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A review on PUVA pricks-A debilitating adverse event
Martin Wyckmans1, An Bervoets1,2
1Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
Photodermatology, Photoimmunology & Photomedicine
|July 30, 2022
Summary
PUVA phototherapy can cause painful "PUVA pricks," a condition resembling nerve pain. Effective treatments include topical creams like capsaicin and oral medications such as phenytoin.
Area of Science:
- Dermatology
- Phototherapy
- Neurology
Background:
- PUVA phototherapy is a common treatment for dermatological conditions.
- Adverse events, including PUVA pricks, can lead to treatment discontinuation.
- PUVA pricks were first described in 1979.
Purpose of the Study:
- To review the literature on PUVA pricks, an adverse event of PUVA phototherapy.
- To understand the characteristics and potential mechanisms of PUVA pricks.
- To identify effective management strategies for PUVA pricks.
Main Methods:
- A systematic literature search was conducted on PubMed from January 1979 to February 2021.
- 1228 unique articles were initially retrieved.
- 33 patients from 9 articles published between 1979 and 2005 were included in the review.
Main Results:
- PUVA pricks manifest as paroxysmal burning or prickling pain.
- The symptoms are similar to peripheral neuropathy affecting unmyelinated C-fibers.
- Potential contributing factors include increased excitability of TRPV1 and TRPA1 channels.
Conclusions:
- Topical treatments like capsaicin 8% cream, urea 4%, or petrolatum emollients are effective.
- Oral antiepileptic drugs such as phenytoin, clonazepam, and gabapentin are viable treatment options.
- N-acetylcysteine may play a role in prevention, warranting further investigation.
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