Photodynamic therapy with methyl aminolaevulinate for cervical and/or facial lesions of folliculotropic mycosis fungoides: interest and limits

Photodynamic Therapy as an Effective Treatment for Cutaneous Lymphomas

Topical photodynamic therapy (PDT) is a non-invasive treatment modality frequently used in dermatology to treat superficial skin cancers but also some inflammatory or infectious dermatoses. PDT appears a more and more promising therapeutic option also for cutaneous lymphomas, either of T- or B-cell origin. It is a well-tolerated treatment and has excellent cosmetic outcomes, less side effects compared to other therapies (steroids, surgery, radiotherapy, and so on), no particular contraindications, and is easily repeatable in case of relapses. However, how PDT works in the treatment of cutaneous lymphoproliferative diseases is poorly understood and the literature data are still controversial. Further randomized, controlled clinical trials involving a greater number of patients and centers with a long follow-up are necessary to assess the efficacy of PDT and establish a unique standardized treatment protocol in relation to the lymphomatous disease and the type, thickness, and location of the lesions.

Photodynamic therapy as an alternative treatment for mycosis fungoides: a systemic review and meta-analysis

INTRODUCTION

Mycosis fungoides is the most common cutaneous T cell lymphoma. Selection of appropriate treatment for mycosis fungoides (MF) is based on prognostic factors and overall clinical stage at diagnosis. In the past decade, clinical success has been reported using photodynamic therapy (PDT) as an alternative target-specific therapy to treat mycosis fungoides. This review aimed to summarize the current advances in management of mycosis fungoides by administration of photodynamic therapy.

EVIDENCE ACQUISITION

Twenty-four articles, published between 1994 and 2017, were reviewed to assess the efficacy of PDT for MF.

EVIDENCE SYNTHESIS

Methyl-aminolevulinic acid has increased lipophilic properties; red light at around 630 nm achieves deepest and best tissue penetration. However, the total number of PDT sessions depends on the clinical response.

CONCLUSIONS

Further multicenter clinical studies are warranted to assess the cost-effectiveness of PDT.

Folliculotropic Mycosis Fungoides in 20 Korean Cases: Clinical and Histopathologic Features and Response to Ultraviolet A-1 and/or Photodynamic Therapy

Background

Folliculotropic mycosis fungoides (FMF) is a variant of mycosis fungoides (MF) that is characterized clinically by variable types of skin eruptions, including plaques, acneiform lesions, and alopecic patches. Histopathologically, FMF is characterized by folliculotropic infiltrates.

Objective

This study was conducted to scrutinize the clinical and histopathologic features of FMF in Koreans and the responses to phototherapy.

Methods

Twenty Koreans diagnosed with MF who had histopathologic evidence of folliculotropism were enrolled.

Results

Eighteen patients had head-and-neck-region infiltration, while five had solitary lesion. In all patients, the atypical lymphocytic infiltrate had a perifollicular distribution. Twelve patients were treated with ultraviolet A (UVA)-1. Eleven of these 12 patients with early-stage FMF experienced >80% improvement (8: complete remission; 3: partial remission). Four patients, including 2 who relapsed after UVA-1, were treated with photodynamic therapy (PDT), reaching complete remission after PDT.

Conclusion

As FMF has variable clinical presentations, skin biopsy is required to confirm the diagnosis. And both UVA-1 and methyl aminolevulinate-PDT are clinically effective in treatment of early-stage FMF.

Photodynamic therapy as an alternative treatment for relapsed or refractory mycosis fungoides: A systemic review

Mycosis fungoides is the most common cutaneous T-cell lymphoma. It is characterized by slow progress over years to decades, developing from patches to infiltrated plaques, and sometimes to tumors. Therapies such as localized chemotherapy, photochemotherapy and radiotherapy are often employed when lesions of refractory or relapsing mycosis fungoides are resistant to conventional therapies. However, these methods have acute or chronic side effects and toxicity, which may accumulate with repeated and protracted treatment cycles. Photodynamic therapy is a promising, well-tolerated option for the treatment of localized lesions with excellent cosmetic outcomes. In this article, we systematically reviewed and discussed clinical application of photodynamic therapy in relapsed or refractory mycosis fungoides. There are 20 papers included in this review article.

Photodynamic therapy with methyl-aminolevulinic acid for paucilesional mycosis fungoides: a prospective open study and review of the literature

BACKGROUND

Publications reporting photodynamic therapy (PDT) in mycosis fungoides (MF) are rare, involve small samples, and are difficult to compare because of a lack of technical standardization.

OBJECTIVE

We sought to assess PDT effectiveness and tolerability in early-stage MF using a strict reproducible procedure.

METHODS

This was a prospective study conducted in Nantes University Hospital, France, including patients older than 18 years with histologically proven MF (stage IA or IB). Methyl-aminolevulinic acid-PDT sessions were repeated monthly for 6 months. Clinical and histologic responses were assessed 1 month after the last session. Patient satisfaction was assessed by telephone survey.

RESULTS

Twelve patients (with 29 lesions) were treated with PDT. An objective response in target lesions was obtained in 75% of patients. Response rates were similar between plaques and patches but higher in sun-protected compared with sun-exposed areas (trend without reaching significance). During PDT, new lesions appeared in 5 of 12 patients in untreated areas. Most patients were highly satisfied and preferred PDT to the topical chemotherapy previously used.

LIMITATIONS

PDT procedure criteria selection was partially arbitrary.

CONCLUSIONS

In early-stage MF, PDT is effective and appreciated (especially when compared with conventional topical chemotherapy). Unilesional and paucilesional forms and lesions in sun-protected areas are to be preferred.