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Photochemotherapy necessitates close monitoring for acute toxicity and cutaneous carcinogenic effects. Oral methoxsalen plus UVA was associated with the highest incidence of side-effects. Severe phototoxic reactions (mainly associated with topical psoralen or oral methoxsalen plus UVA) can be avoided by carefully monitoring UV exposure. Nausea (reported in 29% of the patients treated with methoxsalen) can be reduced by taking food.10 It seems that wearing UVA-opaque glasses for 24 hours after psoralen ingestion makes the risk of cataract development negligible. Liver and renal function tests and ophthalmologic examination should be repeated annually.17

In patients with psoriasis, long-term PUVA therapy was associated with an increased risk of skin cancer.18,19 Although the risk seems to be lower in patients with vitiligo (possibly because of the lower cumulative dosages and/or darker skin types), guidelines for maximum cumulative PUVA doses should follow those recommended for psoriasis.20 Both PUVA and UVB therapies should not be continuous, to minimise carcinogenic potential.

No systemic or local side-effects are reported for UVB therapy, except for erythema, pruritus and xerosis. Long-term side-effects and risk for skin carcinogenesis are unknown.10 Side-effects of topical calcipotriol were negligible in the two trials reported.11,12 Abnormal liver function tests were observed in 17% of patients using oral khellin.10

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