PUVA: An Ancient Remedy?


Dennis P. Valenzeno
Associate Dean for Medical Sciences
Chair and Professor of the Department of Medical Sciences
The University of Kansas Medical Center - Wichita
1010 N. Kansas St., Wichita, KS 67214-3199
dvalenzeno@kumc.edu

(Reprinted from an article in the ASP Newsletter No. 129, Oct/Nov 1990)

PUVA, psoralen plus UV-A, is a treatment protocol for psoriasis which is well-known to most photobiologists. But how many of us are aware that this mode of therapy was used, and detailed in writing, as early as the 13th century? Psoriasis was not the disease treated, however, Rather, powdered seeds from umbelliferous plants and sunlight were combined in a treatment for vitiligo. The active components from the powdered seeds are now known to be furocoumarins and the active wavelengths in sunlight were, of course, the UV.

Vitiligo is a condition characterized by irregular whitish patches of skin caused by an inability of these patches to produce melanin, the normal pigment of skin. It is harmless physically, but can sometimes have serious psychological consequences because of its perceived unsightliness. A remedy for vitiligo is given in Ibn El Bitar's Mofradat al Adwiya written in the 13th century (Weber, 1980). El Bitar's account indicates that in northwest Africa vitiligo was treated by grinding the seeds of the umbelliferous plant, Ammi majus Linn. His prescription, translated into English, reads as follows.

"Mix 1 derum (about 3 g) of the powdered
seeds with less than 1 g of a pellitar root and honey,
and take it by mouth."

Dosimetry was a little cruder in those days. The treated area was exposed to sunlight for 1 or 2 hours, or until the patient began to perspire. Blisters formed after this exposure only on the affected areas. When the blisters eventually broke, the underlying skin would have near normal pigmentation.

This general mode of treatment was apparently handed on from generation to generation, so that vitiligo was not considered to be a significant problem in some areas of Africa. In some cases the cure was made even easier by simply having the subject eat the seeds of the plant, followed by sun exposure the next day.

This simple treatment was revolutionary in the treatment of vitiligo and has become even more important as a treatment for psoriasis, yet it lay forgotten for seven hundred years until its rediscovery in the middle of this century. How many other similar observations are hidden in the history of photobiology, just waiting to be found?

Reference

Weber, G. (1980) Photochemotherapy: Information for Doctors and Patients.
    Year Book Medical Publishers, Chicago, IL.