Cancer incidence among Finnish psoriasis patients treated with 8-methoxypsoralen bath PUVA

Hannuksela-Svahn, A; Pukkala, Eero; Koulu, Leena; Jansén, Christer T.; Karvonen, Jaakko

doi:10.1016/s0190-9622(99)70148-9

Cited by 48 publications

(43 citation statements)

References 12 publications

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“…The number of exposures (22 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] vs 23 ) and treatment duration (43 vs 44 [23-66] days) was comparable for both methoxsalen dilutions (P = .97). Median psoralen plasma levels were 0 (0-26) ng/mL after the 1 mg/L methoxsalen immersion and 30 (0-64) ng/mL after the 5 mg/L immersion (P = .001).…”

Section: Resultsmentioning

confidence: 99%

Randomized, double-blind comparison of 1 mg/L versus 5 mg/L methoxsalen bath-PUVA therapy for chronic plaque-type psoriasis

Vongthongsri

Konschitzky

Seeber

et al. 2006

Journal of the American Academy of Dermatology

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Section: Resultsmentioning

confidence: 99%

Randomized, double-blind comparison of 1 mg/L versus 5 mg/L methoxsalen bath-PUVA therapy for chronic plaque-type psoriasis

Vongthongsri

Konschitzky

Seeber

et al. 2006

Journal of the American Academy of Dermatology

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“…9,10 A large Scandinavian retrospective analysis demonstrated that bath PUVA with trimethoxypsoralen bears only a low risk of long-term carcinogenicity. 11,12 In recent years, bath PUVA has increasingly replaced oral PUVA in Germany and other European countries. In contrast to Scandinavia, in central Europe methoxsalen is commonly used instead of trimethoxypsoralen as a photosensitizer.…”

Section: Reatment Of Moderate Tomentioning

confidence: 99%

“…Nevertheless, long-term UV exposure due to repeated courses of UV treatment might be associated with an increased risk of photocarcinogenesis. 34,35 At baseline, our study participants had a median PASI of 17 (25th-75th percentile, [12][13][14][15][16][17][18][19][20][21][22][23]. Patients with this disease severity are also likely candidates for systemic antipsoriatics.…”

Section: -02mentioning

confidence: 99%

Bath PUVA and Saltwater Baths Followed by UV-B Phototherapy as Treatments for Psoriasis

Schiener¹,

Brockow²,

Franke³

et al. 2007

Arch Dermatol

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To evaluate the efficacy of psoralens dissolved in a warm-water bath followed by exposure to UV-A irradiation (bath PUVA) or saltwater phototherapy (SW UV-B) compared with tap-water phototherapy (TW UV-B) or UV-B irradiation alone in psoriasis.Design: Multisite, prospective, randomized, controlled trial with 4 parallel groups.Setting: Total of 102 dermatologic outpatient clinics.Patients: Total of 1241 patients with stable psoriasis vulgaris and a Psoriasis Area and Severity Index score of 7 or greater.Interventions: Four-times-weekly UV-B, TW UV-B, SW UV-B, or bath-PUVA with baths preceding UV irradiation over a maximum of 8 weeks. The UV dose was adapted to erythemal response.Main Outcome Measures: Incidence of therapeutic success, defined as a reduction of the Psoriasis Area and Severity Index or affected body surface area of 50% or more.Results: Patients who received TW UV-B had a significantly higher incidence of therapeutic success than did patients treated with UV-B alone (60.7% vs 43.3%; PϽ.001; number needed to treat, 5.8; 95% confidence interval [CI], 3.9-10.9). Patients who received SW UV-B or bath PUVA had a significantly higher incidence of therapeutic success than did patients treated with TW UV-B (74.9% vs 60.7%; PϽ.001; number needed to treat, 7.0; 95% CI, 4.6-14.9; and 78.4% vs 60.7%; PϽ.001; number needed to treat, 5.7; 95% CI, 4.0-9.7, respectively). Bath PUVA was not superior to SW UV-B (78.4% vs 74.9%; P=.34). Conclusion:Bath PUVA and SW UV-B are comparably effective treatments in psoriasis and superior to UV-B and TW UV-B.

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“…Among the 12 studies analysing risk of lymphoma in psoriasis compared to controls, seven showed an association between total lymphoma, [28][29][30] Hodgkin lymphoma, 30,31 nonHodgkin lymphoma [31][32][33][34] and psoriasis. Two studies 30,34 specifically assessed the risk of skin lymphoma in psoriasis and found an increased risk of cutaneous T-cell lymphomas (CTCL) associated with psoriasis.…”

Section: Cancersmentioning

confidence: 99%

Psoriasis, cardiovascular events, cancer risk and alcohol use: evidence‐based recommendations based on systematic review and expert opinion

Richard

Barnetche²,

Horreau

et al. 2013

Acad Dermatol Venereol

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The relationship between psoriasis, chronic inflammation, cardiovascular risk and risk of cancer has long been debated.In addition, it has been suggested that alcohol consumption may be a risk factor for psoriasis onset and severity.The aim of this study was to develop evidence-based recommendations on the risk of comorbidities and its management for daily clinical use, focusing on cardiovascular risk, risk of cancer and alcohol use in psoriasis.A scientific committee identified and selected through the Delphi method clinically relevant questions about cardiovascular risk, risk of cancer and alcohol use in psoriasis. To address these questions, a systematic literature search was performed in Medline, Embase and the Cochrane Library databases. Systematic literature reviews including meta-analysis whenever possible were performed. Subsequently, an Expert board meeting involving 39 dermatologists took place to analyse the evidence and to elaborate recommendations on the selected questions. Recommendations were graded according to the Oxford level of evidence grading system. The degree of agreement of these recommendations was assessed on a 10-point scale, as well as their potential impact on daily clinical practice.A total of 3242 articles were identified through the systematic literature searches, among which 110 were included in the systematic reviews. Overall, 12 recommendations were elaborated regarding comorbidities management in psoriasis patients. A moderate increased risk of cardiovascular diseases (CVD), mainly myocardial infarction (MI) [meta-analysis of cohort studies: OR = 1.25 (95% CI 1.03-1.52) and of cross-sectional studies: OR = 1.57 (95% CI 1.08-2.27)], and coronary artery disease (CAD) [meta-analysis of cross-sectional: OR = 1.19 (95% CI 1.14-1.24), of cohort studies: OR = 1.20 (95% CI 1.13-1.27) and of case-control studies: OR = 1.84 (95% CI 1.09-3.09)] was acknowledged. This increased cardiovascular risk requires appropriate prevention measures. There was a lack of substantial evidence that conventional systemic treatment has any effect on cardiovascular risk although methotrexate might be cardioprotective. An increased risk of solid cancer potentially associated with smoking and alcohol use was identified. The role of systemic treatment on cancer risk could not be assessed thoroughly due to limited long-term follow-up data. A higher risk of non-melanoma skin cancers especially squamous cell carcinoma was shown, mainly due to previous exposure to oral 8-methoxypsoralen-ultraviolet-A (PUVA), ciclosporin and possibly methotrexate. No firm conclusion could be drawn regarding alcohol and psoriasis due to high variability in alcohol usage assessment in studies. Clinical experience suggests higher alcohol consumption among psoriasis patients compared to the general population. The mean expert participants' level of agreement on these recommendations varied from 6.8 to 9.4. These 12 recommendations are evidence based and supported by a panel of expert dermatologists. The next step is now to dis...

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Cancer incidence among Finnish psoriasis patients treated with 8-methoxypsoralen bath PUVA

Cited by 48 publications

References 12 publications

Randomized, double-blind comparison of 1 mg/L versus 5 mg/L methoxsalen bath-PUVA therapy for chronic plaque-type psoriasis

Randomized, double-blind comparison of 1 mg/L versus 5 mg/L methoxsalen bath-PUVA therapy for chronic plaque-type psoriasis

Bath PUVA and Saltwater Baths Followed by UV-B Phototherapy as Treatments for Psoriasis

Psoriasis, cardiovascular events, cancer risk and alcohol use: evidence‐based recommendations based on systematic review and expert opinion

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