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Psoralen plus ultraviolet‐A‐bath photochemotherapy as an adjunct treatment modality in cutaneous chronic graft versus host disease
Author(s) -
Leiter Ulrike,
Kaskel Peter,
Krähn Gertraud,
Gottlöber Petra,
Bunjes Donald,
Peter RalfUwe,
Kerscher Martina
Publication year - 2002
Publication title -
photodermatology, photoimmunology and photomedicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.736
H-Index - 60
eISSN - 1600-0781
pISSN - 0905-4383
DOI - 10.1034/j.1600-0781.2002.00719.x
Subject(s) - medicine , puva therapy , prednisone , azathioprine , graft versus host disease , dermatology , psoralen , immunosuppression , methotrexate , surgery , transplantation , disease , psoriasis , genetics , biology , dna
Background: Cutaneous chronic graft versus host disease (GVHD) is a severe complication following allogeneic stem cell (PBSCT) and bone marrow transplantation (BMT). Immunosuppressive therapy consists of prednisone, cyclosporine‐A, azathioprine or mycophenolate mofetil (MMF). Treatment of patients refractory to immunosuppression represents a major problem. Methods: We report six patients suffering from severe chronic GVHD of the skin who did not respond to immunosuppressive therapy or relapsed after reduction of glucocorticosteroids. Patients were treated with psoralen plus ultraviolet (PUVA)‐bath photochemotherapy three times weekly following a standardized treatment protocol under continued treatment with prednisone and/or MMF. One patient was additionally pretreated with ultraviolet‐A1 (UV‐Al). Results: After a median of 14, 5 treatment sessions, skin lesions improved. Out of six patients, three showed a complete remission. In all patients, systemic immunosuppressive therapy could be reduced. In sclerodermic lesions, skin thickness returned to the levels of normal skin after 25 treatments confirmed by 20 MHz ultrasound evaluation. In a follow‐up ranging from 2 to 21 months (median 10, 3 months), skin conditions remained stable. Conclusion: Psoralen plus ultraviolet‐A‐bath represents an effective adjunct treatment option for extensive chronic and sclerodermic cutaneous GVHD offered by dermatologists. This is of high interest in patients suffering from cutaneous GVHD resistant to conventional immunosuppressive therapy and should be included to the menu of topical treatment options for chronic cutaneous GVHD.