Methoxsalen and ultraviolet A radiation in treatment of chronic cutaneous graft-versus-host reaction

Chronic cutaneous graft-versus-host reaction following bone marrow transplantation has been difficult to manage in some patients because of poor response to immunosuppressive agents or because of toxicity to these drugs. We recently used methoxsalen and ultraviolet A therapy and found it to be successful in controlling chronic cutaneous lichenoid graft-versus-host reaction in a bone marrow transplant patient. Although there was an initial flare of an eruption resembling acute cutaneous graft-versus-host reaction, both this acute eruption and the lichenoid lesions subsided and cleared with continued treatment. The skin lesions recurred when treatment was discontinued but responded promptly when it was initiated for the second time. Other than mild phototoxicity, there were no other significant side effects.