RESUMEN
Psoralens plus ultraviolet A (PUVA) therapy is widely used in the treatment of psoriasis and other cutaneous conditions. We present the case of a patient who developed a superficial spreading melanoma 3 years after first being treated with PUVA. The development of melanomas in patients receiving PUVA is reviewed. During 13,224 person-years of prospective follow-up of 1380 patients enrolled in the PUVA follow-up study, three melanomas were diagnosed, which does not differ significantly from the expected rate (relative risk = 1.5 with 90% confidence interval 0.3 to 7.3). However, considering the effects of PUVA on melanocytes and that the development of melanomas may have a long latent period, continued follow-up studies are indicated.
Asunto(s)
Melanoma/inducido químicamente , Terapia PUVA/efectos adversos , Psoriasis/tratamiento farmacológico , Neoplasias Cutáneas/inducido químicamente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Melanoma/epidemiología , Persona de Mediana Edad , Factores de Riesgo , Neoplasias Cutáneas/epidemiologíaRESUMEN
It has been shown previously that alopecia areata can be treated with dinitrochlorobenzene (DNCB) and other contact allergens. Whether these agents work by inducing immunologic stimulation or simply a nonspecific inflammatory reaction has not been definitively demonstrated. To test the relative importance of these two mechanisms, we have randomly studied 22 patients with alopecia areata to whom either DNCB or croton oil was applied topically. Sixty-three percent of patients without spontaneous regrowth of hair regrew hair after DNCB application. None of those treated with croton oil regrew hair when treated later with DNCB. Therefore, a proved contact allergen was shown to be required for therapeutic success. Patient acceptance of the induced contact dermatitis was excellent. In light of recent data on the mutagenicity of DNCB to bacteria, other contact allergens for topical immunotherapy are being sought.