This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
—I read with interest the comments by Zachariae and colleagues in which they relate their experience with a group of patients with systemic sclerosis. Because their patients differed substantially from the ones we treated with photopheresis and would not have fulfilled the entrance requirements for our study, we cannot readily compare their observations with ours. Furthermore, their study was not blinded or randomized, and they evaluated their patients by different standards. Nevertheless, their findings may contribute to a definition of which patients might benefit from photopheresis.We concur that all patients with systemic sclerosis do not respond to photopheresis; even in our carefully selected patient group, approximately one third showed either no improvement or worsened. Because we selected patients with progressing skin sclerosis in the absence of serious internal organ involvement, our study does not provide meaningful information about the capacity of photopheresis to reverse advanced lung, kidney, heart, or