RT Book, Section
A1 Hönigsmann, Herbert
A1 Szeimies, Rolf-Markus
A1 Knobler, Robert
A2 Kang, Sewon
A2 Amagai, Masayuki
A2 Bruckner, Anna L.
A2 Enk, Alexander H.
A2 Margolis, David J.
A2 McMichael, Amy J.
A2 Orringer, Jeffrey S.
SR Print(0)
ID 1161346310
T1 Photochemotherapy and Photodynamic Therapy
T2 Fitzpatrick's Dermatology, 9e
YR 2019
FD 2019
PB McGraw-Hill Education
PP New York, NY
SN 9780071837798
LK accessmedicine.mhmedical.com/content.aspx?aid=1161346310
RD 2024/04/19
AB AT-A-GLANCEPhotochemotherapy  (psoralen  and  ultraviolet  A  light  [PUVA])  has  been  successfully  used  for  more  than  40  years.  Its  effectiveness  has  profoundly  influenced  dermatologic  therapy  in  general,  providing  treatment  for  many  diverse  disorders  besides  psoriasis  and  vitiligo.PUVA  can  be  combined  with  topical  treatments  and  with  some  systemic  agents  (retinoids,  methotrexate,  and,  perhaps,  biologics)  to  enhance  efficacy  and  to  reduce  the  number  of  exposures.The  most  important  adverse  effects  of  oral  PUVA  consist  of  an  increased  risk  of  squamous  cell  carcinoma  and  a  possible  risk  of  melanoma.  No  such  increased  risk  was  found  so  far  with  bath-PUVA.Extracorporeal  photochemotherapy  (ECP)  was  introduced  in  the  1980s  for  the  palliative  treatment  of  erythrodermic  cutaneous  T-cell  lymphoma.ECP  appears  to  have  a  major  impact  in  the  treatment  of  graft-versus-host  disease  after  allogeneic  bone  marrow  transplantation  where  it  allows  progressive  reduction  or  even  discontinuation  of  the  concomitant  immunosuppressive  therapy  without  an  increase  in  graft-versus-host  disease  activity.  Several  other  indications  are  under  investigation.No  serious  side  effects  have  been  reported  with  ECP.Photodynamic  therapy  (PDT)  for  skin  tumors  started  with  the  introduction  of  topical  photosensitization  by  a  porphyrin  precursor  (5-aminolevulinic  acid  or  its  methyl  ester)  that  would  avoid  generalized  light  sensitivity  over  many  weeks.Current  experience  with  PDT  of  epithelial  cancers  and  precancerous  conditions  suggests  that  actinic  keratoses,  Bowen  disease,  superficial  and  nodular  basal  cell  carcinomas,  and  early  squamous  cell  carcinomas  can  be  treated  curatively.Cosmetic  outcomes  following  PDT  are  excellent;  therefore,  it  is  also  used  for  rejuvenation  purposes,  frequently  in  combination  with  laser  treatment.The  only  significant  side  effect  of  topical  PDT  is  a  stinging  pain  during  and  shortly  after  irradiation.  With  daylight-mediated  PDT,  pain  is  no  longer  an  issue.  PDT  has  neither  mutagenic  nor  carcinogenic  potential.