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Turbo-PUVA: Dihydroxyacetone-Enhanced Photochemotherapy for Psoriasis
A Pilot Study
Charles R. Taylor, MD;
Chartchai Kwangsukstith, MD;
Joanne Wimberly, MPA;
N. Kollias, PhD;
R. Rox Anderson, MD
Arch Dermatol. 1999;135:540-544.
Background Dihydroxyacetone (DHA), a colorless sugar in "sunless" tanning lotions, binds to stratum corneum to form a UV-A–protective brown pigment. Bound DHA polymer is shed faster from hyperproliferative skin sites such as psoriatic plaques. We tested the hypothesis that selective shedding of DHA pigment during psoralen–UV-A (PUVA) treatment of psoriasis may allow higher UV-A doses, thus accelerating clearing while protecting uninvolved skin. Concurrent use of lactic acid was investigated as an aid in removing scale and residual DHA from psoriatic plaques.
Observations Thirty psoriatic patients with more than 20% body surface area involvement were recruited. The 6 PUVA study groups were (1) standard American style, (2) American style plus lactic acid, (3) DHA-PUVA or "topical ultraviolet-resisting barrier to optimize PUVA" (Turbo-PUVA), (4) Turbo-PUVA with lactic acid, (5) European style, and (6) European style plus DHA. Combinations of lactic acid and European-style treatment were not studied. Each subject received up to 30 oral PUVA treatments twice weekly 3 days apart. The DHA-PUVA groups used 15% DHA lotion twice weekly. Lactic acid groups used 7% lotion daily except on treatment days. Psoriasis area and severity index scores were recorded weekly. Turbo-PUVA allowed higher UV-A exposures with minimal burns, showed faster clearing, and required fewer treatments for 90% clearing (P<.001).
Conclusions Protection of uninvolved skin by DHA during PUVA treatment allows higher UV-A exposures to be tolerated, demonstrates faster clearing, and requires fewer treatments to clear psoriasis. By reducing the total body dose received, Turbo-PUVA may also reduce long-term risks.
From Gange Photomedicine Research Center, Wellman Laboratories of Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard University, Boston (Drs Taylor, Kollias, and Anderson and Ms Wimberly); and the Section of Dermatology, Department of Medicine, Chiang Mai University, Chiang Mai, Thailand (Dr Kwangsukstith). None of the authors received salary support from or have any financial interests in Esteé-Lauder, Melville, NY, or Spex Inc, Edison, NJ, whose Sunscreen Machine was used in the diffuse reflectance spectroscopy measurements.
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