PHOTOCHEMOTHERAPY OF PSORIASIS
Corresponding Author
ULLA-BRITT NIETSCHE M.D.
Department of Dermatology, University Hospital, Trornsoe, Norway
2 Ulla-Britt Nietsche, M. D., Department of Dermatology, Malmo Allmanna Sjukhus, Malmo, Sweden.Search for more papers by this authorCorresponding Author
ULLA-BRITT NIETSCHE M.D.
Department of Dermatology, University Hospital, Trornsoe, Norway
2 Ulla-Britt Nietsche, M. D., Department of Dermatology, Malmo Allmanna Sjukhus, Malmo, Sweden.Search for more papers by this authorAbstract
ABSTRACT: Orally administered 8-methoxypsoralen followed by irradiation with longwave ultraviolet light (UVA, 320–400 nm, maximum 365 nm) resulted in 90–100% clearing in 24 of 26 psoriasis patients. Recurrence could be prevented by maintenance treatment. The treatment was tolerated well; no serious side effects were observed. A moderate increase of serum transaminase values was observed in 6 patients; in 5, these values became normal in a short time. The connection between these enzyme increases and the treatment is uncertain. At completion of the treatment the skin is universally, evenly hyperpigmented—a side effect considered positive by the patients.
References
- 1 Perry, H. O., Soderstrom, C. W., and Schulze, R. W.: The Goeckerman treatment for psoriasis. Arch. Dermatol. 98: 178, 1968.
- 2 Weinstein, G. D., and Frost, P.: Abnormal cell proliferation in psoriasis. J. Invest. Dermatol. 50: 254, 1968.
- 3 Epstein, E., Jr., and Ugel, A. R.: Effects of topical mechlorethamine on skin lesions of psoriasis. Arch. Dermatol. 102: 504, 1970.
- 4 Roenigk, H. H., Jr., Maibach, H. I., and Weinstein, G. P.: Methotrexate therapy for psoriasis. Arch. Dermatol. 108: 35, 1973.
- 5 Milstein, H. C., Cornell, R. C., and Stoughton, R. B.: Azaribine in the treatment of psoriasis. Arch. Dermatol. 108: 43, 1973.
- 6 Leavel, U. W., and Yarbro, J. W.: Hydroxyurea, A new treatment for psoriasis. Arch. Dermatol. 102: 144, 1970.
- 7 Parrish, J. A., Fitzpatrick, T. B., Tanenbaum, L., and Pathak, M. A.: Photochemotherapy of psoriasis with oral methoxsalen and longwave ultraviolet light. N. Engl. J. Med. 291: 1207, 1974.
- 8 Pathak, M. A., Allen, B., Ingram, D. J. E., and Fellman, J. H.: Photosensitization and the effect of ultraviolet radiation on the production of unpaired electrons in the presence of furocoumarins (Psoralens). Biochim. Biophys. Acta. 54: 506, 1961.
- 9 Musajo, L., Rodighiero, G., and Dall'Acqua, F.: Evidence of a photoreaction of the photosensitizing furocoumarins with DNA and with pyrimidine nucleosides and nucleotides. Expeirentia 21: 24, 1965.
- 10 Musajo, L., and Rodighiero, G.: Studies on the photo-C4-cyclo-addition reactions between skin-photosensitizing furocoumarins nucleic acids. Photochem. Photobiol. 11: 27, 1970.
- 11 Pathak, M. A., and Kraemer, D. M.: Photosensitization of skin in vivo by furocoumarins (psoralens). Biochim. Biophys. Acta. 195: 197, 1969.
- 12 Rodighiero, G., Musajo, L., Dall'Acqua, F., Marciano, S., Caporale, G., and Ciavatta, L.: wiechanism of skin photosensitization by furocoumarins Photoreactivitf of various furocoumarins with native DNA and with ribosomal RNA. Biochim. Biophys. Acta. 217: 40, 1970.
- 13 Baden, H. P., Parrington, J. M., Delhanty, J. D. A., et al.: DNA synthesis in normal and xeroderma pigmentosum fibroblasts following treatment with 8-methoxypsoralen and longwave ultraviolet light. Biochim. Biophys. Acta. 262: 247, 1972.
- 14 Cole, R. S.: Light-induced cross-linking of DNA in the presence of a furocoumarin (psoralen). Biochim. Biophys. Acta. 217: 30, 1970.
- 15 Dall'Acqua, F., Marciani, S., Ciavatta, L., et al.: Formation of interstrand crosslinks in the photoreactions between furocoumarins and DNA. 2. Naturforsch. (B) 26: 561, 1971.
- 16 Epstein, J. H., and Fukuyama, K.: A study of 8-methoxypsoralen induced phototoxic effects on mammalian epidermal macromolecule synthesis in vivo. Photochem. Photobiol. 21: 325, 1975.
- 17 Walter, J. F., and Voorhees, J. J.: Psoralen plus black light inhibits epidermal DNA synthesis. Arch. Dermatol. 107: 861, 1973.
- 18 Walter, J. F., and Voorhees, J. J.: Psoriasis improved by psoralen plus black light. Acta Derm. Venereol. 53: 468, 1973.
- 19 Wolff, K., Monigsman, H., Gschnait, F., and Konrad, K.: Photochemotherapie bei psoriasis. Dtsch. Med. Wochenschr. 100: 2471, 1975.
- 20 Fitzpatrick, T. B., Arndt, K. A., El Mofty, A. M., and Pathak, M. A.: Hydroquinone and psoralens in the therapy of hyperrnelanosis and vitiligo Arch. Dermatol. 93: 589, 1966.
- 21 Pathak, M. A., et al.: The effect of structural alterations on the erythemal activity of furocoumarins: psoralens. J. Invest. Dermatol. 35: 165, 1960.
- 22 Pathak, M. A., and Epstein, J. H.: Normal and abnormal reactions of man to light. In Dermatology in General Medicine. Edited by T. Fitzpatrick, et al. New York , McCraw-Hill, 1971, pp. 977–1036.
- 23 Fitzpatrick, T. B., and Pathak, M. A.: Historical aspects of methoxsalen and other flurocoumarins. J. Invest. Dermatol. 32: 229, 1959.
- 24 Fitzpatrick, T. B., Hopkins, C. E., Blickenstaff, D. D., and Swift, S.: Augmented pigmentation and other responses of normal human skin to solar radiation following oral administration of 8-methoxypsoralen. J. Invest. Dermatol. 25: 187, 1955.
- 25 Daniels, F., Jr., Hopkins, C. E., and Fitzpatrick, T. B.: Effect of oral methoxsalen (8-methoxypsoralen) on sunburn and suntan. Arch. Dermatol. Syphilol. 77: 503, 1958.
- 26 Imbrie, J. D., Daniels, F., Jr., Bergeron, L., Hopkins, C. E., and Fitzpatrick, T. B.: Increased erythroderma threshold six weeks after a single exposure to sunlight plus oral methoxsalen. J. Invest. Dermatol. 32: 331, 1959.
- 27 Parrish, J. A., Pathak, M. A., and Fitzpatrick, T. B.: Prevention of overexposure in topical psoralen treatment of vitiligo. Ach. Dermatol. 104: 281, 1971.
- 28 Tronnier, H., and Loehnig, R.: About the current status of the methoxalen-UV-A-therapy in dermatology. Castellania 2: 267, 1974.
- 29 Tronnier, H., and Schule, D.: Zur dermatologischen Therapie von Dermatosen mit langwelligem UV nach photosensibilisierung der Haut mit Methoxsalen. Erste Ergebnisse bei der Psoriasis vulgaris. Z. Hautke. 48: 385, 1973.
- 30 Weber, G.: Combined 8-methoxypsoralen and black light therapy of psoriasis. Technique and results. Br. J. Dermatol. 90: 317, 1974.
- 31 Fischer, T.: Lokalbehandling av psoriasis med trioxsalen och ultraviolett Ijus. LakarsäIIskapets Riksstämma, Stockholm, 26–29, Nov. 1975, Acta Societatis Medicorum Suecanae 1975, band 84, häfte 4: 73.
- 32 Wolff, K., Honingsmann, H., Gschnait, F., and Konrad, K.: Photochemotherapie bei psoriasis. Dtsch. Med. Wochenschr. 100: 2471, 1975.
- 33 Wolff, K., et al.: Photochemotherapy of psoriasis with oral 8-methoxypsoralen. Arch. Dermatol. In press.
- 34 Swanbeck, G., Thyresson-Hok, M., Bredberg, A., and Lambert, B.: Treatment of psoriasis with oral psoralens and longwave ultraviolet light. Acta Derrn. Venereol. 55: 367, 1975.
- 35 Wolff, K. et al.: Phototesting and dosimetry for photochemotherapy. Brit. J. Derm. 96: 1, 1976.
- 36 Fischer, T.: Personal communication, 1976.
- 37 Honingsmann, H.: Personal communication, 1976.
- 38 Fitzpatrick, T. B., Imbrie, J. E., and Labby, D. H.: Studies of liver function in subjects receiving 8-methoxypsoralen. JAMA 167: 186, 1958.
- 39 Tucker, H. A.: Clinical and laboratory tolerance studies in volunteers given oral methoxsalen. J. Invest. Dermatol. 32: 277, 1959.
- 40 Freeman, R. G., and Troll, D.: Photosensitization of the eye by 8-methoxypsoralen. J. Invest. Dermatol. 53: 449, 1969.
- 41 Cloud, T. M., Hakim, R., and Griffin, A. C.: Photosensitization of the eye with methoxsalen 11 chronic needs. Arch. Ophthalmol. 66: 689, 1961.
- 42 Griffin, A. C., Hakim, R. E., and Knox, J. M.: The wavelength effect upon erythemal and carcinogenic response in psoralen treated mice. J. Invest. Dermatol. 31: 289, 1958.
- 43 Griffin, A. C.: Methoxsalen in ultraviolet carcinogenesis in the mouse. J. Invest. Dermatol. 32: 367, 1959.
- 44 Hakim, R. E., Griffin, A. C., and Knox, J. M.: Erythema and tumor formation in methoxsalen-treated mice exposed to fluorescent light. Arch. Dermatol. 82: 577 1960.
- 45 Langner, A., Wolska, H., Jarzabak-Chorzelska, M., and Pavinska, M.: Dermal toxicity of 8-methoxysoralen in hairless mice irradiated with long wave UV. J. Invest. Dermatol. 64: 279, 1975.