RT Book, Section
A1 Hönigsmann, Herbert
A1 Szeimies, Rolf-Markus
A1 Knobler, Robert
A2 Goldsmith, Lowell A.
A2 Katz, Stephen I.
A2 Gilchrest, Barbara A.
A2 Paller, Amy S.
A2 Leffell, David J.
A2 Wolff, Klaus
SR Print(0)
ID 56103966
T1 Chapter 238. Photochemotherapy and Photodynamic Therapy
T2 Fitzpatrick's Dermatology in General Medicine, 8e
YR 2012
FD 2012
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-166904-7
LK accessmedicine.mhmedical.com/content.aspx?aid=56103966
RD 2024/04/23
AB |PrintPhotochemotherapy  and  Photodynamic  Therapy  at  a  GlancePhotochemotherapy  [psoralen  and  ultraviolet  A  light  (PUVA)]  has  been  successfully  used  for  more  than  30  years.  Its  effectiveness  has  profoundly  influenced  dermatologic  therapy  in  general,  providing  treatment  for  a  number  of  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)  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.The  only  significant  side  effect  of  topical  PDT  is  a  stinging  pain  during  and  shortly  after  irradiation.  PDT  has  neither  mutagenic  nor  carcinogenic  potential.