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

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

What is PUVA-Lentigines? (Definition/Background Information)

• Melanotic macules are dark spots that may be observed on the skin, mucus membranes of the mouth, genitalia, and in the nails. Melanotic macules are typically benign and no malignant transformation to a melanoma has been recorded
• A macule indicates the presence of a flat, distinct, discolored area of skin less than 1 cm wide. A macule usually does not involve any change in the thickness or texture of the affected skin
• PUVA-Lentigines form a variant of melanotic macules and are only observed in patients who are being treated with PUVA therapy, usually for a long duration of time
• PUVA (psoralen and ultraviolet A) therapy is a form of photochemotherapy usually used in the treatment of psoriasis, vitiligo, eczema, cutaneous T-cell lymphoma, graft vs host disease of the skin, and other conditions
• In this therapy, the individual is administered oral psoralen medications 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)
• In most cases, PUVA-Lentigines are asymptomatic and do not present any significant signs and symptoms. When PUVA is used in dark-skinned individuals for vitiligo, the resultant pigmented macules can be coal black, much darker than their normal pigmented skin
• In a majority of individuals, discontinuation of the PUVA treatment may help mitigate the condition. The prognosis of PUVA-Lentigines is generally excellent with early recognition and appropriate treatment of the condition

Who gets PUVA-Lentigines? (Age and Sex Distribution)

• PUVA-Lentigines are observed in some individuals who undergo PUVA therapy. It can be seen in 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-Lentigines? (Predisposing Factors)

The primary risk factor for PUVA-Lentigines is 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, a form of cutaneous T-cell lymphoma
• Psoriasis
• Vitiligo
• Bone marrow graft recipients with graft vs host disease of the skin

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-Lentigines? (Etiology)

PUVA-Lentigines are 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 applied on the body as a topical skin cream
• Due to this, the skin cells (the keratinocytes that form the epidermis) are burnt or damaged from prolonged exposure to the ultraviolet A radiation component following psoralen ingestion/application
• It is researched 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-Lentigines?

The clinical signs and symptoms of PUVA-Lentigines include the following:

• The condition may be seen as a visible change in the skin in the body areas which have been treated using PUVA therapy; it can be termed as a side effect of the body to the treatment
• The lentigines/macules form discolored, flat, and asymmetric patches on the skin
• The color of the macules may be uniform or non-uniform; the color may be in shades brown or black
• The macules are usually multiple having irregular borders
• Signs and symptoms of the underlying condition may be present

How is PUVA-Lentigines Diagnosed?

The diagnosis of PUVA-Lentigines may involve the following procedures:

• The diagnosis is usually made by a complete physical examination and evaluation of medical history
• Dermoscopy: Dermoscopy 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, who 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. A skin biopsy is performed to rule out other similar conditions

Note: A skin biopsy is not usually necessary, but may be performed if the healthcare provider suspects a malignancy such as a melanoma in situ of skin.

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-Lentigines?

The complications of PUVA-Lentigines may include the following:

• The longstanding skin patches can cause emotional stress and cosmetic concerns in some individuals
• The appearance of the pigmented spots may induce a fear of melanoma (which is a type of skin cancer)
• Complications that arise from the underlying skin condition

How is PUVA-Lentigines Treated?

The treatment of PUVA-Lentigines may include the following:

• 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)
• The healthcare provider may choose to regularly observe the benign lesions; a “wait and watch” approach may be followed, once a diagnosis is established. In such cases, no treatment is generally required
• If requested for cosmetic reasons, laser or light based treatments may be performed
• Treatment of the underlying associated skin condition is important
• Follow-up care with regular screening and check-ups are encouraged

How can PUVA-Lentigines be Prevented?

• It may not be possible to prevent PUVA-Lentigines in many cases
• Careful follow-up evaluation of individuals on therapy using PUVA to help detect any early skin signs (side effects) may be helpful

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

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

Additional and Relevant Useful Information for PUVA-Lentigines:

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

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