You can manage mild atopic dermatitis at home with over-the-counter (OTC) creams and lotions. People with severe atopic dermatitis, on the other hand, often need to look into additional treatment options.
For people with severe atopic dermatitis that isn’t helped by other treatments, one treatment option that may be a good fit is PUVA — the “P” stands for “psoralen” and the “UVA” stands for “ultraviolet.”
This treatment combines standard phototherapy with a prescription medication that makes your skin more sensitive to treatment. Read on for more information about how PUVA can help relieve your symptoms and calm your skin.
Psoralens make your skin more sensitive to the UVA light used in phototherapy. Exposing your skin to controlled UVA light can help calm an overactive immune system and reduce inflammation of atopic dermatitis and other skin conditions.
PUVA can be used for severe atopic dermatitis that hasn’t responded to other treatments.
Atopic dermatitis is a chronic skin condition that causes dry, red, itchy, and irritated skin.
It is the most common type of eczema. In fact, the terms “atopic dermatitis” and “eczema” are often used interchangeably.
There is no cure for atopic dermatitis. However, treatments focus on managing symptoms and preventing flare-ups, helping improve quality of life.
PUVA is more commonly used for treating skin conditions such as psoriasis than it is for treating atopic dermatitis.
However, PUVA is sometimes used for severe cases of atopic dermatitis. A healthcare professional might recommend PUVA if other atopic dermatitis treatments, including standard phototherapy, haven’t helped your condition.
With PUVA, the addition of psoralen medication makes your skin more sensitive to phototherapy. This, in turn, can make phototherapy more effective. That’s why it can help clear up cases of atopic dermatitis that need stronger treatment.
There are drawbacks to PUVA, though.
Increasing your skin’s sensitivity to UVA light also increases the risks that come with exposure to UVA light. This increased risk is why PUVA is generally used for atopic dermatitis only when other treatments haven’t been successful.
PUVA therapy is generally once a week when used to treat atopic dermatitis. You’ll be given a prescription for medication that you’ll take 1 to 2 hours before each session. Sometimes, topical gel psoralen is used instead of oral medication. The right option for you will depend on your atopic dermatitis and your overall health.
Your first treatments will be brief and include fewer than 5 minutes of UVA exposure. Your exposure will then increase with every session, depending on how your skin responds to treatment. Sessions will never include more than 30 minutes of exposure.
During each session, you’ll stand in a chamber that contains UVA light bulbs. Many chambers have fans to help keep you cool. You’ll be given goggles to help protect your eyes.
The amount of skin you’ll need to have uncovered will depend on which areas of your body atopic dermatitis affects. You might receive the treatment fully clothed or while wearing only underwear.
People with atopic dermatitis on only their hands or feet need PUVA on just those areas. In this case, treatment might involve soaking your hands or feet in a solution of psoralen medication rather than taking it orally. Your hands or feet will then be immediately exposed to UVA.
PUVA therapy can make your skin very sensitive to the sun. It’s important to take extra care of your skin after each session and over the course of your treatment. It’s recommended to always:
- Apply sunscreen to all areas of uncovered skin immediately after each treatment.
- Wear sunglasses both indoors and outdoors between the time you take your psoralen and when the sun sets on treatment days.
- Wear sunglasses under fluorescent lights on treatment days, even after dark.
- Avoid sun exposure on both treatment and non-treatment days.
- Wear long-sleeved shirts, pants, hats, and other protective clothing when outdoors or near windows on treatment and non-treatment days.
- Limit or avoid alcohol during the treatment course.
- See your dermatologist during the treatment course and again once treatment is over.
Though PUVA is more commonly used to treat psoriasis, it is considered to be a very effective treatment for severe atopic dermatitis as well. However, it isn’t a cure.
You’ll still have atopic dermatitis following successful treatment, but your symptoms will be much less severe. Your skin will be much calmer and might have fewer flare-ups.
Your doctor will monitor your progress with each treatment. They might adjust your schedule and number of treatments as your skin responds to UVA.
Generally, treatment courses are at least 24 sessions and typically, you’ll have one session each week. Once your initial treatment course is finished, follow-up PUVA might be recommended. You might still have PUVA treatments once a week, monthly, or if you have a flare-up.
There are some known risks of PUVA therapy for atopic dermatitis. While all phototherapy has risks, these risks may be greater than the risks of standard phototherapy for atopic dermatitis since the addition of the psoralen medication makes your skin very sensitive.
Risks of PUVA include:
- Burning. PUVA treatments can cause a burn called phototoxic erythema that is similar to sunburn, especially in people with pale skin who are prone to sunburns. This reaction often occurs 48 to 72 hours after a session, and you might need to pause treatments until it clears up. Be sure to inform your dermatologist about any medical conditions (such as autoimmune disorders) you have that may increase your sunburn risk. The dermatologist may also order an anti-nuclear antibody test to screen for lupus, an autoimmune disorder that will increase your risk of sunburn.
- Tanning. PUVA can lead to a tanned appearance that lasts for several months. You can still burn very easily with this tan.
- Itching. Your skin can be very dry and itchy following PUVA treatment.
- Skin aging. You might see premature aging to your skin such as wrinkling and discoloration with long-term PUVA therapy.
- Nausea. Psoralen medications can cause nausea for some people. Your doctor might be able to prescribe a different dose or an alternative if this happens.
- Eye damage. Your eyes will be more sensitive to light while you take psoralen medications. It’s important to wear protective sunglasses when you’re outside to avoid developing red and sore eyes.
- Skin cancer. PUVA can cause skin cancer, including squamous cell carcinoma, basal cell carcinoma, and melanoma. This risk is rare and not generally a concern for people who receive PUVA treatment for only a few months. However, this is one reason it’s so important to see a dermatologist during and after your PUVA treatment course.
Other treatment options for atopic dermatitis depend on the severity of your atopic dermatitis and how well it responds to treatment.
These options may include:
- OTC creams, lotions, and ointments that contain hydrocortisone
- keeping your skin clean and well moisturized
- prescription topical steroid creams
- calcineurin inhibitor topical creams
- oral prescriptions, such as antibiotics or oral steroids
- traditional phototherapy
- biologics (e.g., Dupixent)
PUVA is a treatment option for severe atopic dermatitis that hasn’t responded to other treatments.
PUVA combines phototherapy with a class of medications called psoralens. Psoralens make your skin more sensitive to UV light and can make phototherapy more effective.
There are more risks involved with PUVA than standard phototherapy, and it’s important to take care to protect your skin from the sun during your entire treatment course.
PUVA can’t cure atopic dermatitis but it can help relieve severe symptoms and reduce flare-ups.