PUVA phototherapy-induced secondary amyloidosis in patients with mycosis fungoides: a rare adverse effect of phototherapy Itır
PUVA phototherapy-induced secondary amyloidosis in patients with mycosis fungoides: a rare adverse effect of phototherapy Itır
Aim: Amyloidosis is a common disorder in adults. Secondary amyloidosis in patients with mycosis fungoides (MF) after photochemotherapy with 8-methoxypsoralen followed by ultraviolet A (PUVA) treatment has not been reported. Our aim is to describe the clinical and histological features of PUVA phototherapy-induced secondary amyloidosis. Materials and methods: Sixty-one patients with MF treated with PUVA phototherapy were analyzed clinically and pathologically and by staining with Congo red and crystal violet. Results: Of 61 patients, 5 met the study criteria. Secondary amyloidosis was detected in 5 patients treated with PUVA. The secondary amyloidosis appeared after a mean of 56 exposures (range: 30 81) and a mean cumulative PUVA radiation dose of 131.7 J/cm2 (range: 31 305.5). The mean follow-up duration from the date of occurrence of the secondary amyloidosis was 18.2 weeks (range: 10 30). Histologically, vacuolar interface changes, colloid bodies, and melanophages were seen in all 5 patients. There were 4 patients who had perivascular lymphocytic infiltration and 1 patient had lichenoid lymphocytic infiltration. Conclusion: It should be noted that secondary amyloidosis can be present in patients who have been treated with PUVA therapy and it can be a result of the apoptotic effect of PUVA on the basal keratinocytes.
___
- 1. Baron ED, Stevens SR. Phototherapy for cutaneous T-cell lymphoma. Dermatol Ther 2003; 16: 30310.
- 2 . Morita A, Werfel T, Stege H, Ahrens C. Evidence that singlet oxygen-induced human T-helper cell apoptosis is the basic mechanism of ultraviolet-A radiation phototherapy. J Exp Med 1997; 186: 17638.
- 3 . Nasser N, Sassevılle D. Amyloidosis. Dermatol Rounds 2005; 4: 3.
- 4 . Buxbaum JN, Tagoe CE. The genetics of the amyloidoses. Ann Rev Med 2000; 51: 54369.
- 5 . Picken MM. The changing concepts of amyloid. Arch Pathol Lab Med 2001; 125: 3843.
- 6 . Falk RH, Comenzo RL, Skinner M. The systemic amyloidoses. N Engl J Med 1997; 337: 898909.
- 7 . Schreml S, Szeimies RM, Vogt T, Landthaler M, Schroeder J, Babilas P. Cutaneous amyloidoses and systemic amyloidoses with cutaneous involvement Eur J Dermatol 2010; 20: 15260.
- 8 . Breathnach SM. Amyloid and amyloidosis. J Am Acad Dermatol 1988; 18: 116.
- 9 . Glenner GG. Amyloid deposits and amyloidosis. The betafibrilloses (first of two parts). N Engl J Med 1980; 302: 128392.
- 10 . Kumakiri M, Hashimoto K. Histogenesis of primary localized cutaneous amyloidosis: sequential change of epidermal keratinocytes to amyloid via filamentous degeneration. J Invest Dermatol 1979; 73: 15062.
- 11 . Li WM. Histopathology of primary cutaneous amyloidoses and systemic amyloidosis. Clin Dermatol 1990; 8: 305.
- 12 . Brownstein MH, Helwig EB. Secondary systemic amyloidosis: analysis of the underlying disorders. South Med J 1971; 64: 4916.
- 13 . Hashimoto K, Brownstein MH. Localized amyloidosis in basal cell epitheliomas. Acta Derm Venereol 1973; 53: 3319.
- 14 . Hashimoto K, Kumakiri M. Colloid-amyloid bodies in PUVAtreated human psoriatic patients. J Invest Dermatol 1979; 72: 7080.
- 15 . MacDonald DM, Black MM. Secondary localized cutaneous amyloidosis in melanocytic naevi. Br J Dermatol 1980; 103: 5536.
- 16 . Powell AM, Albert S, Bhogal B, Black MM. Discoid lupus erythematosus with secondary amyloidosis. Br J Dermatol 2005; 153: 7469.
- 17 . Ramírez-Santos A, Suárez-Amor O, Pérez-Pérez L, Loureiro M, Peteiro C, Toribio J. Localized cutaneous amyloidosis secondary to porokeratosis: a retrospective histopathologic study of 30 patients. Actas Dermosifiliogr 2008; 99: 63943 (article in Spanish with English abstract).
- 18 . Johansen JD, Frosch PJ, Lepoıttenvın JP. Contact Dermatitis. Berlin: Springer; 2011. p.15562
- 19 . DallAcqua F, Vedaldi D, Bordin F, Rodighiero G. New studies on the interaction between 8-methoxypsoralen and DNA in vitro. J Invest Dermatol 1979; 73: 1917.
- 20 . Laskin JD, Lee E, Laskin DL, Gallo MA. Psoralens potentiate ultraviolet light-induced inhibition of epidermal growth factor binding. Proc Natl Acad Sci USA 1986; 83: 82115.
- 21 . Zatebsku Z. Cell membrane, a target for PUVA therapy. J Photochem Photobiol B 1994; 23: 1019.
- 22 . Coven TR, Walters IB, Cardinale I, Krueger JG. PUVA-induced lymphocyte apoptosis: mechanism of action in psoriasis. Photodermatol Photoimmunol Photomed 1999; 15: 227.
- 23 . Sontheimer RD. Lichenoid tissue reaction/interface dermatitis: clinical and histological perspectives. J Invest Dermatol 2009; 129: 108899.
- 24 . Karadağ AS, Güler Şimşek G. Familial amyloidosis cutis dyschromica. Turk J Med Sci 2010; 40: 1514.
- 25 . Chang YT, Liu HN, Wang WJ, Lee DD, Tsai SF. A study of cytokeratin profiles in localized cutaneous amyloids. Arch Dermatol Res 2004; 296: 838.
- 26 . Miura Y, Harumiya S, Ono K, Fujimoto E. Galectin-7 and actin are components of amyloid deposit of localized cutaneous amyloidosis. Exp Dermatol 2013; 22: 3640.
- 27 . Hashimoto K, Ito K, Taniguchi Y, Yang F, Youngberg G. Keratin in cutaneous amyloidoses. Clin Dermatol 1990; 8: 5565.
- 28 . Grene I, Cox AJ. Amyloid deposition after psoriasis therapy with psoralen and long-wave ultraviolet light. Arch Dermatol 1979; 115: 12002.
- 29 . Crowson AN, Magro CM. Recent advances in the pathology of cutaneous drug eruptions. Dermatol Clin 1999; 17: 53760.
- 30 . Epstein JH. Phototoxicity and photoallergy. Semin Cutan Med Surg 1999; 18: 27484.