An evaluation of the treatment of parapsoriasis with phototherapy

Abstract

Whether parapsoriasis represents an early stage of T-cell cutaneous lymphoma is still the subject of controversy. We evaluated the efficacy of phototherapy in the treatment of parapsoriasis and its relation with TCCL. Patients diagnosed with parapsoriasis and treated with phototherapy PUVA or UVB-NB were selected. Between 1 to 8 years following treatment the evolution of their disease was evaluated. In 62 patients the cure rate was 79.3% and 17.2% showed improvement of the lesions. Only two patients developed full blown T-cell cutaneous lymphoma. Phototherapy is an excellent treatment for parapsoriasis, with high cure rates, regardless of the type of phototherapy employed. Of the 62 patients under study, parapsoriasis showed no general tendency to progress to T-cell cutaneous lymphoma.

Phototherapy with PUVA: Versatility and efficacy in dermatoses

“…Cell membrane and DNA damage 3 occur due to photochemical reactions that have anti-inflammatory, immunosuppressive and antiproliferative effects. 1,4 In order to determine the time and intensity of the sessions, a minimal erythematous dose (DEM), which is the minimum energy required to produce a uniform erythematous response within 24 hours, is calculated. Treatment is started with 75 to 90% of this dose.…”

“…1 PUVA treatment uses oral or topical psoralen followed by exposure to UVA irradiation. 4 Psoralens are tricyclic furocoumarins derived from plants and activated by UV rays. 4,5 The PUVA procedure with oral psoralens should be preceded by ophthalmologic evaluation and serum dosage of ALT, AST, gamma-glutamyltransferase (gamma GT), alkaline phosphatase, urea, creatinine, BHCG for women of childbearing age and antinuclear antibodies (ANA) to detect potential sensitivity to R-UVA.…”

“…4 Psoralens are tricyclic furocoumarins derived from plants and activated by UV rays. 4,5 The PUVA procedure with oral psoralens should be preceded by ophthalmologic evaluation and serum dosage of ALT, AST, gamma-glutamyltransferase (gamma GT), alkaline phosphatase, urea, creatinine, BHCG for women of childbearing age and antinuclear antibodies (ANA) to detect potential sensitivity to R-UVA. Topical PUVA, in turn, is indicated primarily for patients with hepatic or gastrointestinal dysfunction, cataract, drug interactions, and for children.…”

“…Topical PUVA, in turn, is indicated primarily for patients with hepatic or gastrointestinal dysfunction, cataract, drug interactions, and for children. 4,5 The absolute contraindications for PUVA are xeroderma pigmentosum, some genodermatoses, systemic lupus erythematosus, dermatomyositis, previous history of melanoma and trichothiodystrophy. Relative contraindications include age less than 10 years, previous or current history of non-melanoma skin cancer, immunosuppressive treatment, gestation, cataracts, severe hepatic dysfunction, and history of systemic malignant tumors.…”

“…As a late manifestation there is photoaging. 1,4,6 Medical supervision and periodic laboratory evaluation are fundamental, as well as avoiding sun exposure with the use of physical and chemical barriers during treatment. 2 This article aims to report three clinical cases, one of psoriasis, one of vitiligo and one of pityriasis alba, treated with PUVA with excellent response and, thus, show the diversity of dermatoses that can be treated with this therapeutic option.…”