In 1974, a new therapeutic approach to psoriasis based on photochemotherapy with psoralen and ultraviolet A radiation (PUVA) was introduced.1 Assessments of its long-term safety continue. Adding to earlier observations about cyclosporine and cutaneous psoriasis,2 in this issue of the Archives data supporting the efficacy of therapy for psoriatic arthritis based on immunosuppression with cyclosporine are presented.3 There are likely to be many parallels in the evolution of the role of PUVA and cyclosporine as treatments for psoriasis.
Since psoriasis is a chronic disease, initial clearing is only the first step in a continued effort to control both the cutaneous and extracutaneous manifestations of this disease. Previous experience with these treatments and knowledge about their mechanism of action raise substantial concern about their safety in long-term use for a chronic, often disabling, but not life-threatening disease.
Today, with cyclosporine therapy we are at a point similar to where we were
Stern RS. Risk Assessment of PUVA and CyclosporineLessons From the Past; Challenges for the Future. Arch Dermatol. 1989;125(4):545-547. doi:10.1001/archderm.1989.01670160093019