In the late 1970s, I switched to a dermatologist at an academic medical center. After I listed the topical treatments that I had used for my psoriasis, he recommended that I try phototherapy. Twice a week, I went to their phototherapy center, where I disrobed and took a 30-minute tar bath, with about 2 ounces of coal tar solution in a tub of hot water. Not surprisingly, the room smelled like the burning tar used to install a roof on a home. Then I would put on a bathrobe, walk over to the therapy room, don green goggles, and step into an octagonal, metal box that was about 3 feet wide and 7 feet high and lined with vertical UVB lightbulbs. After standing naked in the box for about 2 minutes, I would walk over to the bath area and take a shower to wash off the tar. Try as I might, despite frequent washing with soap, excessive use of deodorant and aftershave, the tar smell lingered for the remainder of the day.
After a while, I noticed that the light treatment was causing a bad sunburn “where the sun don’t shine.” I reported this to the dermatologist, and the next time I visited the center, they had posted notices that males should cover their privates before entering the light box. Talk about a little too late and after the fact.
The UVB light treatment was effective for a while, but then the psoriasis lesions reappeared. The dermatologist switched me to UVA light therapy. The tar bath was followed by standing in a different but similarly shaped box lined with UVA vertical lightbulbs. Once again, this worked for a while, but the positive effects tapered off. So the dermatologist recommended that I try a PUVA treatment, which consisted of UVA light treatment together with an oral medication called psoralen. This PUVA treatment seemed to work quite well and quickly. However, within a couple of weeks, I developed an unbelievable, subcutaneous (below the skin, so not visible) itch across my abdomen. The itch was unreachable and unbearable. I immediately reported this to the dermatologist, who told me that the itch was totally unrelated to the PUVA treatment. I found this rather impossible, and sometimes it is best to follow your “gut feeling.” I discontinued the PUVA treatment, and not surprisingly, the itch disappeared. (I considered this an example of what I call “Rick’s Scientific Method.”)
Notwithstanding the dermatologist’s assurances, which may have represented the consensus at the time, I later learned that this abdominal itch phenomenon became known as “PUVA itch.” Frustrating? You bet.
About 35 years later, during one of my regular dermatologist visits, the doctor noticed a sizeable growth on my right calf. She took a biopsy and diagnosed it as a melanoma (skin cancer). I had the growth removed by a dermatological surgeon using the MOHS technique, removing microscopic layers of skin under local anesthesia. After each stage of excision, the surgeon waited 30 minutes and then examined the skin cells under a microscope to confirm that all cancer cells have been removed. In my case, after three rounds of excisions, the surgeon repaired and reconstructed the wound. My current dermatologist has attributed this growth and another one on my abdomen to the fact that I had PUVA treatments.
Although it was not known at the time of my PUVA treatment, in 2001 researchers determined that there was a significant risk of developing melanoma 15 years after the first PUVA treatment. While PUVA is an effective treatment for psoriasis, doctors now recommend that patients receiving PUVA treatment be carefully monitored throughout their lives, paying particular attention to skin abnormalities.
Photo Credit: Evgeniy_Salov / Getty Images
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