What are the other Names for this Condition? (Also known as/Synonyms)

• Keratosis due to PUVA Therapy
• Psoralen and Ultraviolet A Keratosis
• PUVA Therapy causing Keratosis

What is PUVA Keratosis? (Definition/Background Information)

• PUVA Keratosis is a skin condition that occurs only in patients who are being treated with PUVA therapy. PUVA (psoralen and ultraviolet A) therapy is a form of photochemotherapy usually used in the treatment of psoriasis, vitiligo, eczema, and other conditions
• In this therapy, the individual is administered an oral  medication and then treated with light therapy; the ultraviolet A component in the light reacts with the chemicals in the medication to help treat the condition (such as psoriasis and vitiligo)
• PUVA Keratosis can be described as a type of actinic keratosis manifesting in the PUVA treated skin areas of the body. Actinic keratosis is an ultraviolet light induced premalignant skin condition
• The signs and symptoms may include the formation of skin lesions with itching or burning sensation. This may later develop to form larger skin patches with thickened skin. Longstanding treatment with PUVA may place an individual at a higher risk for skin cancer
• The treatment of the PUVA Keratosis may include a discontinuation of the therapy, when possible. Other skin therapies may be considered based on the evaluation by a healthcare provider. The prognosis is generally excellent with appropriate treatment

Who gets PUVA Keratosis? (Age and Sex Distribution)

• PUVA Keratosis is observed in some individuals who undergo PUVA therapy. Study reports indicate that about 2-5% individuals treated using the therapy may develop PUVA Keratosis
• This condition may develop in both children and adults
• No gender inequality has been observed and both males and females are at risk
• The condition is seen across all races and ethnicities

What are the Risk Factors for PUVA Keratosis? (Predisposing Factors)

The primary risk factor for PUVA Keratosis is a chronic treatment with PUVA (or psoralen and ultraviolet A therapy). All individuals who are treated using PUVA therapy for the following skin conditions may be at risk:

• Eczema
• Large-plaque parapsoriasis
• Mycosis fungoides
• Psoriasis
• T-cell lymphoma affecting the skin
• Vitiligo
• Individuals with graft vs host disease of the skin following bone marrow transplantation

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of PUVA Keratosis? (Etiology)

PUVA Keratosis is caused by PUVA therapy; PUVA is a type of photochemotherapy using the drug psoralen and ultraviolet radiation exposure.

• In this ultraviolet (UV) light therapy, the affected skin (due to various other medical conditions) is exposed to UV A light following skin sensitization using the drug psoralen, which is taken orally or (less frequently) applied on the body as a topical  cream
• Due to this, the skin cells and other cells in the ultraviolet radiation field  (the keratinocytes that form the epidermis) are altered or damaged from prolonged exposure to the ultraviolet A radiation component following psoralen ingestion/application
• It is proposed that the exposed skin areas subjected to the therapy have weak immunity, due to a high-dose radiation exposure, resulting in the associated signs and symptoms

What are the Signs and Symptoms of PUVA Keratosis?

PUVA Keratosis may be observed as a visible change in the skin in the body areas which have been treated using PUVA therapy. The signs and symptoms may include:

• Initial formation of light skin lesions that appear as sunspots, which later turn dry, red, and scaly with raised patches
• Gradually the skin condition gets rough, inflamed, and thickening occurs. The size of the patches grow bigger and multiple lesions are observed
• Itching or burning sensations may be experienced. When the condition is acute, there may be pain, bleeding/oozing from the sores
• Signs and symptoms of the underlying condition may be present

How is PUVA Keratosis Diagnosed?

A diagnosis of PUVA Keratosis is made through:

• Physical examination of the skin and detailed medical history assessment
• Examination of the skin by a dermatologist/skin specialist
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of PUVA Keratosis?

The possible complications due to PUVA Keratosis may include:

• The main complication that may arise due to PUVA Keratosis is that it could develop to form a type of skin cancer
  • Individuals, who have been on long-term high-dose exposure to psoralen and ultraviolet radiation therapy (or PUVA), have an increased risk for squamous cell carcinoma of skin
  • Some studies show that individuals who have undergone over 300 PUVA therapy session have a very high risk for cancer
• Complications that may arise due to the underlying condition which required PUVA therapy
• PUVA treatments accelerate photoaging. The findings of photoaging can decrease self-esteem and are hard to reverse

How is PUVA Keratosis Treated?

The treatment measures available for PUVA Keratosis may include (as determined by a healthcare provider):

• Use of alternative measures to treat the underlying skin condition; discontinuing photochemotherapy using PUVA (may be for a certain period as assessed by the healthcare provider)
• Use of topical ointments, lotions, and creams. These may be anti-inflammatory applications
• Chemical peeling, in which strong chemicals applied on the skin, cause it to peel and shed, giving way to formation of new skin
• Use of photodynamic treatments: Light selectively destroys the damaged cells after they have been pretreated with a special medical application
• Cryotherapy: Controlled use of liquid nitrogen to force spontaneous peeling and removal of skin
• Treatment of the underlying associated skin disorder
• Follow-up care with regular screening and check-ups are encouraged

How can PUVA Keratosis be Prevented?

It may not be possible to prevent PUVA Keratosis, although the following may be considered to reduce the risk for the condition:

• Careful follow-up evaluation of individuals on therapy using PUVA to help detect any early skin signs (side effects) may be helpful
• Use of alternative treatment methods: Treatment using the ultraviolet light component ‘UV B’ has yielded better results in many individuals

What is the Prognosis of PUVA Keratosis? (Outcomes/Resolutions)

• Early diagnosis, followed by adequate treatment of PUVA Keratosis can help result in an excellent prognosis
• However, the overall prognosis may depend upon the severity of the underlying condition (such as psoriasis or eczema)

Additional and Relevant Useful Information for PUVA Keratosis:

Please visit our Skin Care Health Center for more physician-approved health information:

https://www.dovemed.com/healthy-living/skin-disorders/