Bath psoralen plus ultraviolet A shows good efficacy in the treatment of mycosis fungoides

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1. Bath PUVA (8-methoxypsoralen bath with UVA) exhibited good efficacy in treating patients with both refractory mycosis fungoides (MF) (50% complete response) and folliculotropic MF (71% complete response). 

Evidence Rating Level: 2 (Good) 

Study Rundown: Psoralen and ultraviolet A (PUVA) is a therapy used for a variety of skin conditions including early-stage mycosis fungoides (MF). Psoralens are compounds that sensitize the skin to UVA, facilitating its effects on the lymphocytic infiltrate of MF. However, systemic PUVA and its alternative, narrowband (NB) UVB, have limited efficacy and tolerability in some patients. This lack of effectiveness is emphasized in those with the folliculotropic variant of MF, in which lymphocytes extend deeper into the hair follicles. Bath PUVA is an alternative method in which patients soak in 8-methoxypsoralen in place of taking oral psoralen, allowing for a lower serum psoralen and fewer side effects. This study assessed the efficacy of bath PUVA in 26 patients, revealing a complete clinical response in 71% of those with folliculotropic MF and 50% in those refractory to NB-UVB after an average of 33 weeks of treatment. However, the study was not a randomized-controlled trial and was limited by its small sample size and lack of placebo control.

Click to read the study in JAAD

Relevant Reading: Bath vs. oral psoralen plus ultraviolet A: is one more effective than the other?

In-Depth [retrospective study]: This study evaluated 26 patients, 12 with classic MF refractory to NB-UVB and 14 with folliculotropic MF, all of whom were ineligible for or unwilling to receive oral PUVA. Each patient was treated with a 0.2 mg/L 8-methoxypsoralen bath 3 times a week followed by irradiation with an escalating dose of 0.3 J/cm² UVA over the treatment course. Skin disease was assessed every 2-3 weeks and was classified based on amount of lesion clearance into complete (100% clearance), partial (>50% clearance), or failed (<50% clearance) responders. 16 (62%) patients had a complete response, including 6 (50%) with NB-UVB refractory MF and 10 (71%) with folliculotropic MF. Response took 31 weeks for the NB-UVB refractory group and 44 for the folliculotropic group, for an average of 33 weeks. 8 patients had a partial response. The therapy was well tolerated, with only side effects including mild burn/erythema and photosensitivity, PUVA lentigines, and pigmented stripes from bath PUVA. The study suggested that bath PUVA was an effective alternative to systemic PUVA and NB-UVB, although larger controlled studies may be necessary.

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