On the issue of tolerability and safety of phototherapy in patients with psoriasis

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Abstract

BACKGROUND: Phototherapy using different wavelengths of the ultraviolet (UV) spectrum has been successfully used to treat a variety of dermatoses. Along with the positive effects of this intervention, there are both acute and long-term side effects that should be taken into account by the clinicians.

AIM: to study the tolerability and safety of phototherapy (PUVA and UVB-311 nm) in patients with moderate to severe psoriasis.

MATERIALS AND METHODS: There were 920 patients with psoriasis under our supervision from 2005 to 2021, of which 756 (82%) patients suffered from psoriasis vulgaris, 36 (4%) ― guttate psoriasis, 73 (8%) ― exudative psoriasis, 55 (6%) ― inverse psoriasis. 249/920 (27%) were diagnosed with psoriatic arthritis. Patients with moderate psoriasis received 311 nm UVB therapy (n=473), with severe psoriasis ― PUVA therapy (n=447).

RESULTS: Out of 920 patients with psoriasis during the entire follow-up period, 385 (41.8%) noted one or more early side effects, which were short-lived and disappeared after the end of the PUVA course if the recommendations were followed. Among the early side effects that occurred during the procedures from taking a photosensitizer, the most common were transient nausea, vomiting, dizziness, headache, transient increase in hepatic transaminases. Side effects from the action of ultraviolet rays were reduced to the manifestation of itching, photodermatitis in the form of erythema, photodermatitis in the form of blisters, photoallergic reaction in the form of papular rash, dry skin, photoconjunctivitis, herpes simplex and even photoonycholysis. Patients treated with UVB-311 nm phototherapy complained on xerosis of the skin, itching, photodermatitis in the form of erythema, burning of the skin as early side effects. Long-term side effects in patients treated with PUVA therapy included lentigo (persistent mottled pigmentation), growth of melanocytic neoplasms, PUVA keratosis. In 11 (2.3%) patients with psoriasis who received UVB-311 nm therapy, new nevi appeared. In 42 (9.6%) patients treated with PUVA therapy and in 17 (3.8%) patients treated with UVB-311 nm, signs of photoaging were detected as well. In our study, only 1 (0.2%) patient was diagnosed with facial skin basal cell carcinoma, who received 5 courses of PUVA (119 procedures).

CONCLUSION: Our study showed that side effects, especially long-term ones, were fewer and significantly less pronounced in patients treated with UVB-311 nm therapy. Comparing the benefits and risks of phototherapy sessions, we can conclude in favor of the effectiveness, good tolerability and safety of PUVA and UVB-311 nm therapy for the treatment of patients with moderate to severe psoriasis. A dose-dependent effect of photoaging was established: the more phototherapy courses were received, the more pronounced the signs of photoaging were, especially after PUVA therapy.

About the authors

Olga Yu. Olisova

I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)

Email: olisovaolga@mail.ru
ORCID iD: 0000-0003-2482-1754
SPIN-code: 2500-7989

MD, Dr. Sci. (Med.), Professor, Corresponding member of the Russian Academy of Sciences

Russian Federation, Moscow

Ekaterina V. Grekova

I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)

Author for correspondence.
Email: grekova_kate@mail.ru
ORCID iD: 0000-0002-7968-9829
SPIN-code: 8028-5545
https://journals.eco-vector.com/1560-9588/user/registerUser#formErrors

MD, Cand. Sci. (Med.), Assistant Lecturer

Russian Federation, Moscow

Konstantin V. Smirnov

I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)

Email: puva3@mail.ru
ORCID iD: 0000-0001-7660-7958
SPIN-code: 2054-1086

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Olga S. Yazkova

Central Polyclinic

Email: olesha230808@mail.ru
ORCID iD: 0000-0002-9644-4778

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Danila A. Koriakin

I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)

Email: danila110920021@gmail.com
ORCID iD: 0000-0003-3619-206X

Student

Russian Federation, Moscow

Nigina I. Melikova

I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)

Email: niginamelikova29@gmail.com
ORCID iD: 0000-0003-0404-779X

Graduate Student

Russian Federation, Moscow

References

  1. Olisova OY, Smirnov KV. PUVA-therapy in dermatology. Russ J Skin Venereal Diseases. 2001;(6):71. (In Russ).
  2. Torres AE, Lyons AB, Hamzavi IH, et al. Role of phototherapy in the era of biologics. J Am Acad Dermatol. 2021;84(2):479–485. doi: 10.1016/j.jaad.2020.04.095
  3. Barros NM, Sbroglio LL, Buffara MO, et al. Phototherapy. An Bras Dermatol. 2021;96(4):397–407. doi: 10.1016/j.abd.2021.03.001
  4. Banerjee S, Das S, Roy AK, et al. Comparative effectiveness and safety of methotrexate versus PUVA in severe chronic stable plaque psoriasis. Indian J Dermatol. 2021;66(4):371–377. doi: 10.4103/ijd.IJD_492_20
  5. Ahmed S. The efficacy and safety of systemic PUVA and UVB phototherapy in the management of chronic plaque psoriasis. IAHS Med J. 2021;4(1):47–50. doi: 10.3329/iahsmj.v4i1.59133
  6. Ceryn J, Skibińska M, Barasiñska P, et al. UVB-induced bullous pemphigoid in a patient with psoriasis. Postepy Dermatol Alergol. 2022;39(1):228–230. doi: 10.5114/ada.2020.97725
  7. Wang E, Sasaki J, Nakamura M, et al. Cutaneous carcinogenic risk of phototherapy: An updated comprehensive review. J Psoriasis Psoriatic Arthritis. 2015;1(1):44–51. doi: 10.1177/247553031500100107
  8. Wu YH, Chou CL, Chang HC. Risk of skin cancer after ultraviolet phototherapy in patients with vitiligo: A systematic review and meta-analysis. Clin Exp Dermatol. 2022;47(4):692–699. doi: 10.1111/ced.15010
  9. Cupertino F, Niemeyer-Corbellini JP, Cuzzi T, et al. Persistent keratoses in vitiligo. Skinmed. 2019;17(6):380–385.
  10. Van Praag MC, Bavinck JN, Bergman W, et al. PUVA keratosis. A clinical and histopathologic entity associated with an increased risk of nonmelanoma skin cancer. J Am Acad Dermatol. 1993;28(3):412–417.
  11. Laube S, George SA. Adverse effects with PUVA and UVB phototherapy. J Dermatolog Treat. 2001;12(2):101–105. doi: 10.1080/095466301317085390
  12. Almutawa F, Alnomair N, Wang Y, et al. Systematic review of UV-based therapy for psoriasis. Am J Clin Dermatol. 2013;14(2):87–109. doi: 10.1007/s40257-013-0015-y
  13. Dogra S, De D. Narrowband ultraviolet B in the treatment of psoriasis: The journey so far! Indian J Dermatol Venereol Leprol. 2010;76(6):652–661. doi: 10.4103/0378-6323.72461
  14. Legat FJ. Importance of phototherapy in the treatment of chronic pruritus. Hautarzt. 2018;69(8):631–640. doi: 10.1007/s00105-018-4229-z
  15. Krönauer C, Eberlein-König B, Ring J, et al. Influence of UVB, UVA and UVA1 irradiation on histamine release from human basophils and mast cells in vitro in the presence and absence of antioxidants. Photochem Photobiol. 2003;77(5):531–534. doi: 10.1562/0031-8655(2003)077<0531:iouuau>2.0.co;2
  16. Herzinger T, Berneburg M, Ghoreschi K, et al. S1-Guidelines on UV phototherapy and photochemotherapy. J Dtsch Dermatol Ges. 2016;14(8):853–876. doi: 10.1111/ddg.12912
  17. Schweintzger NA, Bambach I, Reginato E, et al. Mast cells are required for phototolerance induction and scratching abatement. Exp Dermatol. 2015;24(7):491–496. doi: 10.1111/exd.12687
  18. Guan LL, Lim HW, Mohammad TF. Recognizing photoallergy, phototoxicity, and immune-mediated photodermatoses. J Allergy Clin Immunol. 2022;149(4):1206–1209. doi: 10.1016/j.jaci.2022.02.013
  19. Parrish JA, Jaenicke KF, Morison WL, et al. Solar urticaria: treatment with PUVA and mediator inhibitors. Br J Dermatol. 1982;106(5):575–580. doi: 10.1111/j.1365-2133.1982.tb04561.x
  20. Elmets CA, Lim HW, Stoff B, et al. Joint American academy of dermatology-national psoriasis foundation guidelines of care for the management and treatment of psoriasis with phototherapy. J Am Acad Dermatol. 2019;81(3):775–804. doi: 10.1016/j.jaad.2019.04.042
  21. Calzavara-Pinton PG, Carlino A, Manfredi E, et al. Ocular side effects of PUVA-treated patients refusing eye sun protection. Acta Derm Venereol Suppl (Stockh). 1994;186:164–165.
  22. Malanos D, Stern RS. Psoralen plus ultraviolet A does not increase the risk of cataracts: A 25-year prospective study. J Am Acad Dermatol. 2007;57(2):231–237. doi: 10.1016/j.jaad.2007.04.027
  23. Archier E, Devaux S, Castela E, et al. Ocular damage in patients with psoriasis treated by psoralen UV-A therapy or narrow band UVB therapy: A systematic literature review. J Eur Acad Dermatol Venereol. 2012;26(3):32–35. doi: 10.1111/j.1468-3083.2012.04521.x
  24. Yu Y, Wang P, Yu R, et al. Long-Term exposure of psoralen and isopsoralen induced hepatotoxicity and serum metabolites profiles changes in female rats. Metabolites. 2019;9(11):263. doi: 10.3390/metabo9110263
  25. Zhou W, Chen X, Zhao G, et al. Psoralen induced liver injury by attenuating liver regenerative capability. Front Pharmacol. 2018;(9):1179. doi: 10.3389/fphar.2018.01179
  26. Tegner E. Severe skin pain after PUVA treatment. Acta Derm Venereol. 1979;59(5):467–470.
  27. Wyckmans M, Bervoets A. A review on PUVA pricks-A debilitating adverse event. Photodermatol Photoimmunol Photomed. 2022. doi: 10.1111/phpp.12824
  28. Wilder-Smith AJ. Hell’s itch due to sunburn. J Travel Med. 2019;26(1). doi: 10.1093/jtm/tay124
  29. Toljan K. Another report of Hell’s itch due to sunburn. J Travel Med. 2020;27(7):taaa182. doi: 10.1093/jtm/taaa182
  30. Weatherhead S, Robson SC, Reynolds NJ. Management of psoriasis in pregnancy. BMJ. 2007;334(7605):1218–1220. doi: 10.1136/bmj.39202.518484.80
  31. Ibbotson SH, Bilsland D, Cox NH, et al.; British Association of Dermatologists. An update and guidance on narrowband ultraviolet B phototherapy: A british photodermatology group workshop report. Br J Dermatol. 2004;151(2):283–297. doi: 10.1111/j.1365-2133.2004.06128.x
  32. Shirzadian Kebria A, Hosseini M, Khafri S. The effect of narrowband ultraviolet B phototherapy on serum folate level. Caspian J Intern Med. 2021;12(2):180–183. doi: 10.22088/cjim.12.2.180
  33. Salminen A, Kaarniranta K, Kauppinen A. Photoaging: UV radiation-induced inflammation and immunosuppression accelerate the aging process in the skin. Inflamm Res. 2022;71(7-8):817–831. doi: 10.1007/s00011-022-01598-8
  34. Stern RS. Actinic degeneration and pigmentary change in association with psoralen and UVA treatment: A 20-year prospective study. J Am Acad Dermatol. 2003;48(1):61–67. doi: 10.1067/mjd.2003.15
  35. Rhodes AR, Stern RS, Melski JW. The PUVA lentigo: An analysis of predisposing factors. J Invest Dermatol. 1983;81(5):459–463. doi: 10.1111/1523-1747.ep12522663
  36. Wang E, Sasaki J, Nakamura M, et al. Cutaneous carcinogenic risk of phototherapy: An updated comprehensive review. J Psoriasis Psoriatic Arthritis. 2015;1(1):44–51. doi: 10.1177/247553031500100107
  37. Thatiparthi A, Martin A, Liu J, et al. Risk of Skin cancer with phototherapy in moderate-to-severe psoriasis: An updated systematic review. J Clin Aesthet Dermatol. 2022;15(6):68–75.
  38. Stern RS, Nichols KT, Väkevä LH. Malignant melanoma in patients treated for psoriasis with methoxsalen (psoralen) and ultraviolet A radiation (PUVA). The PUVA Follow-Up Study. N Engl J Med. 1997;336(15):1041–1045. doi: 10.1056/NEJM199704103361501
  39. Stern RS; PUVA Follow-Up Study. The risk of squamous cell and basal cell cancer associated with psoralen and ultraviolet A therapy: A 30-year prospective study. J Am Acad Dermatol. 2012;66(4):553–562. doi: 10.1016/j.jaad.2011.04.004
  40. Hong JY, Ahn J, Won S, et al. Risk of malignancy in patients with psoriasis according to treatment modalities in Korea: A nationwide cohort study. Sci Rep. 2022;12(1):20690. doi: 10.1038/s41598-022-23518-w
  41. Lee E, Koo J, Berger T. UVB phototherapy and skin cancer risk: A review of the literature. Int J Dermatol. 2005;44(5):355–360. doi: 10.1111/j.1365-4632.2004.02186.x
  42. Rooney JF, Straus SE, Mannix ML, et al. UV light-induced reactivation of herpes simplex virus type 2 and prevention by acyclovir. J Infect Dis. 1992;166(3):500–506. doi: 10.1093/infdis/166.3.500
  43. Vladimirov VV. Classification of skin phototypes for administration of an efficient phototherapy. Vestn Dermatol Venerol. 2009;(4):65–67. (In Russ).
  44. Smirnov KV. Long-term results of PUVA-therapy in psoriasis [dissertation abstract]. Moscow; 2008. 36 р. (In Russ).

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Copyright (c) 2023 Olisova O.Y., Grekova E.V., Smirnov K.V., Yazkova O.S., Koriakin D.A., Melikova N.I.

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