Stir Up the Sun Therapy: Topical PUVASOL Therapy in Palmoplantar Psoriasis

Background: Palmoplantar psoriasis is a variant of psoriasis localized to palms and soles and is usually resistant to conventional topical therapy owing to the anatomical variations. Topical psoralen therapy was widely practiced during olden times due to less systemic side effects and sunlight was used as a source of UVA in developing countries due to its cost-effectiveness. Materials and Methods: After obtaining informed consent, 30 patients with palmoplantar psoriasis were asked to apply a diluted solution of psoralen (1 part of 8-methoxypsoralen was diluted with 10 parts of tap water) over the lesions. They were told to stay indoors for 30 min and exposed to sun for a maximum of 2 min on alternate days for 6 weeks. Palmoplantar psoriasis area and severity index was calculated at the beginning of the study and at the end of 6 weeks. Percentage improvement was calculated based on pre- and post-treatment scores and was categorized as minimal improvement (up to 25%), moderate improvement (26%–50%), marked improvement (51%–75%), and total/near total improvement (76%–100%). Results: Three patients (10.34%) showed mild improvement, 6 patients (20.68%) showed moderate improvement, 8 patients (27.58%) showed marked improvement, and 12 patients (41.37%) showed total or near total improvement. One patient reported phototoxicity and was excluded from the study. There was also a statistically significant correlation between smoking and alcohol with reduced response to therapy. Conclusion: Topical Psoralen plus Ultraviolet A obtained by solar light (PUVASOL) can be reintroduced as a cost-effective alternative to other conventional and newer topical therapies. The chances of side effects due to systemic drugs can also be reduced with this.