The time course of topical PUVA erythema following 15- and 5-minute methoxsalen immersion.
BACKGROUND
Limited data exist in the literature concerning the characteristics of erythema following psoralen UV-A (PUVA) treatment using topical methoxsalen. To optimize the phototherapeutic regimen and reduce short- and long-term risks, knowledge of such basic information is essential.


METHODS
The characteristics of PUVA erythema following 15- and 5-minute immersion in methoxsalen was determined. The PUVA erythema after 15-minute methoxsalen immersion exhibited a broad peak, with the lowest median minimal phototoxic dose (MPD) at 96, 120, and 144 hours after UV-A irradiation. Seventy-three percent of subjects experienced peak erythema at 120 hours compared with only 45% at 72 hours. From the dose-response data, an increase in the erythema index of 0.025 (equivalent to the MPD) was significantly lower when determined at 120 hours after UV-A irradiation than at 72 hours (P =.03). The median maximum slope of the dose-response curve occurred at 144 hours. After 5-minute immersion, PUVA erythema displayed a broad peak from 72 hours. Erythema summation scores followed a trend similar to that of 15-minute immersion, but the intensity was significantly reduced.


CONCLUSIONS
Methoxsalen-UV-A erythema exhibited a broad plateau between 96 and 144 hours, with most subjects at peak erythema at 120 hours. Reduction of methoxsalen immersion time significantly lowered the erythemal intensity. Minimum phototoxic dose reading at 72 hours underestimates the phototoxic effect of topical methoxsalen PUVA, and a change in the MPD assessment time should be considered.
Man
Irene
I
Photobiology Unit, Department of Dermatology, Ninewells Hospital and Medical School, Dundee, DD1 9SY Scotland. iwman@yahoo.com
Kwok
Yew Kai
YK
Dawe
Robert S
RS
Ferguson
James
J
Ibbotson
Sally H
SH
D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004890:Erythema / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D007101:Immersion; D008297:Male; D008730:Methoxsalen / Q000008:administration & dosage*; D008875:Middle Aged; D011701:PUVA Therapy / Q000009:adverse effects*; D017319:Photosensitizing Agents / Q000008:administration & dosage*; D011874:Radiometry; D012016:Reference Values; D013997:Time Factors
D017319:Photosensitizing Agents; D008730:Methoxsalen