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U
SER
M
ANUAL
& T
ECHNICAL
D
ESCRIPTION
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Page 24 of 30
7.3 UVA (PUVA) – Treatment recommendations
Recommendations on the initial dose in photochemotherapy
Skin Type
PUVA orally
(8-MOP)
J/cm²
PUVA orally
(5-MOP)
J/cm²
PUVA-bath
(1.0 mg/l 8-MOP)
J/cm²
I 0.3 0.4 0.2
II 0.5 1.0 0.3
III 0.8 1.5 0.4
IV 1.0 2.0 0.6
Alternatively, the initial dose can be specified by determining the minimal phototoxic dose (MPD).
The initial phase of the treatment extends almost to the absence of clinical symptoms. Irradiations are
carried out two to four times per week, but at least twice a week. Dose increases should not be made
more frequently than at intervals of 72 hours (European PUVA protocol). There is no fixed scheme for
dose increases, the essential parameters should be the response of the treated skin disorder and the
individual sensitivity to photochemotherapy. A barely recognizable erythema is seen, as clinical indicator
for an adequate UVA dosage. Ahead of each UV-treatment patients should be asked regarding
subjective signs of intolerance or overdosage. The below described procedure has proven in practice.
Photochemotherapy treatment regimen
Steps PUVA orally PUVA-bath
1
(optional)
Determination of
the minimal
phototoxic dose
(MPD)
Evaluation after
72-96 hours Evaluation after
96-120 hours
2 Start of treatment Initial dose
Standard dose
according to skin type
respectively 50-70% of
MPD Standard dose
according to skin type
respectively 30% of
MPD
3
Continuation of the
treatment, two to
four times per
week
No erythema,
good response
Increase by
30% max.
twice per week Increase by
30% max.
twice per week
Minimal
erythema
No increase No increase
Persistent
asymptomatic
erythema
No increase No increase
Painful erythema
with or without
edema or
blistering
No treatment until
remission No treatment until
remission
4
Resumption of
treatment After remission of
symptoms
Reduction of last dose
by 50%, further
increase by 10% Reduction of last dose
by 50%, further
increase by 10%