Treatment of Genito-Anal Lesions in Inflammatory Skin Diseases with PUVA Cream Photochemotherapy: An Open Pilot Study in 12 Patients

Abstract

Background: Localized skin lesions of the genito-anal region such as in lichen sclerosus et atrophicus or in lichen planus are a burden for many patients, and therapeutic efforts, including therapies with potentially hazardous side-effects, are often unsatisfactory. Recently, PUVA bath photochemotherapy has been proven highly effective in the treatment of various inflammatory skin diseases, including localized scleroderma. Another form of topical PUVA therapy, 8-methoxypsoralen-containing cream or gel preparations, has been proven to be as effective as PUVA bath therapy for palmoplantar dermatoses. Objective: We evaluated the clinical effects of PUVA cream photochemotherapy in patients with genital lesions of inflammatory skin diseases. Methods: Twelve patients with lichen sclerosus et atrophicus, lichen planus, vulvar eczema and pruritus vulvae were included in the study. PUVA cream therapy was performed up to 4 times a week. Results: PUVA cream photochemotherapy induced a significant clinical improvement of genital lesions in most patients, as revealed by clinical examination. Clinical improvement (reduction in size of lesions of erythema, and/or of pruritus) was achieved in most patients after 10–20 treatments and was reduced in patients that had only received 5–15 treatments. Cumulative doses ranged between 4.5 and 180 J/cm²; all patients tolerated PUVA cream phototherapy well without any side-effects. Conclusion: PUVA cream phototherapy represents a highly effective therapy that should be further investigated as an alternative treatment for patients with genital lesions of inflammatory skin diseases.

Diagnosis and Treatment of Lichen Sclerosus

“…Reichrath et al [132] tretated five women with vulvar LS with topical psoralen plus UVA (PUVA) therapy using 8-methoxypsoralen (8-MOP)-containing cream. The mean number of treatments administered was 25.6 (range 5–104), and the mean cumulative UVA dose was 44.2 J/cm 2 (range 4.0–180).…”

UVA/UVA1 phototherapy and PUVA photochemotherapy in connective tissue diseases and related disorders: a research based review

“…Interestingly, single UVA1 progressed from 0.3 to 2.3 J/cm 2 resulting in a cumulative dose of 31.7 J/cm 2 during a six week period. In addition to the extragenital manifestation, PUVA cream photochemotherapy has also been proven to be even effective in genitoanal lesions of LSA [60]. Nevertheless, despite the absence of any short-term side effect, UVA irradiation of genital affections should be performed extremely carefully in order to prevent long-term negative adverse consequences.…”

Phototherapy for sclerosing skin conditions

“…The details of these reports are available in Table 4 [49][50][51][52][53][54][55]. Because genital LS is associated with an increased risk of squamous cell carcinoma, phototherapy in these patients should be undertaken with great caution only after first-line treatments have failed.…”