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Peter Wolf, MD; Hannes Seidl, PhD; Barbara Bäck; Barbara Binder, MD; Gerald Höfler, MD; Franz Quehenberger, PhD; Christine Hoffmann, MD; Helmut Kerl, MD; Sabine Stark, PhD; Herbert J. Pfister, PhD; Pawel G. Fuchs, PhD

Arch Dermatol. 2004;140:317-324.

Background  Patients with psoriasis treated with psoralen–UV-A (PUVA) are at increased risk of skin cancer; however, the exact causes of this increased incidence are not well understood. It has been suggested that PUVA may increase expression of the tumorigenic agent human papillomavirus (HPV) in skin by directly stimulating virus replication, immune suppression, or both, thereby leading to skin cancer formation.

Objective  To determine whether HPV DNA prevalence in the skin is increased after long-term PUVA treatment.

Design  Screening for the presence of HPV sequences in DNA isolated from plucked body hairs of patients with psoriasis with a history of PUVA exposure and a history of skin cancer (group A), PUVA exposure and no history of skin cancer (group B), and no PUVA exposure and no history of skin cancer (group C).

Setting  University hospital.

Patients and Methods  Hair samples were obtained from 81 patients with psoriasis (56 men and 25 women; mean age, 52 years), including 16 in group A (mean number of PUVA exposures, 702), 35 in group B (mean number of PUVA exposures, 282), and 30 in group C. DNA was isolated from the hair samples and analyzed by polymerase chain reaction with the use of 2 nested primer systems specific for epidermodysplasia verruciformis–associated or related and genital or mucosal virus types, respectively.

Results  The rate of HPV DNA positivity was significantly higher in groups A (73% [11/15]) and B (69% [24/35]) than in group C (36% [10/28]) (A + B vs C, P = .009; ² test; age adjusted).

Conclusion  The prevalence of HPV in the skin (hair follicles) is increased in patients with psoriasis who have a history of PUVA exposure.

From the Department of Photodermatology (Dr Wolf), Department of Dermatology (Drs Wolf, Seidl, Binder, Hoffmann, and Kerl and Ms Bäck), Institute of Pathology (Dr Höfler), and Institute of Medical Informatics, Statistics, and Documentation (Dr Quehenberger), Karl-Franzens-University, Graz, Austria; and Institute of Virology, Cologne Center for Molecular Medicine, University of Cologne, Cologne, Germany (Drs Stark, Pfister, and Fuchs). The authors have no relevant financial interest in this article.
Dr Fuchs is deceased.