Oral Methoxsalen Photochemotherapy Research Articles

Antinuclear antibodies and oral methoxsalen photochemotherapy (PUVA) for psoriasis

Antinuclear antibodies and oral methoxsalen photochemotherapy (PUVA) for psoriasis

Antinuclear Antibodies and Oral Methoxsalen Photochemotherapy (PUVA) for Psoriasis

In view of theoretical concern that psoralen ultraviolet A radiation (PUVA) therapy might induce a systemic lupus erythematosus-like syndrome, we studied serum antinuclear antibodies (ANAs) in patients with psoriasis who received PUVA and are participating in a five-year prospective study. At 14 centers, 1,023 patients had two or more ANA determinations. When first and last tests were compared, the incidence of positive tests for ANAs was not significantly different (P greater than .2). In addition, there was no apparent relationship between the frequency of PUVA treatments and the probability of a positive test. Over a two-year period, there is no evidence to indicate that PUVA therapy for psoriasis has resulted in a significantly higher number of positive tests for ANAs within our population.

Dermatology: An Annotated Bibliography of Recent Literature

Dermatology: An Annotated Bibliography of Recent Literature

Dermatological and Ocular Examinations in Rabbits Chronically Photosensitized with Methoxsalen

Four groups of female Dutch-belted rabbits (Oryctulagus cuniculus) were given methoxsalen (12 mg/kg) or placebo by oral intubation and 1 hr later were exposed to UVA for either 2 or 8 hr. This procedure was repeated 5 days each week for 18 mo. A fifth group received no drug and no UVA exposure. The skin of the animals given methoxsalen and UVA showed signs of acute and chronic phototoxicity. Multiple peripheral blood parameters of hepatic, renal and hematologic function were normal and were not different between groups. Complete ophthalmoscopic examinations were performed periodically. No cataracts were seen in any of the animals. This data provides the perspective that in one species the daily dose of methoxsalen and UVA required to induce chronic cutaneous photosensitization is lower than the daily dose required to induce cataracts. It is inadvisable to interpret this data as suggesting that no risk exists for patients being treated with oral methoxsalen photochemotherapy. The experimental evidence supporting photosensitization as a cause of cataracts and implicating a role of lens DNA in this cataractogenesis is reviewed. Because methoxsalen-UVA alterations of lens DNA or protein could lead to delayed onset of cataracts, and because of the serious nature and potential preventability of phototoxic lens opacification, appropriate protective eye wear is recommended for all patients receiving oral psoralen photochemotherapy.

Risk of Cutaneous Carcinoma in Patients Treated with Oral Methoxsalen Photochemotherapy for Psoriasis

A 2.1-year prospective study of 1373 patients given oral 8-methoxypsoralen photochemotherapy for psoriasis revealed 30 patients with a total of 48 basal-cell and squamous-cell carcinomas. The observed incidence of cutaneous carcinoma was 2.63 (95 per cent confidence limits = 1.91 to 3.90) times that expected for an age, sex and geographically matched population. Relative risk to patients with history of ionizing radiation was 3.68 (99 per cent confidence limits, 2.42 to 8.69). Patients with a previous cutaneous carcinoma had a relative risk of 10.22 (99 per cent confidence limits, 4.78 to 37.08). A higher than expected proportion of squamous-cell carcinomas and an excess of squamous-cell carcinomas in areas not exposed to sun were seen. New patients with known histories of ionizing-radiation exposure or of skin tumors should be given 8-methyoxypsoralen photochemotherapy only if they understand the risks and have disabling psoriasis untreatable by other means.

Oral methoxsalen photochemotherapy of recalcitrant dermatoses of the palms and soles.

PUVA therapy successfully cleared various dermatoses mainly confined to the palms and soles in 18 of 20 patients treated. The conditions treated were: plaque-type psoriasis, pustular psoriasis, endogenous eczema and persistent palmoplantar pustulosis. Seventeen patients were treated in a controlled study of PUVA therapy versus no treatment at all and in 16 of these patients the disease was cleared in the PUVA-treated areas while the untreated areas remained unchanged or deteriorated. Twelve of the 18 patients were maintained in a clear state by continued maintenance PUVA treatment over 6--31 months while 3 patients had a spontaneous remission and are free of disease off all treatment.

Augmentation of Oral Methoxsalen-Photochemotherapy with an Oral Retinoic Acid Derivative

To improve the efficacy and reduce potential long-term hazards of photochemotherapy, we treated 36 patients with severe plaque-type psoriasis with a combination of oral methoxsalen-photochemotherapy (PUVA) and another oral chemotherapeutic agent, a retinoic acid derivative. Two groups of patients thus treated were cleared with 9.7 ± 4 treatments within 17.3 ± 7.6 days, and 6.3 ± 3.5 treatments within 11.0 ± 6.7 days, respectively; by contrast, 59 control patients treated with standard PUVA required 14.3 ± 7.8 treatments and 27.8 ± 15.2 days for clearing. Total cumulative doses of UVA energy required for clearing were 93.2 (mean) Joules/cm 2 for PUVA, and 36.2 (mean) Joules/cm 2 and 22.6 (mean) Joules/cm 2 , respectively, for the 2 patient groups receiving the combined treatment. 12 patients with severe palmoplantar psoriasis were cleared with 7 ± 3 treatments within 12.8 ± 5.5 days, requiring 21.4 ± 17.3 Joules/cm 2 . The combined treatment also cleared 11 patients who had been PUVA-treatment failures. The combined treatment thus considerably decreases the total energy of UVA required for PUVA alone; it accelerates the response of psoriasis to PUVA; and it is effective in the small group of patients who have to be considered PUVA failures. It is therefore more effective than PUVA and since it reduces the energy requirements of PUVA therapy it may diminish potential long-term hazards of this treatment.

Oral Methoxsalen Photochemotherapy for The Treatment of Psoriasis: a Cooperative Clinical Trial

Extensive psoriasis in 1,308 patients has been treated two or three times a week with oral 8-methoxypsoralen followed by high intensity, long-wave ultraviolet light (PUVA). Excluding 169 patients still under early treatment, psoriasis cleared in 88% and failed to clear in 3%. One percent dropped out due to complications of treatment, and 8% for other reasons. The twice-a-week schedule was superior for patients with lighter skin types. Once a remission was induced, there was no difference in its maintenance when patients were treated once a week, once every other week, or once every third week. Each of these schedules was superior to no maintenance treatment. Immediate side effect of the 45,000 treatments administered in the first 18 months of this study were uncommon, temporary, and generally mild. No clinically significant changes in laboratory screening or eye examinations attributable to PUVA have been uncovered.