Where can a pediatric patient with psoriasis access UVA (Ultraviolet A) light for PUVA (Psoralen and Ultraviolet A) therapy?

Where to Access UVA Light for PUVA Therapy in Pediatric Psoriasis

UVA light for PUVA therapy should be accessed at specialty psoriasis centers or dermatology clinics with phototherapy equipment, though this treatment has limited supporting evidence in children and should only be considered after narrowband UVB has failed. 1

Primary Treatment Locations

Specialty Psoriasis Centers

• Specialty psoriasis centers are the primary location for PUVA therapy, as traditional combination phototherapy options including PUVA have been relegated to treatment-resistant cases in these specialized facilities. 1
• These centers have the necessary UVA light equipment and expertise to safely administer PUVA photochemotherapy with either topical or oral psoralen. 1

Dermatology Outpatient Clinics

• Hospital-based or outpatient dermatology clinics with phototherapy equipment can provide PUVA therapy. 2
• These facilities must have trained personnel for proper monitoring and dose administration. 3

Home Phototherapy (Limited Applicability)

• In-home UV light equipment is a viable alternative for geographically isolated patients, but this typically applies to narrowband UVB rather than PUVA due to the complexity of psoralen administration and the need for strict 24-hour protective eyewear with PUVA. 1, 3, 4
• Home PUVA is generally not recommended for pediatric patients due to safety monitoring requirements. 4

Critical Treatment Context for Pediatric Patients

Evidence Limitations

• PUVA therapy in children with psoriasis may be efficacious and well tolerated but has limited supporting evidence (Strength C recommendation, Level III evidence). 1
• The American Academy of Dermatology and National Psoriasis Foundation guidelines note insufficient data for PUVA in pediatric psoriasis. 1

Preferred Alternative

• Narrowband UVB (311-313 nm) is strongly recommended as the first-line phototherapy option for moderate to severe pediatric plaque and guttate psoriasis (Strength B recommendation). 1, 3, 5
• NB-UVB achieves 90% skin clearance in 60% of pediatric patients after 12 weeks of twice-weekly treatment. 1, 3
• NB-UVB has largely replaced PUVA as the initial choice in full-body phototherapy for children because it is easier to deliver with less resultant erythema and does not require strict 24-hour protective eyewear. 4

When PUVA Might Be Considered

• PUVA should only be considered after NB-UVB has proven inadequately effective, typically after 20-30 treatments (8-12 weeks at 2-3 times weekly). 5, 2
• PUVA is more effective for refractory psoriasis plaques than UVB but has greater side effects. 3
• For younger patients (<20 years), NB-UVB should be prioritized over PUVA due to lower long-term carcinogenic risk. 5

Practical Access Considerations

Treatment Frequency

• Initial phototherapy frequency is typically 3 times per week, which can be decreased to 2 times per week upon improvement. 1, 5
• This requires consistent access to a facility with phototherapy equipment, which may be challenging for some families. 1

Alternative When Access Is Limited

• Natural sunlight in moderation may be recommended when in-office phototherapy is not feasible, though this is a less controlled option. 1, 3

Common Pitfalls

• Do not initiate PUVA as first-line phototherapy in pediatric patients—always trial narrowband UVB first unless there are specific contraindications. 5, 4
• Ensure the facility has experience with pediatric phototherapy, as dosing protocols differ from adults. 1
• Verify that proper safety equipment (protective eyewear for PUVA, genital shields) is available and that parents understand the 24-hour eyewear requirement with systemic PUVA. 3, 4
• Counsel families about the delayed onset of efficacy (>4 weeks), which can lead to premature discontinuation. 1, 3