Comparison of Therapeutic Efficacy of Topical PUVA, Oral Etretinate, and Combined PUVA and Etretinate for the Treatment of Psoriasis and Development of PUVA Lentigines and Antinuclear Antibodies

Abstract

Sixty‐two and 38 psoriatic patients were treated with topical PUVA and combined etretinate and topical PUVA (Re‐PUVA), respectively. In both groups, 50% of the patients showed initial recovery after 6 weeks and over 90% after 14 weeks. Re‐PUVA was more effective than PUVA alone in obtaining complete clearance (p<0.05). To clear psoriasis in 50% of the patients, PUVA and Re‐PUVA required 63 and 26 weeks, respectively. Furthermore, the integrated clearance rates after 70 weeks were 50% in PUVA and 63% in Re‐PUVA. Each therapy showed a similar remission period; psoriasis recurred in 50% of the patients after 4 months. In addition, 17 patients were treated with oral etretinate, and Re‐PUVA was found to be more effective than etretinate monotherapy. Another aim was to determine whether etretinate would inhibit the development of PUVA side effects. Adding etretinate failed to inhibit the production of PUVA lentigines but clearly suppressed antinuclear antibody (ANA) expression. Six of 56 patients treated with PUVA alone developed ANA during the treatment. In marked contrast (p=0.05), ANA was detected in none of 34 patients treated with Re‐PUVA.

Treatment of a Case of Mycosis Fungoides and One of Parapsoriasis en Plaque with Topical PUVA Using a Monofunctional Furocoumarin Derivative, 4,6,4'‐Trimethylangelicin

“…Furthermore, we have previously demonstrated that TMA possesses much lower phototoxicity on human skin than 8MOP (13). As a likely result of this property of TMA, our patients did not develop phototoxic erythema reactions, severe pigmentation, or PUVA lentigines, which are the adverse effects commonly observed with topical 8MOP PUVA (21). This is a preliminary report of TMA PUVA in the treatment of mycosis fungoides, but it suggests some interesting possibilities.…”

Treatment of PUVA‐ and Retinoid‐PUVA‐resistant Severe Psoriasis with Systemic Cyclosporin A

“…The overall efficacy of CyA was higher than that of PUVA, retinoids, or combined Re-PUVA, as assessed in our institute (13). Initiating treatment of psoriasis with CyArather than other more conventional therapies is not recommended for all patients, however, because the risk-benefit ratio of CyA treatment has not been fully determined.…”

“…Patients Twenty patients were selected for this study from our cohort of 400 because of the severity of their psoriasis and its unresponsiveness to conventional therapies. As summarized in Table 1, 17 patients had been treated with our standard regimen of topical PlNA (13). Complete clearance had been achieved in 9, but these patients had subsequently become resistant to PlNA therapy.…”

“…Recent studies have shown that intralesional CyA is also effective (9,10). We have extensive experience treating psoriasis with photochemotherapy (PlNA) (11,12) and retinoids (13), and we have a cohort of 400 patients in our clinic. A significant proportion of these patients has been treated successfully, but a considerable number have not responded or have become resistant to these conventional treatments.…”

Topical PUVA, Etretinate, and Combined PUVA and Etretinate for Palmoplantar Pustulosis: Comparison of Therapeutic Efficacy and the Influences of Tonsillar and Dental Focal Infections

“…The initial irradiation dose was 1.0j/em"; the UVA dose was subsequently increased to 1.5, 2.0JI ern", and up to the therapeutic dose by 1.0 j/cm 2 increases. The therapeutic UVA dose was just below the phototoxic dose, and the maximum dose used in this study was 9.0 j/em", Etretinate Etretinate (Tigasonw, Nippon Roche Co., Tokyo, japan) was administered orally at a daily dose of 1.0 mg/kg body weight in the initial four weeks; the dose was decreased to 0.5 mg/kg thereafter (12).…”