PUVA treatment

Non melanotic malignant neoplasm of the skin - PUVA treatment Factor

PUVA is defined by the RMA as "photochemotherapy with oral methoxsalen (psoralen) and ultraviolet A radiation".

Description

Psoralen (which may be referred to as methoxypsoralen, methoxsalen or oxsoralen) is a photosensitiser which may be in capsule form or as a lotion for topical application.  It has been used to treat many cases of vitiligo but is also used to treat severe, recalcitrant or disabling psoriasis.  Oxsoralen alone has no effect but must be followed by UV exposure (either sunlight or artificial source) and only the skin that is exposed is altered.  Following ingestion, the skin becomes photosensitive in about 1 hour.  Peaking 2 hours after intake, this sensitivity vanishes in 8 hours.  The exposure time and intensity of UV light must be measured and controlled.

Note:  The RMA definition of PUVA treatment limits this to the oral taking of psoralen with long-wave UVA.  It does not include topical application of psoralen.

Establishing a history of PUVA therapy

If a person had undergone PUVA treatment, this would have been carried out by a specialist.  Such medical treatment would normally be recorded in doctors' notes and/or hospital records.  However, these records may have been destroyed or can no longer be obtained.  Therefore, if there is a reliable history of PUVA treatment at a particular time, this generally will be accepted, unless there is contradictory evidence.  Seek medical advice if it is unclear whether the claimed PUVA treatment is medically feasible.

Last reviewed for CCPS 26 September 2007.

Investigative Documents

Preliminary questions [12814]

12960 there is some evidence that PUVA treatment may be a factor in the development of the condition under consideration.

12852 the veteran underwent PUVA therapy at some time.

12853 the veteran underwent PUVA therapy to side and site of the body at some time.

34506 the veteran underwent PUVA therapy to side and site of the body, where at least 25 PUVA treatments were administered, at some time.

34507 the veteran's PUVA therapy to side and site of the body, where at least 25 PUVA treatments were administered, was materially contributed to by treatment of an illness or injury which is identifiable.

12855  the veteran has established the causal connection between PUVA treatment and VEA service for the clinical onset of the condition under consideration.

12857   the veteran has established the causal connection between PUVA treatment and operational service for the clinical onset of the condition under consideration.

or

12858   the veteran has established the causal connection between PUVA treatment and eligible service for the clinical onset of the condition under consideration.

Clinical onset and operational service [12857]

12859 the identified illness or injury made a material contribution to the veteran's PUVA therapy to side and site of the body, where at least 25 PUVA treatments were administered, before the clinical onset of the condition under consideration.

12861 where the identified illness or injury made a material contribution to the veteran's PUVA therapy to side and site of the body, where at least 25 PUVA treatments were administered, before the clinical onset of the condition under consideration, the first of those treatments commenced at least five years before the clinical onset of the condition under consideration.

34508  the identified illness or injury, which made a material contribution to the veteran's PUVA therapy to side and site of the body, where at least 25 PUVA treatments were administered before the clinical onset of the condition under consideration, is causally related to operational service.

Clinical onset and eligible service [12858]

12860 the veteran has undergone PUVA therapy to side and site of the body, where at least 50 PUVA treatments were administered, at some time.

12845 the identified illness or injury made a material contribution to the veteran's PUVA therapy to side and site of the body, where at least 50 PUVA treatments were administered.

12856 the identified illness or injury made a material contribution to the veteran's PUVA therapy to side and site of the body, where at least 50 PUVA treatments were administered, before the clinical onset of the condition under consideration.

12862 where the identified illness or injury made a material contribution to the veteran's PUVA therapy to side and site of the body, where at least 50 PUVA treatments were administered, before the clinical onset of the condition under consideration, the first of those treatments commenced at least five years before the clinical onset of the condition under consideration.

34509  the identified illness or injury, which made a material contribution to the veteran's PUVA therapy to side and site of the body, where at least 50 PUVA treatments were administered before the clinical onset of the condition under consideration, is causally related to eligible service.