MULTIPLE SQUAMOUS-CELL CARCINOMAS IN A PSORIATIC PATIENT FOLLOWING HIGH-DOSE PHOTOCHEMOTHERAPY AND CYCLOSPORINE TREATMENT - RESPONSE TO LONG-TERM ACITRETIN MAINTENANCE

Cumulative toxicity is a well known limitation of antipsoriatic treatm ents. In particular, the induction of multiple squamous cell carcinoma s following long-term PUVA treatment is well established. In the prese nt report, a psoriatic patient is described who was treated for more t han 14 years with photochemotherapy (PUVA) and who received excessive amounts of topical corticosteroids. The patient developed, in total, 3 4 squamous cell carcinomas. In all, three squamous cell carcinomas dev eloped during long-term PUVA treatment, and 21 carcinomas appeared dur ing 16 months of treatment with cyclosporin. Subsequently, a marked in hibition of the occurrence of new tumours occurred during prolonged tr eatment with acitretin, and no new tumours have appeared during the la st 4 years of continuous treatment with this retinoid at a dose of 60 mg/day. Modulation of the expression of PUVA-induced squamous cell car cinomas by cyclosporin and acitretin are discussed. The present report lends support to the hypothesis that cyclosporin causes an increased occurrence of PUVA-induced carcinomas, whereas acitretin (60 mg/day) i s of value in preventing the occurrence of new squamous cell carcinoma s in patients who were treated with longterm PUVA.