance of psoriasis than 0-PUVA. Bath water delivery gives uniform distribution of the drug over the entire immersed skin.  Equal effectiveness of both the treatment modalities but lower dose requirement of UVA for bath PUVA has been reported.  Our study found BPUVA to be more effective but the amount Of UVA required for both the groups were nearly same, possibly because we started with high initial dose. We also did not attempt at finding the MPD as we have consistently failed to demonstrate it even with UVA doses as high as 17J/cm 2 following oral psoralens. An additional advantage of B-PUVA is its use even during monsoon, when PUVASOL is attempted. While it is possible to initiate this treatment when adequate sunlight is available and complete the exposure in half an hours time, it is difficult to predict the availability of sunlight for O-PUVA, especially during monsoon. B-PUVA, although practical, is nearly 40 times as expensive as O-PUVA as 2 tablets of 8-MOP cost the patient 1 rupee and 16 Paise while 8-MOP solution costs him 41 rupees.
| References|| |
|1.||Fisher T, Alsins J. Treatment of psoriasis with trioxsalen baths and dysprosium lamps. Acta Derm-Veneriol (Stockh) 1979; 59 : 467-70. |
|2.||Thune P. Plasma levels of 8-methoxypsoralen and phototoxicity studies during PUVA treatment of psoriasis with meladinin tablets. Acta Germ-Veneriol (Stockh) 1978; 58 : 149-51. [PUBMED] |
|3.||Lowe N J, Weingaeten D, Bourget T, Moy L S. PUVA therapy for psoriasis : comparison of oral and bath-water delivery of 8methoxypsoralen. J Am Acad Dermatol 1986 : 754-60. |
|4.||Turjanmaa K, Salo H, Reunala T. Comparison of trioxsalen bath and oral methoxsalen PUVA in psoriasis. Acta Derm-Venereol (Stockh) 1985; 65 : 86-8. [PUBMED] |
[Table - 1], [Table - 2]
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