U
SER
M
ANUAL
&
T
ECHNICAL
D
ESCRIPTION
N-LINEpro_User Manual_2018-09-20.doc
MEDlight GmbH
Werrestr. 94
32049 Herford
Germany
Phone: +49 5221 99429-0
Fax: +49 5221 99429-40
e-mail: [email protected]
www.medlight.eu
Page 21 of 30
headache or dizziness, caused by the photosensitizer. The nausea can be avoided by using of 5-MOP
instead of 8-MOP.
As chronic damage of the photo(chemo)therapy occur UV-induced lentigines, light-induced skin aging
and especially the development of actinic keratoses and invasive squamous cell carcinomas.
Statistically secured is the development of squamous carcinoma after systemic PUVA treatment with
high cumulative UVA doses, or with a high number of individual treatments. In modern PUVA therapy,
cancer risk is probably much lower than in the prospectively conducted American PUVA cohort from the
70s, because nowadays a much more careful patient selection is performed, and improved irradiation
protocols with only rare excessive phototoxic reactions and the consequent use of combination
therapies, and the avoidance of maintenance treatments lead to a significantly lower phototoxic burden
of the skin. After bath PUVA treatments, an increased carcinoma risk has so far not been observed. This
may be based on statistical deficiencies of the present studies, or a still too short follow-up period. Until
this question is resolved, a strict indication selection for bath-PUVA therapy must be demanded. Basal
cell carcinomas are probably not induced by the photo(chemo)therapy; controversial is the induction of
melanoma due to PUVA treatment or higher dosed UVA irradiation.
Side Effect
UVA / UVA1
<20 J/cm²
UVA / UVA1
>20 J/cm²
PUVA
Erythema or phototoxic reaction due to overdosing
--
--
++
Phototoxic reaction due to unintentional intake of a
photosensitizer
+
++
++
Conjunctivitis and keratitis (if no eye protection is
used)
--
--
++
Provocation of photodermatoses
+
++
±
UV-Lentigines
±
+
++
Photoaging of the skin
±
++
++
Actinic keratoses and squamous-cell carcinoma
?
±
++
Melanoma
?
?
?
++
high risk
+
moderate
risk
±
low risk
--
due to known mechanisms
of action not likely
?
in principle possible,
but no data available
Because of the potential, acute and chronic risks of photochemotherapy, the indication must
be kept strict. This requires also particular demands on the participation of the patient.
Besides the general guidelines, following recommendations apply:
A combination treatment with Cyclosporine A, has to be avoided.
Particular caution is advised for the pre-treatment with arsenic or X-rays, with concomitant use
of photosensitizing drugs, with more pronounced liver damage (delays in metabolic insufficiency
the sensitization phase, which must be taken into account) and at high cumulative UVA doses
(more than 150-200 individual treatments). In some cases, these circumstances may constitute a
contraindication.
Regarding the risk of combination with systemic fumarates, no field reports exist.