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April 1989, Vol 125, No. 4 >
Article | April 1989

Risk Assessment of PUVA and Cyclosporine: Title and subTitle BreakLessons From the Past; Challenges for the Future

Robert S. Stern, MD
[+] Author Affiliations

Department of Dermatology Beth Israel Hospital 330 Brookline Ave Boston, MA 02113


Arch Dermatol. 1989;125(4):545-547. doi:10.1001/archderm.1989.01670160093019
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In 1974, a new therapeutic approach to psoriasis based on photochemotherapy with psoralen and ultraviolet A radiation (PUVA) was introduced.1 Assessments of its long-term safety continue. Adding to earlier observations about cyclosporine and cutaneous psoriasis,2 in this issue of the Archives data supporting the efficacy of therapy for psoriatic arthritis based on immunosuppression with cyclosporine are presented.3 There are likely to be many parallels in the evolution of the role of PUVA and cyclosporine as treatments for psoriasis.

Since psoriasis is a chronic disease, initial clearing is only the first step in a continued effort to control both the cutaneous and extracutaneous manifestations of this disease. Previous experience with these treatments and knowledge about their mechanism of action raise substantial concern about their safety in long-term use for a chronic, often disabling, but not life-threatening disease.

Today, with cyclosporine therapy we are at a point similar to where we were

REFERENCES

1 +
Parrish JA, Fitzpatrick TB, Tanenbaum L, Pathak MA.  Photochemotherapy of psoriasis with oral methoxsalen and long-wave ultraviolet light . N Engl J Med. 1974;;291:1207-1211.
2 +
Ellis CN, Gorsulowsky DC, Hamilton TA, et al.  Cyclosporine improves psoriasis in a double-blind study . JAMA . 1986;;256:3110-3116.
3 +
Gupta AK, Matteson EL, Ellis CN, et al.  Cyclosporine in the treatment of psoriatic arthritis . Arch Dermatol. 1989;;125:507-510.
4 +
Stern RS, Laird N, Melski J, Parrish JA, Fitzpatrick TB, Bleich HL.  Cutaneous squamous-cell carcinoma in patients treated with PUVA . N Engl J Med. 1984;;310:1156-1161.
5 +
Stern RS, Lange R.  Non-melanoma skin cancer occurring in patients treated with PUVA five to ten years after first treatment . J Invest Dermatol. 1988;;91:120-124.
6 +
Stern RS, Lange R.  Cardiovascular disease, cancer, and cause of death in patients with psoriasis: 10 years prospective experience in a cohort of 1,380 patients . J Invest Dermatol. 1988;;91:197-201.
7 +
Forman AB, Roenigk HH Jr, Caro WA, Magid ML.  Long-term follow-up of skin cancer in the PUVA-48 cooperative study . Arch Dermatol. 1989;;125:515-519.
8 +
Van Joost T, Bos JD, Heule F, Meinardi MM.  Low-dose cyclosporin A in severe psoriasis: a double-blind study . Br J Dermatol. 1988;;118:183-190.
9 +
Penn I, First MR.  Development and incidence of cancer following cyclosporine therapy . Transplant Proc. 1986;;18:210-215.
10 +
Myers BD, Sibley R, Newton L, et al.  The long-term course of cyclosporine-associated chronic nephropathy . Kidney Int. 1988;;33:590-600.
11 +
Chapman JR, Marcen R, Arias M, et al.  Hypertension after renal transplantation: a comparison of cyclosporine and conventional immunosuppression . Transplantation . 1987;;43:860-864.
12 +
Dougados M, Awada H, Amor B.  Cyclosporin in rheumatoid arthritis: a double blind, placebo controlled study in 52 patients . Ann Rheum Dis. 1988;;47:127-133.
13 +
Bencini PL, Montagnino G, Sala F, et al.  Cutaneous lesions in 67 cyclosporin-treated renal transplant recipients . Dermatologica . 1986;;172:24-30.
14 +
Thompson JF, Allen R, Morris PJ, Wood R.  Skin cancer in renal transplant patients treated with cyclosporin . Lancet . 1985;;1:158-159.
15 +
Servilla KS, Burnham DK, Daynes RA.  Ability of cyclosporine to promote the growth of transplanted ultraviolet radiation— induced tumors in mice . Transplantation . 1987;;44:291-295.
16 +
Rhodes AR, Harrist TJ, Momtaz TK.  The PUVA-induced pigmented macule: a lentiginous proliferation of large, sometimes cytologically atypical, melanocytes . J Am Acad Dermatol. 1983;;9:47-58.
17 +
Rhodes AR, Stern RS, Melski JW.  The PUVA lentigo: an analysis of predisposing factors . J Invest Dermatol. 1983;;81:459-463.
18 +
Lockshin A.  Lethality of human melanoma cells for normal mice immunosuppressed with cyclosporine A . Cancer Lett. 1987;;35:159-166.
19 +
Lorber MI, Van Buren CT, Flechner SM, et al.  Hepatobiliary and pancreatic complications of cyclosporine therapy in 466 renal transplant recipients . Transplantation . 1987;;43:35-40.

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1 +
Parrish JA, Fitzpatrick TB, Tanenbaum L, Pathak MA.  Photochemotherapy of psoriasis with oral methoxsalen and long-wave ultraviolet light . N Engl J Med. 1974;;291:1207-1211.
2 +
Ellis CN, Gorsulowsky DC, Hamilton TA, et al.  Cyclosporine improves psoriasis in a double-blind study . JAMA . 1986;;256:3110-3116.
3 +
Gupta AK, Matteson EL, Ellis CN, et al.  Cyclosporine in the treatment of psoriatic arthritis . Arch Dermatol. 1989;;125:507-510.
4 +
Stern RS, Laird N, Melski J, Parrish JA, Fitzpatrick TB, Bleich HL.  Cutaneous squamous-cell carcinoma in patients treated with PUVA . N Engl J Med. 1984;;310:1156-1161.
5 +
Stern RS, Lange R.  Non-melanoma skin cancer occurring in patients treated with PUVA five to ten years after first treatment . J Invest Dermatol. 1988;;91:120-124.
6 +
Stern RS, Lange R.  Cardiovascular disease, cancer, and cause of death in patients with psoriasis: 10 years prospective experience in a cohort of 1,380 patients . J Invest Dermatol. 1988;;91:197-201.
7 +
Forman AB, Roenigk HH Jr, Caro WA, Magid ML.  Long-term follow-up of skin cancer in the PUVA-48 cooperative study . Arch Dermatol. 1989;;125:515-519.
8 +
Van Joost T, Bos JD, Heule F, Meinardi MM.  Low-dose cyclosporin A in severe psoriasis: a double-blind study . Br J Dermatol. 1988;;118:183-190.
9 +
Penn I, First MR.  Development and incidence of cancer following cyclosporine therapy . Transplant Proc. 1986;;18:210-215.
10 +
Myers BD, Sibley R, Newton L, et al.  The long-term course of cyclosporine-associated chronic nephropathy . Kidney Int. 1988;;33:590-600.
11 +
Chapman JR, Marcen R, Arias M, et al.  Hypertension after renal transplantation: a comparison of cyclosporine and conventional immunosuppression . Transplantation . 1987;;43:860-864.
12 +
Dougados M, Awada H, Amor B.  Cyclosporin in rheumatoid arthritis: a double blind, placebo controlled study in 52 patients . Ann Rheum Dis. 1988;;47:127-133.
13 +
Bencini PL, Montagnino G, Sala F, et al.  Cutaneous lesions in 67 cyclosporin-treated renal transplant recipients . Dermatologica . 1986;;172:24-30.
14 +
Thompson JF, Allen R, Morris PJ, Wood R.  Skin cancer in renal transplant patients treated with cyclosporin . Lancet . 1985;;1:158-159.
15 +
Servilla KS, Burnham DK, Daynes RA.  Ability of cyclosporine to promote the growth of transplanted ultraviolet radiation— induced tumors in mice . Transplantation . 1987;;44:291-295.
16 +
Rhodes AR, Harrist TJ, Momtaz TK.  The PUVA-induced pigmented macule: a lentiginous proliferation of large, sometimes cytologically atypical, melanocytes . J Am Acad Dermatol. 1983;;9:47-58.
17 +
Rhodes AR, Stern RS, Melski JW.  The PUVA lentigo: an analysis of predisposing factors . J Invest Dermatol. 1983;;81:459-463.
18 +
Lockshin A.  Lethality of human melanoma cells for normal mice immunosuppressed with cyclosporine A . Cancer Lett. 1987;;35:159-166.
19 +
Lorber MI, Van Buren CT, Flechner SM, et al.  Hepatobiliary and pancreatic complications of cyclosporine therapy in 466 renal transplant recipients . Transplantation . 1987;;43:35-40.

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