Summary
Oral psoralen photochemotherapy was introduced for the treatment of psoriasis in the mid-1970s. Since then it has become an established technique, generally giving good clearance rates of affected areas, and its usefulness has extended to treatment of other conditions. It is popular with patients but possible ocular complications must be avoided and the potential for carcinogenesis should be recognised. Although essentially palliative rather than curative, it has achieved major successes in the treatment of psoriasis and cutaneous T-cell lymphoma, and is also of benefit in the management of vitiligo. This article reviews over a decade of clinical and laboratory findings. Therapeutic responses are summarised and consideration is given to the protection of patients and staff.
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References
Abel EA, Cox AJ, Farber EM. Epidermal dystrophy and actinic kertoses in psoriasis patients following oral psoralen photochemotherapy (PUVA). Journal of the American Academy of Dermatology 7: 333–340, 1982
Addo HA, Sharma SC. UVB phototherapy and photochemotherapy (PUVA) in the treatment of polymorphic light eruption and solar urticaria. British Journal of Dermatology 116: 539–547, 1987
Baydoun S, Young A. Furocoumarin photosensitization: wavelength dependence of monoaduct and crosslink formation in yeast. In Moreno G et al. (Eds) Photosensitization, pp. 305–310, Springer-Verlag, Berlin, 1988
Bickers DR. Photochemotherapy of psoriasis: risk:benefit ratio. Journal of the American Academy of Dermatology 4: 90–93. 1981
Bickers DR. Position paper — PUVA therapy. Journal of the American Academy of Dermatology 8: 265–270, 1983
Bleehen SS. Freckles induced by PUVA treatment. British Journal of Dermatology 99: 20, 1978
Brickl R, Schmid J, Koss FW. Clinical pharmacology of oral psoralen drugs. Photodermatology 1: 174–186, 1984
Buck HW, Magnus IA, Porter AD. The action spectrum of 8-methoxypsoralen for erythema in human skin. British Journal of Dermatology 72: 249–255, 1960
Cloud TM, Hakim R, Griffin AC. Photosensitization of the eye with methoxsalen. Archives of Ophthalmology 64: 346–351, 1960
Cox AJ, Abel EA. Epidermal dystrophy: occurrence after psoriasis therapy with psoralen and long-wave ultraviolet light. Archives of Dermatology 115: 567–570, 1979
Cox NH, Jones SK, Downey DJ, Tuyp EJ, Japy JL, et al. Cutaneous and ocular side-effects of oral photochemotherapy. British Journal of Dermatology 116: 145–152, 1987
Cripps DT, Lowe KJ, Lerner AB. Action spectra of topical psoralens: a re-evaluation. British Journal of Dermatology 107: 77–82, 1982
Davey JB, Diffey BL, Miller JA. Eye protection in psoralen photochemotherapy. British Journal of Dermatology 104: 295–300, 1981
Edelson R, Berger C, Gassparro F, Jegasothy B, Heald P, et al. Treatment of cutaneous T-cell lymphoma by extracorporeal photochemotherapy. New England Journal of Medicine 316: 297–303, 1987
Ehrsson H, Nilsson SO, Ehrnebo M, Wallin I, Wennersten G. Effects of food on kinetics of 8-MOP. Clinical Pharmacology and Therapeutics 25: 167–171, 1979
Eskelinen A, Halme K, Lassus A, Idanpaan-Heikkila J. Risk of cutaneous carcinoma in psoriatic patients treated with PUVA. Photodermatology 2: 10–14, 1985
Farber EM, Abel EA, Cox AJ. Long-term risk of psoralen and UV-A therapy for psoriasis. Archives of Dermatology 119: 426–431, 1983
Farr PM, Diffey BL. Treatment of actinic prurigo with PUVA: mechanism of action. British Journal of Dermatology 120: 411–418, 1989
Fenton DA, Wilkinson JD. Dose-related visual field defects in patients receiving PUVA therapy. Lancet 1: 1106, 1983
Forrest JB, Forrest JH. Malignant melanoma arising during drug therapy for vitiligo. Journal of Surgery and Oncology 12: 337–340, 1980
Freeman RG, Troll D. Photosensitization of the eye by 8-methoxypsoralen. Journal of Investigative Dermatology 53: 449–453, 1969
Fritsch P, Honigsmann H. Combination phototherapy: a critical reappraisal. Current Problems in Dermatology 15: 238–253, 1986
Fulton Jr JE, Leyden J, Papa C. Treatment of vitiligo with topical methoxsalen and blacklite. Archives of Dermatology 100: 224–229, 1969
Gibbs NK, Honigsmann H, Young AR. PUVA treatment strategies and cancer risk. Lancet 1: 150–151, 1986
Gilchrist A, Parrish JA, Tannenbaum L, Hagnes HA, Fitzpatrick TB. Oral methoxsalen photochemotherapy of mycosis fungoides. Cancer 38: 683–689, 1976
Gould PW, Wilson L. Psoriasis treated with clobetasol proprionate and photochemotherapy. British Journal of Dermatology 98: 133–136, 1978
Gschnait F, Wolff K, Honigsmann H. Long-term photochemotherapy. British Journal of Dermatology 103: 11–22, 1980
Guiotto A, Rodighiero P, Manxinin P, Pastorini G, Bordin F, et al. 6-methylangelicin: a new series of potential photochemotherapeutic agents for the treatment of psoriasis. Journal of Medical Chemistry 27: 959–967, 1984
Hammershoy O, Jessen F. A retrospective study of cataract formation in 96 patients treated with PUVA. Acta Dermato-Venereologica 62: 444–446, 1982
Hashimoto K, Kumakiri M. Colloid-amyloid bodies in PUVA treated human psoriatic patients. Journal of Investigative Dermatology 72: 70–80, 1979
Henseler T, Christophers E, Honigsmann H, Wolff K. Skin tumours in the European PUVA study. Journal of the American Academy of Dermatology 16: 108–116, 1987
Henseler T, Wolff K, Honigsmann H, Christophers E. Oral 8-methoxypsoralen photochemotherapy of psoriasis: the European study; a co-operative study among 18 European centres. Lancet 1: 853–857, 1981
Herfst MF, Wolff FA. Influence of food on the kinetics of 8-MOP in serum and suction blister fluid in psoriatic patients. European Journal of Clinical Pharmacology 23: 75–80, 1982
Honigsmann H, Jaschke E, Gschnait F, Brenner W, Fritsch P, et al. 5-Methoxypsoralen (Bergapten) in photochemotherapy of psoriasis. British Journal of Dermatology 101: 369–378, 1979
Kaidbey KH. An action spectrum for 8-methoxypsoralen-sensitized inhibition of DNA synthesis in vivo. Journal of Investigative Dermatology 85: 98–101, 1985
Kemmett D, Reshad H, Baker H. Nodular malignant melanoma and multiple squamous cell carcinomas in a patient treated by photochemotherapy for psoriasis. British Medical Journal 289: 1498, 1984
Kenicer KJA, Lakshmipathi T, Addo HA, Johnson BE, FrainBell W. An assessment of the effect of photochemotherapy (PUVA) and UV-B phototherapy in the treatment of psoriasis. British Journal of Dermatology 105: 629–639, 1981
Lafond G, Roy PE, Grenier R. Lens opacities appearing during therapy with methoxsalen and long-wavelength ultraviolet radiation. Canadian Journal of Ophthalmology 19: 173–175, 1984
Lassus A, Reunala T, Idanpaan-Heikkila J, Juvakoski T, Salo O. PUVA treatment and skin cancer: a follow-up study. Acta Dermato-Venereologica 61: 141–145, 1981
Lerman S, Megaw J, Garner K. Psoralen-long wave ultraviolet therapy and human cataractogenesis. Investigative Ophthalmology 23: 801–804, 1982
Lerman S, Megaw J, Willis I. Potential ocular complications from PUVA therapy and their prevention. Journal of Investigative Dermatology 74: 197–199, 1980
Levins PC, Gange RW, Momtaz TK, Parrish JA, Fitzpatrick TB. A new liquid formulation of 8-methoxypsoralen: bioactivity and effect of diet. Journal of Investigative Dermatology 82: 185–187, 1984
Lobel E, Paver K, King R, Le Guay J, Pozzer K, et al. The relationship of skin cancer to PUVA therapy in Australia. Australasian Journal of Dermatology 22: 100–103, 1981
Lowe NJ, Urbach F, Bailion P, Weingarten DPP. Comparative efficacy of two dosage forms of oral methoxsalen in psoralens plus ultraviolet A therapy of psoriasis. Journal of the American Academy of Dermatology 16: 994–998, 1987
Marx JL, Auerbach R, Possick P, Myrow R, Gladstein AH, et al. Malignant melanoma in situ in two patients treated with psoralens and ultraviolet A. Journal of the American Academy of Dermatology 9: 904–911, 1983
Melski JW, Tannenbaum L, Parrish JA, Fitzpatrick TB, Bleich HL. Oral methoxsalen photochemotherapy for the treatment of psoriasis: a co-operative clinical trial. Journal of Investigative Dermatology 68: 328–335, 1977
Morison WL, Montaz K, Parrish JA, Fitzpatrick TB. Combined methotrexate-PUVA in the treatment of psoriasis. Journal of the American Academy of Dermatology 6: 46–51, 1982
Morison WL, Parrish JA, Fitzpatrick TB. Controlled study of PUVA and adjunctive topical therapy in the management of psoriasis. British Journal of Dermatology 98: 125–132, 1978
Mortazawi SAM. Meladinine mit UVA bei vitiligo, psoriasis, parapsoriasis under akne vulgaris. Dermatologische Monatsschrift 158: 908–911, 1972
Moseley H. Non-ionising radiation, Adam Hilger, Bristol, 1988
Moseley H, Cox NH, MacKie RM. The suitability of sunglasses used by patients following ingestion of psoralen. British Journal of Dermatology 118: 247–253, 1988
Moseley H, Davison M, MacDonald I. A system for solar radiation data storage and analysis. Photodermatology 3: 249–255, 1986
Moseley H, Davison M, MacKie RM. Measurements of daylight UVA in Glasgow. Physics in Medicine and Biology 28: 589–597, 1983
Moseley H, Diffey BL, Marks JM, MacKie RM. Personal solar UVA doses received by patients undergoing oral psoralen photochemotherapy for psoriasis. British Journal of Dermatology 105: 573–577, 1981
Mutzhas MF, Holzle E, Hofmann C, Plewig G. A new apparatus with high radiation energy between 320–460nm: physical description and dermatological applications. Journal of Investigative Dermatology 76: 42–47, 1981
Nakagawa H, Rhodes AR, Momtaz-TK, Fitzpatrick TB. Morphologic alterations of epidermal melanocytes and melanosomes in PUVA lentigines. Journal of Investigative Dermatology 82: 101–107, 1984
Niemi K-M, Niemi A, Kanerva L. Morphologic changes in epidermis of PUVA treated patients with psoriasis with or without a history of arsenic therapy. Archives of Dermatology 119: 904–909, 1983
Ortell B, Tanew A, Honigsmann H. Vitiligo treatment. In Honigsmann H (Ed.) Current problems in dermatology, vol.16, pp. 265–271, Karger, Basel, 1986
Parrish JA, Fitzpatrick TB, Tanenbaum L, Pathak MA. Photochemotherapy of psoriasis with oral methoxsalen and long-wave ultraviolet light. New England Journal of Medicine 291: 1207–1211, 1974
Pathak MA. Mechanisms of psoralen photosensitization reactions. National Cancer Institute Monograph 66: 41–46, 1984
Pathak MA, Daniels F, Hopkins CE, Fitzpatrick TB. Ultraviolet carcinogenesis in albino and pigmented mice receiving furocoumarins: psoralen and 8-methoxypsoralen. Nature 183: 728–730, 1959
Pathak MA, Joshi PC. Production of active oxygen species (1O2 and O2) 1O2 by psoralens and ultraviolet radiation (320-400n). Biochimica et Biophysica Acta 798: 115–126, 1984
Pathak MA, Mosher BD, Fitzpatrick TB, Parrish JA. Relative effectiveness of three psoralens and sunlight in repigmentation of 365 vitiligo patients. Journal of Investigative Dermatology 74: 252, 1980
Pierard GE, Ackerman AB. Histopathology of remodelling induced by PUVA in the superficial dermis. British Journal of Dermatology 100: 251–256, 1979
Pierard GE, Franchimont C, Van Cauwenberge D. PUVA and specific changes in the superficial dermis. In Farber EM & Cox AJ (Eds) Proceedings of the Third International Symposium on Psoriasis, pp. 459–460, Grune and Stratton Inc, New York, 1982
Plewig G, Holzle E, Lehmann P. Phototherapy for the photodermatoses. In Honigsmann H (Ed.) Current problems in dermatology, vol. 15, pp. 254–264, Karger, Basel, 1986
Powell FC, Spiegel GT. Treatment of parapsoriasis and mycosis fungoides: the role of psoralen and long wave ultraviolet light A (PUVA). May Clinic Proceedings 59: 538–546, 1984
Ree K. Reduction of Langerhans cells in human epidermis during PUVA therapy. Journal of Investigative Dermatology 78: 488–492, 1982
Reshad H, Challoner F, Pollock DJ, Baker H. Cutaneous carcinoma in psoriatic patients treated with PUVA. British Journal of Dermatology 110: 299–305, 1984
Rhodes AR, Stern RS, Melski JW. The PUVA lentigo: an analysis of predisposing factors. Journal of Investigative Dermatology 81: 459–463, 1983
Roenigk HH. Photochemotherapy for psoriasis. Archives of Dermatology 115: 576–579, 1979
Rogers S, Marks J, Shuster S, Hillyard CJ. Effect of PUVA on serum 25-OH vitamin D in psoriatics. British Medical Journal 2: 833–834, 1979
Ros A-M, Wennersten G, Lagerholm B. Long-term photochemotherapy for psoriasis. Acta Dermato-Venereologica 63: 215–221, 1983
Souteyrand P, Thivolet J, Fulton R. Treatment of parapsoriasis on plaques and mycosis fungoides with an oral aromatic retinoid (RO 10-9359). In Orfanos CE (Ed.) Retinoids: advances in basic research and therapy, pp. 313–316, Springer, Berlin, 1981
Stern RS, Laird N, Melski J, Parrish JA, Fitzpatrick TB, et al. Cutaneous squamous cell carcinoma in patients treated with PUVA. New England Journal of Medicine 310: 1156–1161, 1984
Stern RS, Parrish JA, Fitzpatrick TB. Ocular findings in patients treated with PUVA. Journal of Investigative Dermatology 85: 269–273, 1985
Strauss GH, Bridges BA, Greaves M, Hall-Smith P, Price M, et al. Inhibition of delayed hypersensitivity reaction in skin (DNCB test) by 8-methoxypsoralen photochemotherapy. Lancet 2: 556–559, 1980
Tanew A, Ortel B, Wolff K, Honigsmann H. PUVA for cutaneous T-cell lymphoma: 10 years after. In Honigsmann H (Ed.) Current problems in dermatology, Vol. 15, pp. 232–237, Karger, Basel, 1986
Turjammaa K, Salo H, Rennala T. Comparison of trioxsalen bath and oral methoxsalen PUVA in psoriasis. Acta Dermato-Venereologica (Stockholm) 65: 86–88, 1985
Volden G. PUVA. In Mier PD & van de Kerkhof PCM (Eds) Text book of psoriasis, pp. 211–232, Churchill-Livingstone, 1986
Weber G. Photochemotherapy. Year Book Medical Publishers, Chicago, London, 1980
Wolff K. PUVA Klinik and Praxis. In Braun-Falco O & Wolff HH (Eds) Fortschritte der praktischen Dermatologie und Venereologie, BD9 pp. 129–138, Springer Verlag, Berlin-Heidelberg, 1979
Wolff K, Honigsmann H. Safety and therapeutic effectiveness of selected psoralens in psoriasis. National Cancer Institute Monograph 66: 159–164, 1984
Woo TY, Wong RC, Wong JM, Anderson TF, Lerman S. Lenticular psoralen photoproducts and cataracts of a PUVA-treated psoriatic patient. Archives of Dermatology 121: 1307–1308, 1985
Young AR, Magnus IA, Davies AC, Smith NP. A comparison of the phototumorigenic potential of 8-MOP and 5-MOP in hairless albino mice exposed to solar simulated radiation. British Journal of Dermatology 108: 507–518, 1983
Zelickson AS, Mottaz JH, Muller SA. Melanocyte changes following PUVA therapy. Journal of the American Academy of Dermatology 1: 422–430, 1979
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Moseley, H., Ferguson, J. Photochemotherapy. Drugs 38, 822–837 (1989). https://doi.org/10.2165/00003495-198938050-00007
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DOI: https://doi.org/10.2165/00003495-198938050-00007