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March 20, 2019

Psoralen Plus UV-A Therapy in the 21st Century: Use It or Lose It

Author Affiliations
  • 1Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
JAMA Dermatol. 2019;155(5):529-531. doi:10.1001/jamadermatol.2018.5844

Our readership may question why JAMA Dermatology is publishing a study on psoralen plus UV-A (PUVA), an old therapeutic modality now rarely used in the United States. Not surprisingly, most residents and junior faculty have never ordered or administered PUVA, and more seasoned dermatologists may only remember the uncommon but horrific complications of secondary skin cancers, at times leading to death. In this issue, Vieyra-Garcia et al,1 to our knowledge, show for the first time in a prospective randomized clinical trial that low-dose, low-frequency induction oral PUVA followed by maintenance is very effective in the treatment of early mycosis fungoides (MF), and results in a safe, low cumulative dose of UV-A. Moreover, another recent publication from the same research group using a high-throughput sequencing assay indicates that PUVA can eradicate malignant T-cell clones in MF patch lesions, while shifting the tumor-infiltrating lymphocytes from a helper T cell, type 2 (TH2) to a TH1 cytokine profile and promoting an immune response to resolve more advanced lesions.2 These studies raise the question of whether we should resurrect PUVA in our treatment armamentarium.