Leaflet Details
| Title | Hand and Foot PUVA Treatment |
| Department | Dermatology |
| Author(s) | Dr Samina Imran |
| Review Date | November 2022 |
| Next Review | November 2024 |
| Download | A5 Booklet PDF |
| Accessibility Options | Click on the Recite Me button to show our accessibility resources |
Patient Information
What is hand and foot PUVA treatment?
Ultraviolet radiation from artificial light sources has been used by dermatologists for almost 100 years and is a widely used and effective treatment in a number of skin disorders. PUVA therapy is a combination of UVA light and a medicament (8-Methoxy-Psoralen = 8-MOP) which sensitises your skin to UVA light with the aim to make the treatment more effective.
PUVA = Psoralen + UVA
The choice of PUVA over other forms of treatment depends on a wide range of factors including type of skin disease, age, skin type, previous therapy, current medication, and many others. In hand and foot bath PUVA treatment Psoralen is administered topically to the skin of your hands and/or feet as a diluted bath solution. The medicament penetrates your skin while you immerse your hands and / or feet in water.
Procedure
All treatments are nurse supervised. Following assessment in the General Dermatology Clinic by a doctor, and after gaining your consent (patient’s consent), a nurse will book 15-35 phototherapy appointments for you (the exact number of treatments depends on various factors). The appointment time allocated to you will usually be the same at each visit. Hand and foot PUVA treatment is usually given 2 times per week, with 2 days intervals. This might be reduced to once a week or even once a fortnight when your skin condition improves.
The Phototherapy unit is open 08.00 - 17.00 Monday, Wednesday, Thursday, and Friday. The unit is closed on all Bank Holidays. The staff will inform you of any changes.
At each visit you will soak your hands and / or feet in a warm, diluted Psoralen solution for 15 minutes. Then followed by UVA irradiation given though means of special UV lamps, while you sit. Initially the UV irradiation will take only a few seconds, gradually increasing to a maximum of approximately 30 minutes.
About the Hand and Foot PUVA
A concentrated Psoralen solution is dispensed by the hospital pharmacy and delivered directly to our department. The 8-MOP concentrate has to be diluted with water before skin contact. One of our phototherapy nurses will do this for you. You will then sit for 15 min. with your hands and/or feet immersed in the medicament water. You should keep moving your hands and / or feet slowly to prevent settling of the solution and allow even skin sensitisation. After soaking for 15 minutes, pat dry your hands and/or feet with a towel (provided by the hospital), please do not rub.
About the Light Treatment
After the hand and/or feet have been soaked and dried, UVA irradiation is given through means of a special hand and foot light device. Goggles or a visor will be provided to shield your eyes/face. After the light treatment, it is advisable to wash your hands and/or feet in order to remove any remaining Psoralen solution from the skin. Dry with a second towel (provided by the hospital). You should then apply an emollient cream to your hands and feet, as PUVA treatment can dry your skin.
Adverse Effects
Mild side effects are common, but usually only short lasting. Most of them can be treated by creams or will spontaneously disappear a few days after stopping treatment. Possible side effects include:
- Erythema: You will get a tan in treated areas. Sometimes some redness and discomfort of the treated skin might occur (similar to sunburn). If you start to go red on the day of treatment, apply a steroid cream or lotion, e.g., Dermovate, Betnovate, Elocon and get in touch with the phototherapy nurse as soon as possible (Tel. 01932 723322). We may suspend treatment until symptoms have settled. Very occasionally severe redness or blisters may develop. You must inform the nurse if you develop any skin redness, so that we can adjust the UV dose and treat the problem, if necessary.
Sometimes thickened skin and scaling on palms and soles might come off quite suddenly during your course of treatment. If this has happened, inform your phototherapy nurse before the light is administered, as the dose might have to be reduced slightly in order to avoid unnecessary redness.
- Skin Dryness: There will be an increased tendency for dryness of treated skin areas during therapy and for about 4 weeks after treatment. As part of your treatment, you must apply emollients twice daily.
- Photosensitivity: In those who have a concomitant photodermatosis (i.e., a skin condition caused or aggravated by light), a flare up may occur.
- ‘PUVA itch’: Sometimes the skin can become itchy after light treatment. This may last for some days. Anti-itch emollients such as Balneum PLUS cream or Dermol cream can be helpful (store in the fridge for added relieve). Please let us know if you suffer with this problem.
- Long Term Side Effects:
Premature ageing and risk of skin cancer development.
Do’s and Don’ts
- In the five hours following the hand and foot PUVA, you have to protect all soaked skin areas from sunlight (even through window glass) by wearing socks, shoes and gloves. Alternatively, you can apply a sun protection cream (broad-spectrum filter, SPF 50+). This should be applied liberally and re-applied every 2 hours and after washing your hands. Please ask the phototherapy nurse for recommendations and / or samples.
- Dry flaky skin will deflect the light, rendering UV therapy less effective. It is therefore especially important to keep your skin well moisturised by applying an emollient liberally twice a day. However, as some creams are not ideal to be used prior to UV treatment, we recommend to apply only Diprobase cream, Cetraben cream, Oilatum cream or Doublebase before treatment on phototherapy days. Avoid tar containing creams, steroids, protopics, oils and vitamin D and A preparations directly prior to your UV treatment.
- If you have thickened skin on your palms and / or soles, you should have been prescribed a 10% Salicylic Acid containing emollient. This softens thickened skin and removes scales, so that the UV light can penetrate your skin adequately. Please apply the Salicylic Acid cream twice per day to allow the treatment to be effective.
If you don’t have a Salicylic Acid cream or have run out, ask your doctor or one of our phototherapy nurses for a prescription.
- Never use a sun bed or indulge in sunbathing during the entire course of your light treatment. This would increase the risk of burning and makes it impossible to determine the cause and / or dose of burning.
- Always remember to inform the doctor or nurse if you are taking, or about to start any new medication or cream while having UV treatment. This includes over-the-counter products such as St. John’s Wort.
- Plants and weeds may have photosensitisers in them, so avoid handling them for at least two hours before treatment (e.g., cooking with celery, parsnips or figs).
- In order to maximise the benefits of your phototherapy regular and punctual attendance is mandatory. Treatment will otherwise have to be withdrawn if you have missed 2 appointments without informing the Phototherapy Unit.
- Jewellery should be removed for treatment. Rings, if worn at the start of treatment, have then to be worn at every treatment thereafter, as areas covered at the start will burn if subsequently exposed.
- If you need to bring children with you it is advisable to bring another adult to supervise them.
Additional Information
In case of emergencies or if you need to cancel your appointment, please telephone 01932 723322. An answer phone is in use when the unit is not open.
