Cutaneous lymphomas in African American/Black patients: pitfalls and presentations

Racial Disparities in Mycosis Fungoides/Sézary Syndrome-A Single-Center Observational Study of 292 Patients

BACKGROUND

Clinical presentation of Mycosis fungoides/Sézary syndrome (MF/SS) in Black and African American (AA) patients can be heterogeneous with poor survival reported in AA/black patients. In this study, we aim to characterize differences between AA/black and white patients with MF/SS.

PATIENTS AND METHODS

A retrospective single-center hospital-based case-control study including 292 MF/SS patients (146 AA/black matched with 146 white patients). We analyzed demographic, clinical and survival differences.

RESULTS

AA/black patients were diagnosed at an earlier age (9 years younger), were predominantly females, had higher rates of Medicaid/Medicare insurance and lower income compared to matched white patients (P <.001). Adjusting for age, sex, insurance type, and income bracket, AA/black patients had significantly worse overall survival (hazard ratio [HR] 2.88, 95%CI 1.21-6.85, P = .017). Association of clinical MF phenotype with survival showed that hypopigmentation was associated with survival in AA/black patients but not in white patients. Erythroderma and ulceration were associated with worse survival risk in AA/black patients.

CONCLUSIONS

AA/black patients with MF/SS have a significant worse survival outcome compared to white patients. The association between clinical phenotypes and survival differed between these groups. Further studies are required to investigate whether race-specific pathogenesis or genetic factors may explain these differences.

Cutaneous T-cell Lymphoma Progression: A Potential Dupilumab Pitfall

Dupilumab is a monoclonal antibody inhibiting key drivers in the inflammatory signaling cascade. It has been considered a saving grace for many patients suffering from severe atopic dermatitis and has quickly become a widespread treatment option for many inflammatory pathologies. However, recent reports have linked dupilumab with exacerbating symptoms and accelerated disease progression of cutaneous T-cell lymphoma (CTCL). This report presents the case of a 60-year-old African American female who was diagnosed with CTCL three months after her initial treatment with dupilumab for presumed atopic dermatitis. An appreciation of this unique relationship, as well as the morphological differences seen in patient presentation, is important for physicians to better guide timely diagnoses while working to uncover the true relationship between dupilumab and CTCL.