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PUVA TREATMENT FOR PSORIASIS CAUSES GENITAL TUMORS IN MEN.

The use of oral methoxsalen followed by ultraviolet A radiation (PUVA) is a highly effective therapy for psoriasis. This disease is characterized by an excessive proliferation of epidermal cells, and PUVA acts (at least in part) by inhibiting DNA synthesis and mitosis in these cells.

Because of concern that PUVA's action on DNA could also have mutagenic and carcinogenic effects, Stern and his colleagues in the Photochemotherapy Follow-up Study conducted long-term prospective studies. They previously demonstrated that patients treated with PUVA have an increased risk of squamous cell carcinoma of the skin. Now, based on a study of 892 men followed for over 12 years, they report a 96-fold increase in squamous cell carcinoma of the genitals. There were a total of 30 genital cancers in 14 patients. The association was clearly dose-related; the patients with the highest exposure had a relative risk 286- fold higher than that of the population at large. In the early years of PUVA therapy, genital skin was not protected from the substantial doses of ultraviolet radiation used.

The authors recommend that male genitals should always be shielded during PUVA treatment and should be protected from ultraviolet radiation during recreational or cosmetic exposure.

— ALK

Published in Journal Watch General Medicine April 27, 1990

Citation(s):

Epstein JH. Phototherapy and photochemotherapy. N Engl J Med 1990 Apr 19 322 1149-1151.

• Medline abstract (Free)

Stern RS et al. Genital tumors among men with psoriasis exposed to psoralens and ultraviolet A radiation (PUVA) and ultraviolet B radiation. N Engl J Med 1990 Apr 19 322 1093-1097.

• Medline abstract (Free)