This month’s issue of The Dermatologist presents an article on the use of acitretin for psoriasis. By itself, acitretin is not a particularly useful treatment for plaque psoriasis (though it may be useful as monotherapy for palmoplantar, erythrodermic and pustular psoraisis). But acitretin in combination with ultraviolet light (UV) is a very effective treatment. Acitretin makes PUVA and office-based UVB work better. It works well with home UVB treatments, too.
But here is the rub: many of my patients are doing well on acitretin in combination with UV obtained by using an indoor tanning bed, a particularly valuable approach for those patients who cannot easily access other forms of phototherapy.
In my opinion, tanning is a viable option and should be used as a treatment for psoriasis. After all, it is perhaps the most widely used form of phototherapy for psoriasis.1 While tanning may increase the risk of skin cancer, many psoriasis treatments have adverse effects, and that does not preclude us offering them to patients. Surely PUVA, which is accepted as an appropriate treatment for psoriasis, is far, far more carcinogenic that tanning.
Overall, as dermatologists we are trying to discourage the general population that does not have psoriasis from tanning. I think we can do that while still making our psoriasis patients aware that it may be an option they could consider.
1. Fleischer AB Jr, Feldman SR, Reboussin DM, Rapp SR, Exum ML, Clark AR: Alternate therapies are commonly used within a population of psoriasis patients. Cutis. 1996;58:216-220.