TOPICAL PSORALEN-ULTRAVIOLET-A THERAPY FOR PALMOPLANTAR DERMATOSES - EXPERIENCE WITH 35 CONSECUTIVE PATIENTS

Objective: To report the effectiveness of topical psoralen-ultraviolet A (PUVA) therapy for palmoplantar dermatoses and to describe our meth od of administration of this treatment modality. Design: We conducted a retrospective study of 35 patients, 27 to 66 years of age, who recei ved topical hand and foot PUVA therapy. Material and Methods: Ten pati ents had psoriasis vulgaris, 8 had pustular psoriasis, 5 had dyshidrot ic eczema, and 12 had other types of dermatitis. The affected area was soaked in a psoralen solution, 0.0005% methoxsalen (10 mg of methoxsa len in 2 L of warm water), for 30 minutes and then exposed to incremen tal amounts of ultraviolet A light three times weekly until the dermat osis subsided or cleared. Treatment frequency was then reduced and ult imately discontinued. Time to maximal improvement of the hands and fee t was defined as the period from the beginning of PUVA treatment to th e point at which the frequency of treatment was reduced from three tim es weekly to twice weekly, Results: Fourteen patients (40%) had cleari ng of their disease, and 14 others (40%) had improvement of their cond itions. The mean time to clearing was 2.8 months (range, 2 weeks to 7 months), and the mean number of treatments was 27.3 (range, 10 to 55). The mean total dose of ultraviolet A received was 140 J/cm(2) (range, 9 to 530), Two patients (6%) had no response to treatment, Mild local ized ultraviolet-related erythema developed in 16 patients (46%). Five patients ''dropped out'' of treatment, and nine other patients discon tinued treatment during maintenance therapy. The principal reason cite d was inconvenience. Conclusion: Topical PUVA therapy is an effective and safe treatment option for recalcitrant dermatoses affecting the pa lms and soles.