Turbo-PUVA: dihydroxyacetone-enhanced photochemotherapy for psoriasis: a pilot study

Area of Science:

• Dermatology
• Phototherapy
• Pharmacology

Background:

• Dihydroxyacetone (DHA) forms a UV-A protective pigment on the skin.
• This pigment sheds faster from psoriatic plaques than healthy skin.
• Selective pigment shedding suggests potential for enhanced phototherapy.

Purpose of the Study:

• To test if DHA can protect uninvolved skin during psoralen-UV-A (PUVA) treatment for psoriasis.
• To investigate if this protection allows higher UV-A doses for faster clearing.
• To explore lactic acid's role in scale and DHA removal.

Main Methods:

• Thirty patients with extensive psoriasis were divided into six PUVA treatment groups.
• Groups included standard PUVA, PUVA with lactic acid, DHA-PUVA (Turbo-PUVA), Turbo-PUVA with lactic acid, European-style PUVA, and European-style PUVA with DHA.
• Treatments were administered up to twice weekly for 30 sessions, with specific protocols for DHA and lactic acid application.

Main Results:

• The DHA-PUVA (Turbo-PUVA) groups tolerated higher UV-A exposures with fewer burns.
• Turbo-PUVA demonstrated significantly faster psoriasis clearing.
• Fewer treatments were required to achieve 90% clearing in the Turbo-PUVA groups (P<.001).

Conclusions:

• DHA provides photoprotection to uninvolved skin during PUVA, enabling higher UV-A doses.
• This approach accelerates psoriasis clearing and reduces the number of required treatments.
• Turbo-PUVA may lower long-term risks by decreasing the total UV dose received.