PUVA-treated Patients Research Articles

Histologic, immunofluorescent, and antinuclear antibody findings in PUVA-treated patients

Twenty-two patients with psoriasis were treated with PUVA therapy for over two years. Skin biopsies from sun-exposed skin were evaluated before, during, and after PUVA therapy. No statistically significant epidermal changes were found when looking for hyperkeratosis, atrophy, melanin, or melanocyte numbers. No dyskeratosis was found. Dermal changes, including alterations in elastic tissue and collagen, were not statistically significant. Amyloid deposits were absent. The amount of mucin deposition was found to correlate with the length of PUVA therapy. In four patients, the mucin disappeared after withdrawal of PUVA, suggesting that this change is reversible.

PUVA treatment and the problem of ocular damage (author's transl)

Recently, psoriasis has been shown to respond favorably to PUVA treatment, i.e., local or systemic therapy with a photosensitizer (e.g., 8-methoxypsoralen) and subsequent long UV irradiation. The possibility of this treatment damaging the eye is discussed in the light of various experimental results. As toxic changes only occur when photosensitizer and UVA act jointly, the eyes of PUVA-treated patients must be shielded from any ultraviolet exposure by UV-absorbing protective glasses with side shields. Such glasses should have no significant absorption in the visible range. The new Spectra Shield process enables lenses to be coated in such a way that virtually no UV or IR radiation is transmitted.

Normalized light reactions in mycosis fungoides patients after complete remission of skin lesions

Eleven mycosis fungoides patients were phototested on apparently normal skin before treatment with mechlorethamine, topically in 8 patients and with methoxsypsoralen followed by longwave ultraviolet light (PUVA) in 3 patients. Abnormal photosensitivity to UVB was seen before treatment in 4, to UVA in 4, and to visible light in one patient. The abnormal photosensitivity to all wavelength regions was normalized after complete remission of the cutaneous lesions. Two of the PUVA-treated patients demonstrated that special care should be taken during the initial phase of this treatment because of the light sensitivity, especially on lesional skin.

Liver biopsy in PUVA-treated patients

Seventy-five liver biopsies were performed in 30 psoriatics and 5 patients with mycosis fungoides undergoing treatment with photochemotherapy with 8-methoxypsoralen and UVA light. All patients had pre- and post-PUVA biopsies, the latter after one year. Five psoriatics had a further biopsy after 2 1/2 years of treatment. No statistically significant differences were found between biopsies taken before and after treatment.

Polyploidization and Hemiploidization Induced by PUVA <i>in viv</i><i>o</i>

To obtain additional information on the in vivo injury induced by PUVA treatment, primary cultures were initiated from biopsies of the uninvolved skin of 15 PUVA-treated psoriatic patients, and the cells generated were analysed for morphological and chromosomal modifications. Three biopsies were obtained from each patient, the first one before commencing PUVA therapy (control) and the other two during the course of therapy. It was found that PUVA treatment has diverse effects on the mitotic activity, mitotic mechanisms and chromosomes of the cutaneous cells: (1) an inhibition of cell proliferation during the early stages of therapy followed by a reversion to normal proliferation as the PUVA treatments were continued; the production of (2) cells with more than one nucleus, (3) macrocells, (4) cells with micronuclei, (5) polyploid cells, (6) haploid cells, (7) cells with 13 chromosomes denoting a twofold reduction in the normal number of metaphase chromosomes, (8) end-associations of the chromosomes as in the pachytene phase of meiosis (9) diplotene chromosomes, and (10) chromosomal translocations.

Serum uric acid levels in untreated and PUVA-treated patients with psoriasis.

Hyperuricemia occurs frequently in patients with psoriasis. An increased purin breakdown due to the enhanced epidermal turnover was stressed as a reasonable explanation. To prove this theory serum uric acid, cholesterol, triglyceride levels and the average body overweight were determined in 318 untreated psoriatic patients and the parameters were correlated with the extent of psoriatic skin involvement. In more than 100 psoriatic patients treated by oral photochemotherapy (PUVA), uric acid serum levels were examined additionally after the PUVA clearing phase and during PUVA maintenance treatment. The present study demonstrates: (1) There is no relationship between the frequency of hyperuricemia and the extent of psoriatic skin involvement, indicating that the increased epidermal turn over may not play a role in psoriatic hyperuricemia. (2) The most reasonable explanation for elevated uric acid in psoriasis seems to be a combination of genetic predisposition and hyperalimentation. (3) No significant change was found in the incidence of hyperuricemia under the influence of photochemotherapy.