PUVA

The letters PUVA stand for Psoralen and Ultra Violet light A.

Psoralens are chemicals which are found in more than 30 common plants.  They alter the skin’s sensitivity to light (either natural sunlight or UVA) and are often used to promote repigmentation of Vitiligo patches, the psoralens are taken orally and sensitise the skin to sunlight so patients have to stay out of the sun for 24 hours and protect the eyes with sunglasses..

Psoralens and sunlight have been used for hundreds of years in the Middle East and the Far East as a treatment for vitiligo.  There are some disadvantages to this method of using psoralens as the amount of sunlight received cannot be controlled.  In the UK where there is not enough regular sunlight for this method to be an option, the treatment is given at the outpatients department of a hospital.  We believe that psoralens should only be used when prescribed as a treatment by a qualified medical practitioner.
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Narrowband UVB treatment

This uses a different spectrum of ultra violet light.  This treatment is replacing PUVA in many centres in the UK.  It is in many ways similar to PUVA treatment but is better:

• Psoralens are not involved so there is no need to take special precautions before and after treatment.
• The normal skin does not develop the deep tan usual with PUVA treatment and the contrast between the treated vitiligo skin and the untreated ‘normal’ skin is less obvious.  Also the vitiligo skin almost always goes back to its normal colour with treatment instead of a darker colour as was common with PUVA.
• It is safer than PUVA for the treatment of children. 
• Treatment time with UVB is generally for a shorter period than with PUVA.
• UVB treatment does not tend to damage the skin nearly as much as PUVA sometimes can.
• Further studies now definitely suggest narrowband UVB is more effective at improving vitiligo.  In recently published research comparing the “Efficacy of Psoralen UVA Therapy vs Narrowband UVB Therapy” the conclusion reached was that “in the treatment of nonsegmental vitiligo, Narrowband UVB therapy is superior to oral PUVA therapy”1.

Narrowband UVB - A Patients Voice

I am a 37 year old who has lived with vitiligo for a quarter of a century.  In my early teens I started to develop patches on my elbows, knees and hands.  This constantly spread until about age 30, by which stage I was about 80% white. 

Through my work as trustee and volunteer with the Vitiligo Society (the Society) I became aware of a new treatment for vitiligo called Narrowband UVB (UVB).  It appeared that certain patients had achieved significant re-pigmentation through the treatment and that was enough for me to investigate further.

The Society had information on UVB and through their information leaflets and speaking to helpline staff I was able to get the background information I needed before visiting my GP to move things forward.

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Narrowband UVB - A Dermatologist Perspective

It is very encouraging to read about Paul’s experiences in having treatment for his vitiligo on a number of levels.  Having armed himself with information from the Vitiligo Society, he was in an excellent position to request referral from his GP to a Consultant Dermatologist, which was appropriately and duly done.  His initial hospital appointment included a thorough evaluation of his vitiligo and enabled all his questions to be answered, before then embarking on a course of narrowband UVB.  His response to this treatment has been truly excellent, especially given the extent of his vitiligo, and the 25 years during which he has had it.
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