Severe burn injuries induced by PUVA chemotherapy.

ABSTRACT

Psoralen-ultraviolet A (PUVA) chemotherapy is an established treatment for certain skin diseases. Burn injury is a serious complication of PUVA therapy. Reports regarding this complication are limited. The aim of this study was to determine the management and outcome of severe PUVA burns. A retrospective review of the medical records of PUVA burns treated at our burn center from 2000 to 2010 was conducted. Data collected included age, sex, condition, mode of PUVA, site, surface area involved, depth of burns, onset of reactions, treatment, and inpatient stay. To evaluate the incidence of this severe complication, a survey of all listed burn care units in Germany, Austria, and Switzerland as well as the legal advisory boards of the medical associations of the federal states of Germany was conducted. The conditions leading to photochemotherapy were three cases of psoriasis vulgaris and one case of severe chronic graft vs host disease. All patients received oral psoralen. Incorrect handling of the radiation system was the reason for all burns. The mean affected TBSA was 73±18%. All patients were treated conservatively and healed without surgical intervention. Burn injury is a serious and preventable complication of PUVA photochemotherapy. Patients should be advised regarding the potential risk of major burns. Care should be given to not exceed the safe dose of psoralen. Burn care specialists must restrain surgical intervention as even deep partial thickness PUVA burns have the potential to heal spontaneously.