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March 1992

Photochemotherapy in Systemic Sclerosis: The Stage Is Set

Author Affiliations

Division of Rheumatology Beth Israel Hospital 330 Brookline Ave, YA-401A Boston, MA 02215

Arch Dermatol. 1992;128(3):389-390. doi:10.1001/archderm.1992.01680130103014

Photochemotherapy in systemic sclerosis—remedy or nostrum? In this issue of the Archives, Rook et al1 report on the results of a randomized, investigator-blind multicenter comparison of extracorporeal photochemotherapy (photophoresis) vs penicillamine in this disease. The study represents a herculean team effort involving a number of high-quality medical centers and, overall, was well performed. It obtained evidence suggesting that photochemotherapy was more effective than penicillamine in decreasing clinical skin involvement, ascertained by gross appearance, and that it was a safer approach as well. The cornerstone for this conclusion was a frequency of 21 (68%) of 31 patients exhibiting improvement in skin scores after 6 months of photochemotherapy that contrasted to only eight (32%) of 25 patients receiving penicillamine. Serious adverse events related to penicillamine required 24% of the patients to permanently discontinue this therapy before a 10-month treatment interval had transpired. Side effects were noted in nine patients receiving photochemotherapy.

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