Oral PUVA Research Articles

Pigmented lesions on the palms and soles during PUVA therapy

Pigmented skin lesions due to PUVA are well recognized. They include freckles, mottled skin, naevus spilus-like lesions and ‘PUVA lentigines’ (Kietzmann & Christophers, 1984). The PUVA lentigo appears to be common, occurring in up to 53% of patients (Rhodes, Stern & Melski, 1983). These discrete brown macules, 2–5 mm in diameter, may become very widespread, particularly in those patients who have had many PUVA treatments. They tend to spare the face and have not previously been reported on the palms or soles. We have now seen three female patients who have developed pigmented lesions on their palms (and in one case also on the sole) whilst receiving long-term oral PUVA therapy for psoriasis. The lesions were of two types: ill-defined light grey-brown macules (histologically a freckle, with no increase in number of basal melanocytes), and discrete dark brown macules. The latter showed focal proliferation of dendritic melanocytes at the dermo-epidermal junction, with increased pigmentation throughout the epidermis and also in the superficial dermis. These lesions developed after a minimum of 70 PUVA treatments (over 18 months) in one case, but only appeared after 5 years' PUVA (330 treatments) in another. Ultrastructural studies (Rhodes, Harrist & Momtaz, 1983) have demonstrated that the melanocytes in PUVA lentigines may show cytological atypia. PUVA lentigines may also persist for up to 2 years (and probably longer) after stopping PUVA. Patients undergoing prolonged PUVA therapy to the palms and soles should be warned about the possibility of developing pigmented lesions which may persist after cessation of therapy.

Langerhans´ cells in patients with psoriasis: effect of treatment with PUVA, PUVA bath, etretinate and anthralin

Suction blisters were raised in lesions and normal appearing skin of patients with psoriasis. The blister roof which contains the epidermis separated at the dermal-epidermal junction was stained with ATPase, OKT-6 and anti-HLA-DR monoclonal antibodies. The technique permits the counting of the Langerhans´ cells per mm2. Their mean number varied between 888-987 cells per mm2 in control subjects with the three staining procedures. In patients with psoriasis, the number of cells before treatment was between 1110-1179 in uninvolved skin and 521-1001 per mm2 in the lesions as measured using both monoclonal antibodies and ATPase. However, the latter technique seemed to be inappropriate for lesional skin. After treatment with PUVA bath or oral PUVA with or without etretinate, fewer Langerhans´ cells were seen in both lesions and normal appearing skin with the appearance of giant Langerhans´ cells with long dendrites. In patients healed with anthralin + UV-B the Langerhans´ cells appeared normal in number and size.

Comparison of trioxsalen bath and oral methoxsalen PUVA in psoriasis

Fifty patients with chronic plaque psoriasis were treated with trioxsalen bath PUVA and 43 patients with oral methoxsalen PUVA. The two treatment regimens gave similar results; 75% and 77% of the patients had excellent or good clearing and a follow-up of one year revealed relapses in 61% and 58% of the patients, respectively. The cumulative UVA dose remained significantly lower in bath PUVA (mean 23.5 J/cm2) than in oral PUVA (mean 131 J/cm2). Nausea and headache occurred in 21% of the patients receiving oral PUVA but in none in the bath PUVA group. Local side-effects were found in 30% of the patients receiving bath PUVA and in 17% of the patients in the oral PUVA group.

Treatment of pityriasis rubra pilaris with an oral aromatic retinoid (RO 10--9359)

A patient with widespread PRP was first treated with an oral aromatic retinoid (RO 10--9359) and PUVA in successive periods. Retinoid treatment resulted in marked improvement but during PUVA treatment the disease became re-activated. The patient was finally treated with aromatic retinoid alone, which brought the disease to remission in 6 weeks.

Current status of oral PUVA therapy for psoriasis.

Current status of oral PUVA therapy for psoriasis.

Combined therapy with oral retinoid and PUVA baths in severe psoriasis.

Combined therapy with oral retinoid and PUVA baths in severe psoriasis.

Dark effect of 8-methoxypsoralen (8-MOP) on lymphocytes.

In order to find, whether 8-MOP has an inhibiting effect on the proliferation of lymphocytes in the dark, we studied in vitro the lymphocyte proliferation by a mitogen (HgCl2) and by an antigen (tuberculin) from 16 psoriatic patients during the first oral PUVA treatment immediately before 8-MOP intake (03.--0.5 mg/kg body weight), 2 h later (time of maximal serum concentration) and after 24 h. The percentages of B- and T-lymphocytes were measured from 15 other psoriatic patients at equal times. There was a significant decrease (P less than 0.05) of the lymphocyte proliferation after stimulation with HgCl2 in culture, 2 h after 8-MOP, returning completely to the starting range after 24 h. On the contrary, neither the proliferation capacity of lymphocytes after stimulation with tuberculin nor the percentages of B- and T-lymphocytes were significantly changed. Obviously, 8-MOP, even without UVA irradiation, has a direct inhibiting effect on lymphocyte proliferation in concentrations therapeutically used. However, this effect is seen only with stimulation by a mitogen, not by an antigen. It cannot be explained by a change in the ratio between B- and T-lymphocytes.