PUVA bath therapyfor psoriasis vulgaris PUVA-bath thera-py with 8-methoxypsoralenfor the treatment oj psorWS-is vu~ar-is B. Zagoričnik S UM MARY Systemic PUVA therapy is being successfully used far the treatment of a variety of skin diseases for nearly two decades. In 1976 Fischer and Alsins published their article on PUVA bath therapy using trioxsalen (TMP) as photosensitizer for the treatment of psoriasis vulgaris. Since then PUVA bath therapy has proven itself as an effective alternative form of PUVA therapy. It has no systemic side effects and when compared with systemic PUVA therapy the same therapeutic effect requires smaller cumulative UVA doses and a smaller number of exposures. This article reviews the author's experience with PUVA bath therapy for the treatment of psoriasis vulgaris. Introduction Psoralen anc\ ult:raviolet A (PUVA) bath therapy is an alternative form of PUVA in which the psoralen is c\eliverec\ highly c\iluted in bath water solution rather than orally prior to UVA treatmen t. Topical delivery of psoralen in bath water bas many advantages over oral delivery of 8-methoxypsoralen (8-MOP) in PUVA: elimination of nausea, low (possibly zero) risk of cataracts, less total UVA irradiation anc\ poss ible reduced risk of PUVA-inducec\ cutaneous cancers (1). The inclication for PUVA bath therapy is moc\erate- to-severe psoriasis, in w hich 20% or more o f body surface area is involved. The PUVA bath therapy is also successfully used in the treatment o f cutaneous T-cell lymphomas (2,3), lichen planus (2,3,4), granuloma annulare disseminatum ( 4), urticaria pigmentosa ( 4) and localized scleroclerma C 4). Before starting the PUVA bath therapy a careful evaluation of the patient is necessary. There are a number of situations in which PUVA bath treatment is relatively or absolutely contrainclicated (1). Absolute contraindications include psoralen allergy, clisplastic nevus syndrome, simultaneous existence of photo- sensitivity-proclu cing conditions (sys te mic lu pus e1ythematosus, porphyria, etc), inability to comply safety precautions ancl pregnancy anc\ lactation ; relative contrainclications incluc\e simultaneou s u se of a photosensitizing drug or topical preparation (sulfo- namides, tetracyclines, coal tars, etc), presence of C linical study 116 acta dermatovenerologica A.P.A. Vol 8, 99, No 3 PUVA bath therapyfor psoriasis vulgaris Clinical study previous history of squamous celi carcinoma or melanoma and history of exposure to arsenic or ionizing irradiation. The patient must be able to understand the safety precautions that are necessaiy for PUVA bath treatment. These include wearing glasses in the light box to protect the eyes, avoiding the careless splashing of psoralen- containing water in the eyes or mouth. Patients should avoid sun exposure at least 24 hours after bathing in psoralen. Although psoralen delivered by bath water should not affect the eyes, the patients should wear protective sunglasses for 24 hours after the treatment. Pregnant women and mothers who are breast- feeding should be excluded (1). Materials and methods 6 female and 5 male patients with moderate-to- severe psoriasis between 26 and 72 years of age (mean age 51,7) were admitted for treatment with PUVA bath therapy. Ali patients had been treated more that 1 year with topical agents (corticosteroids , calcipotriol) or systemic retinoids without success. The patients bathed for 15 minutes in psoralen water solution with fina! concentration 1,0 mg/1 (made of Oxsoralen caps., containing 10mg 8-MOP in one cap- sule, Gerot Pharmazeutika, Wien, Austria) to wet ali psoriatic lesions below the neck. Immediately after the patient's exit from the bath UVA irradiation with Waldmann PUVA 3001 box containing 14 pes special lamps TL 85W /09T fluorescent bulbs , with a peak emission of 365 nm (Waldmann Medizintechnik, Villingen-Schwenningen, Germany) was administered (1). The starting