Extracorporeal photophoresis in the treatment of skin disease

Extracorporeal photopheresis (ECP) is a method of immunomodulatory therapy which had been introduced in to the treatment of patient’s with cutaneous T-cell lymphoma (CTCL) and then also used in other T-cell mediated disorders. During ECP leukocytes separated from the patient’s blood are activated with methoxypsoralens, exposed to ultraviolet A radiation and subsequently reinfused. The mechanism responsible for the suppression of pathogenic cell clones is not fully explained. In CTCL two phenomena are initiated by ECP: induction of apoptosis of the CTCL cells and conversion of peripheral blood monocytes into dendritic cells. Presentation of CTCL antigens by macrophages to responding cytotoxic T cells initiate the anticlonotypic immunity and stimulate the clinically important CTCL suppression. ECP is widely used as the treatment of patients with CTCL as it prolonges life and induces good remission rates. This method is also used in other diseases but for the lack of randomised study the objective estimation of the results is difficult.