甲氧沙林与紫外线A疗法。

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摘要

一项针对1380名接受PUVA治疗的银屑病患者的队列研究发现,皮肤癌(鳞状细胞癌)的风险随着PUVA暴露量的增加而增加;暴露于高剂量的PUVA使患癌症的风险增加了50多倍。该风险独立于电离辐射或煤焦油治疗的任何可能的混淆。还观察到基底细胞癌与暴露于PUVA之间的关联;然而,高暴露的估计风险比观察到的鳞状细胞癌低4倍。两项较小的队列研究未发现皮肤癌风险增加;一项研究仅包括94名患者,另一项研究使用了低剂量,可能没有足够的统计能力来检测效果。一项病例对照研究也报告了PUVA治疗的牛皮癣患者患皮肤癌的风险增加。一些用PUVA治疗牛皮癣或蕈样真菌病的患者发生皮肤癌(基底细胞癌、鳞状细胞癌和恶性黑色素瘤)的病例报告支持了皮肤癌与暴露于PUVA之间的关联。在两项小型随机临床试验中,评估甲氧沙伦是否能预防阳光引起的皮肤癌(通过增加皮肤色素沉着和角质化),甲氧沙伦单独服用两年以上对皮肤癌的发病率没有影响(IARC 1980,1982, 1987)。
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Methoxsalen with ultraviolet A therapy.
A cohort study of 1,380 psoriasis patients treated with PUVA found that the risk of skin cancer (squamous-cell carcinoma) increased with increasing exposure to PUVA; exposure to high doses of PUVA increased the risk of cancer by more than 50-fold. The risk was independent of any possible confounding by treatment with ionizing radiation or coal tar. An association between basal-cell carcinoma and PUVA exposure also was observed; however, the estimated risk at high exposure was fourfold lower than that observed for squamous-cell carcinoma. Increased risks of skin cancer were not reported in two smaller cohort studies; one study included only 94 patients, and the other used a low dose and may not have had sufficient statistical power to detect an effect. A case-control study also reported an increased risk of skin cancer among psoriasis patients treated with PUVA. Supporting the association between skin cancer and PUVA exposure are several case reports of skin cancer (basal-cell and squamous-cell carcinoma and malignant melanoma) in patients treated with PUVA for psoriasis or mycosis fungoides. In two small randomized clinical trials evaluating whether methoxsalen would protect against sunlightinduced skin cancer (by increasing pigmentation and cornification of the skin), methoxsalen administered alone for over two years did not affect the incidence of skin cancer (IARC 1980, 1982, 1987).
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Thiourea. Isoprene. Erionite. Diethyl sulfate. Methoxsalen with ultraviolet A therapy.
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