THE REPORT by Coven et al1 in this issue of the ARCHIVES contains some interesting information on a possible mechanism of action of psoralen–UV-A (PUVA) therapy in the treatment of psoriasis and some limited data on the efficacy of trimethylpsoralen (TMP) bath PUVA therapy. The authors conclude that in comparison with conventional PUVA therapy (oral administration of methoxsalen followed by UV-A radiation), "we believe that TMP bath PUVA therapy represents a sensible alternative for the present." This conclusion raises the obvious question: a sensible alternative for whom? For the physician in an investigative laboratory of a large university and/or the dermatologist in a solo practice far removed from such an academic environment? Rather than answering this question directly it is perhaps timely to evaluate the safety, efficacy, and appropriateness of the various alternatives to conventional PUVA therapy that have been advocated and are used.
Morison WL. Variations of PUVA: Practical and Effective? Arch Dermatol. 1998;134(10):1286–1288. doi:10.1001/archderm.134.10.1286
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