What is the difference between bath PUVA and cream PUVA?

In bath PUVA the skin takes up the photosensitising agent through a 20-minute bath, as a full bath or a partial-body bath; the irradiation follows as directly as possible, at the latest within 20 minutes. In cream PUVA only the affected areas are creamed, for example the palms and soles, and irradiated 60 minutes later. Which form is suitable for you is determined after the examination.

How long does my skin stay sensitive to light after the treatment?

At least 4 hours. During this time avoid being outdoors and do not sunbathe or use tanning beds. What applies if a trip outdoors is unavoidable is described under “Rules for the treatment day”.

How often and for how long do I have to come for PUVA?

In the initial phase usually four times per week, later less often where appropriate. The total duration depends on the condition, for psoriasis for example 6 to 8 weeks, and varies from person to person.

PUVA therapy (bath PUVA and cream PUVA)

PUVA combines pretreating the skin with a photosensitising agent and subsequent UVA irradiation. We carry it out mainly as bath PUVA and as cream PUVA. Here you find the procedure and the rules that apply on every treatment day.

Overview

The abbreviation PUVA stands for treatment with a photosensitising agent (8-methoxypsoralen, a psoralen) followed by irradiation with long-wave ultraviolet light (UVA). The agent makes the skin receptive to the UVA light; the reactions this triggers inhibit, among other things, the division of skin cells and stimulate pigment formation.

In our practice we carry out PUVA mainly as bath PUVA and as cream PUVA. In bath PUVA you first take a 20-minute bath in freshly prepared bath water at 37 °C containing the agent, as a full bath or a partial-body bath. In cream PUVA only the affected skin areas are rubbed with a cream containing the same agent, for example the palms and soles. The UVA irradiation then follows in the whole-body cabin or with a device for the hand and foot region.

Because the pretreated skin remains sensitive to light for hours and the UVA dose is increased over the course of the treatment, PUVA comes with fixed rules for the treatment day. We go through them with you before the start; on this page you can read them again.

Areas of application

Psoriasis
Chronic hand and foot eczema
Further skin conditions for which light therapy is an option, after medical assessment

Procedure

Medical indication assessment and dose setting
First we assess whether and in which form PUVA is suitable for your condition, and we ask about your medication and a possible pregnancy. We set the irradiation dose for you personally and increase it at regular intervals.
Preparation on the treatment day
Before the treatment, do not apply any sun-protection products or perfumed cosmetics (perfume, soaps, aftershave) to the skin. In cream PUVA you usually cream the affected areas at home; from that moment on you protect the creamed parts from UV radiation with gloves or socks and do not touch any other areas of skin with them.
Bath PUVA: the bath
The bath lasts 20 minutes and is prepared freshly for each treatment, at 37 °C and with the agent added, as a full bath or a partial-body bath. The head, face, eyes and neck are not bathed in a full bath. Afterwards you dab the bathed areas with a towel without rubbing. On all treatment days the same areas are pretreated in the same way.
UVA irradiation
In bath PUVA the irradiation takes place as directly after the bath as possible, at the latest within 20 minutes. In cream PUVA it takes place 60 minutes after creaming. During the irradiation you wear UV-protective goggles; in the whole-body cabin men cover their genitals with aluminium foil, because the skin there is very sensitive to light and carries an increased risk of skin tumours.
Rhythm and duration
In the initial phase we usually treat four times per week; later the frequency can be reduced where appropriate. The total duration of the treatment depends on the condition, for example 6 to 8 weeks for psoriasis, and varies from person to person.
After the irradiation and after the course
The bathed or creamed areas remain sensitive to light for at least 4 hours and are consistently protected from UV radiation during this time; you find the rules further down. After a course of light treatment we recommend staying in regular dermatological check-ups in the long term.

What to expect

A bath PUVA session consists of the 20-minute bath and the irradiation that directly follows it.
In cream PUVA you usually cream at home; the irradiation in the practice takes place 60 minutes later.
In the initial phase usually four treatments per week, later fewer where appropriate.
The total duration depends on the condition (e.g. 6 to 8 weeks for psoriasis) and varies from person to person.
The UVA dose is set for you and increased at regular intervals.
Plan the treatment day so that you do not have to be outdoors in the first 4 hours after the irradiation.
After the course we recommend regular long-term dermatological check-ups.

Risks & notes

The most common acute side effect is a sunburn-like reddening; if the dose is too high, stronger reactions up to blistering are possible.
After the treatment the bathed or creamed skin areas remain more sensitive to light for at least 4 hours. How to protect them during this time is described under “Rules for the treatment day”.
Eye protection: you wear UV-protective goggles during every irradiation. If psoralen is exceptionally taken as a tablet (systemic PUVA), the goggles must be worn all day on the treatment day; we mainly use bath and cream PUVA, where this effect is smaller.
UV therapies can increase the risk of skin cancer in the long term and make the skin age prematurely. The dose is therefore controlled and limited by the doctor, in the whole-body cabin the genitals are covered in men, and after the course we recommend long-term dermatological check-ups.
Certain medicines increase sensitivity to light, for example antibiotics such as tetracyclines, blood pressure medication, sedatives and natural products such as St John's wort. Therefore always inform us when you are to take new medication.
You must not be pregnant during the treatment. Please also let us know if you are breastfeeding.
Not suitable for everyone: with certain light-sensitive conditions (e.g. lupus erythematosus, porphyria), an increased risk of skin cancer or a very fair, UV-sensitive skin type, we assess suitability before the treatment begins.

Rules for the treatment day

These instructions are part of the treatment. Please follow them on every treatment day.

Bath PUVA: the UVA irradiation takes place as directly after the bath as possible, at the latest within 20 minutes.
Cream PUVA: the UVA irradiation takes place 60 minutes after creaming. Creaming is usually done at home; time your arrival at the practice accordingly.
The bath is prepared freshly for each treatment, at 37 °C, for 20 minutes, as a full bath or a partial-body bath.
The head, face, eyes and neck are not bathed in a full bath.
After the bath, dab the bathed areas with the towel; do not rub.
Pretreat the same skin areas in the same way on all treatment days. Bathe or cream new areas only after consulting us: the UVA dose, which is increased over the course of the treatment, would be too high for skin that is not accustomed to it.
Do not touch any other areas of skin with wet or creamed hands, for example the face.
In cream PUVA, protect the creamed parts from UV radiation with gloves, socks or the like from the moment of creaming.
Avoid being outdoors for at least 4 hours after the irradiation.
If you nevertheless have to go outdoors, wear gloves (e.g. cotton gloves from the pharmacy) and long-sleeved, light-impermeable clothing (shirt, trousers, socks), depending on the treated areas. This also applies under a cloudy sky and behind window glass.
Sunbathing and tanning beds are strictly to be avoided on treatment days.
Before the treatment, do not apply any sun-protection products or perfumed cosmetics.

Please get in touch with us

Please let us know in these situations:

Bath water has reached the head, face, eyes or neck: rinse the skin or eyes immediately with plenty of clear water and inform us straight away.
You had to interrupt the therapy for a longer time: notify us and come in to see us in person before the first treatment afterwards. The UVA dose, which is increased over the course of the treatment, can be too high after a break and is then reduced if necessary.
You are to take a new medicine, including a natural product: check with us beforehand.
You have become pregnant: tell us immediately.

Frequently asked questions

What is the difference between bath PUVA and cream PUVA?: In bath PUVA the skin takes up the photosensitising agent through a 20-minute bath, as a full bath or a partial-body bath; the irradiation follows as directly as possible, at the latest within 20 minutes. In cream PUVA only the affected areas are creamed, for example the palms and soles, and irradiated 60 minutes later. Which form is suitable for you is determined after the examination.
How long does my skin stay sensitive to light after the treatment?: At least 4 hours. During this time avoid being outdoors and do not sunbathe or use tanning beds. What applies if a trip outdoors is unavoidable is described under “Rules for the treatment day”.
How often and for how long do I have to come for PUVA?: In the initial phase usually four times per week, later less often where appropriate. The total duration depends on the condition, for psoriasis for example 6 to 8 weeks, and varies from person to person.