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February 1979

Photo-onycholysis Secondary to Psoralen Use

Arch Dermatol. 1979;115(2):235. doi:10.1001/archderm.1979.04010020069028

To the Editor.—  I was interested in the report of Rau and his colleagues, in the March Archives, on photo-onycholysis occurring from sun exposure during psoralen treatment (114:448, 1978). They state that there are no reports of this in the medical literature. However, the association was described in two cases by Zala etal.1 These patients were treated with methoxsalen and sun exposure for vitiligo. My colleague, Vella Briffa, and I reported a case of a patient undergoing psoralen -ultraviolet-A therapy for mycosis fungoides.2 Rau and his colleagues list many other causes of photo-onycholysis, one they do not mention is porphyria. Recently, a woman with porphyria variegata came to me for treatment of photo-onycholysis of all her fingernails.Common to all the conditions in which photo-onycholysis has been described is the ability of long-wave ultraviolet light to penetrate the nail plate, whereas the shorter wavelength ultraviolet light does

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