The long-term longitudinal follow-up study of a cohort of psoralen UV-A (PUVA)-treated patients by Jones-Caballero et al1 published in this issue of the Archives provides insight into the complexities of treating psoriasis and the impact of the disease on patients' lives. Psoriasis is a chronic, frustrating condition, and much of the frustration comes from the need to continually use treatments over time. None of the treatments are entirely satisfactory, and as time goes by many patients grow progressively less tolerant of treatment. In the 1970s, PUVA treatment might have seemed to be a relief from the messy and time-consuming Goeckerman treatment. Jones-Caballero et al1 found that most patients treated with PUVA eventually gravitated to other treatment options. Those leaving PUVA for biological treatments were younger, had more formal education, and were more likely to have a greater extent of psoriasis. For these patients, the decision to switch treatment was probably the natural result of a search to identify a more satisfying long-term treatment. These patients sought new approaches even in the face of high cost, possible carcinogenesis (PUVA), or increased risk of infection (biological treatments).
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