Twelve patients with extensive lichen planus, resistant to different regimes of prior external and internal therapy, were treated with PUVA-bath photochemotherapy (psoralen bath followed by UVA irradiation) using bath water containing 0.5 mg/L of 8-methoxypsoralen (8-MOP). In 11 of the 12 patients, the skin lesions showed a significant improvement or even complete remission within six weeks of treatment. In one patient, only limited clinical improvement could be achieved. A mean of 19.1 (SD +/- 3.6) PUVA-bath treatments were carried out. The mean cumulative UVA-dose given until clearance of the lichen planus was 16.7 (SD +/- 4.8) J/cm2. No side effects were seen except an increased phototoxic reaction in two patients manifested as slight erythema. The results of this trial show, that PUVA-bath photochemotherapy with 8-MOP is an effective therapeutic alternative to all other known therapies in the treatment of extensive, exanthematic and also hypertrophic-hyperkeratotic lichen planus. In comparison to oral PUVA therapy and PUVA-bath therapy using 4,s',8-trimethoxypsoralen, balneophotochemotherapy with 8-MOP shows an excellent efficiency-side effect correlation. The clearance of the refractive skin lesions by balneophotochemotherapy with 8-MOP demonstrates the superiority of this therapy over all other common therapeutic modalities used for lichen planus.
Although the association between administration of the antitumor agent bleomycin and the development of cutaneous fibrosis is established, there are only a small number of cases of bleomycin-induced scleroderma described in the literature. We report the development of generalised scleroderma with wide spread hyperpigmentation in a 52-year-old male patient, who received a total dose of 360 mg bleomycin in combination with cisplatin and etoposid for therapy of a malignant testicular seminoma. The clinical cutaneous alterations as well as the histological findings were indistinguishable from those encountered in progressive systemic sclerosis (PSS). In contrast to PSS however, Raynaud's phenomenon, cutaneous calcinosis, teleangiectasia, arthritis and involvement of additional organs were all absent. PSS-typical auto-antibodies were negative. Even 18 months after discontinuation of the drug and treatment with UVA1 phototherapy (3-4 times per week with 20 J/cm2) as well as physiotherapy, the skin changes had still not resolved. Based on our case and a detailed review of the literature, we discuss characteristics of bleomycin-induced scleroderma including pathogenesis, treatment modalities and course.
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