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Furukawa F, Makino T, Torai R, Mori S, Terada Y, Seki T, Shimizu T. Effectiveness of combined bexarotene and excimer laser treatment for folliculotropic mycosis fungoides. Eur J Dermatol 2021; 31:ejd.2021.4085. [PMID: 34405813 PMCID: PMC8572682 DOI: 10.1684/ejd.2021.4085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Fumina Furukawa
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Teruhiko Makino
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Ryotaro Torai
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Shuichi Mori
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Yoshiyuki Terada
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Taiki Seki
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Tadamichi Shimizu
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
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Reddy V, Thibodeaux Q, Bhutani T, Sugarman JL. Lymphomatoid papulosis successfully managed with excimer laser maintenance therapy. JAAD Case Rep 2020; 6:495-497. [PMID: 32490107 PMCID: PMC7256238 DOI: 10.1016/j.jdcr.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Vidhatha Reddy
- Correspondence to: Vidhatha Reddy, BA, 515 Spruce Street, San Francisco, CA 94118.
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Lymphomatoid Papulosis Type A: A Case Report of the "Wait-and-See Strategy" in a 27-Year-Old Male Patient with Extensive Disease. Case Rep Dermatol Med 2019; 2019:1765210. [PMID: 31380123 PMCID: PMC6662440 DOI: 10.1155/2019/1765210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/03/2019] [Indexed: 11/17/2022] Open
Abstract
This is the case of a 27-year-old male patient with a newly diagnosed extensive lymphomatoid papulosis type A involving cosmetically sensitive areas (e.g. face), who refused to be treated with a low dose of methotrexate, as recommended by the published literature. The natural course of the disease was proved to be strikingly satisfying though, with a complete regression of all skin lesions at the 4-week follow-up, including an ulcerated nodule 3 x 3 cm in dimension, which was expected to heal at least in months. We report this case to reconsider weighting the risks and the short-term benefits of methotrexate treatment, even in the case of an extensive disease.
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Abstract
Cutaneous T-cell lymphomas (CTCL) are a heterogenous group of non-Hodgkin lymphomas arising in the skin. Mycosis fungoides (MF), the most common variant, is characterised by clonal proliferation of skin residing malignant T-cells. Initially appearing with erythematous patches and plaques it follows a chronic course with progression to cutaneous tumours and extracutaneous involvement in some patients. Phototherapy with ultraviolet A radiation combined with 8-methoxypsoralen (PUVA) and with narrow-band ultraviolet B radiation (NB-UVB) are among the first line options for the treatment of MF and can induce remission in most patients. Sézary syndrome (SS) is a rare and more aggressive CTCL variant with generalized skin involvement. Patients with SS and with erythroderma from MF can benefit from treatment with extracorporeal photochemotherapy (ECP) where peripheral blood is exposed to PUVA. Phototherapy can be safely combined with systemic agents, most notably interferon-alpha and retinoids. Another photoresponsive CTCL variant is lymphomatoid papulosis (LP), a CD30+ lymphoproliferative disease characterised by chronically recurring papules. The disease responds favourably to PUVA but low dose methotrexate might be preferred for long term disease control. Recently updated treatment guidelines have been published to provide evidence-based algorithms for the stage-oriented treatment of MF, SS and LP. Areas of uncertainty are treatment schedules that are currently not optimised for CTCL, the use of phototherapy for maintenance, and the value of ultraviolet A1 radiation, excimer lasers, and photodynamic therapy.
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Affiliation(s)
- Franz Trautinger
- Department of Dermatology and Venereology, Karl Landsteiner University of Health Sciences, University Hospital of St. Pölten, Austria.
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Fritz K, Salavastru C. [The 308 nm Excimer laser for the treatment of psoriasis and inflammatory skin diseases]. Hautarzt 2018; 69:35-43. [PMID: 29299629 DOI: 10.1007/s00105-017-4105-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Overall, the 308 nm Excimer laser enables not only a more effective and safer UVB therapy than classical UV phototherapy, but also targeted irradiation in higher doses with a lower cumulative load, which results in faster healing of mainly circumscribed skin changes. This also applies to therapy-resistant residual lesions which, despite systemic therapy, did not diminish. Combination therapies usually improve the result and enable the dose of UVB and systemic medication to be reduced. Excimer laser therapy can be used for an increasing number of skin diseases, especially those that respond to phototherapy or photochemotherapy.
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Affiliation(s)
- K Fritz
- Hautärzte- und Laserzentrum Landau (Pfalz), Reduitstr. 13, 76829, Landau, Deutschland. .,Medizinische und Pharmazeutische Universität Carol Davila, Bukarest, Rumänien.
| | - C Salavastru
- Medizinische und Pharmazeutische Universität Carol Davila, Bukarest, Rumänien.,Abteilung für pädiatrische Dermatologie, Colentina-Krankenhaus, Bukarest, Rumänien
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Olsen EA, Hodak E, Anderson T, Carter JB, Henderson M, Cooper K, Lim HW. Guidelines for phototherapy of mycosis fungoides and Sézary syndrome: A consensus statement of the United States Cutaneous Lymphoma Consortium. J Am Acad Dermatol 2015; 74:27-58. [PMID: 26547257 DOI: 10.1016/j.jaad.2015.09.033] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ultraviolet light (UVL) is a long established treatment for mycosis fungoides (MF) and Sézary syndrome (SS), subtypes of cutaneous T-cell lymphoma (CTCL). Treatments have traditionally included broadband, narrowband ultraviolet B light (UVB) and psoralen plus ultraviolet A light photochemotherapy (PUVA), but more recently, treatment options have expanded to include UVA1 and excimer laser. UVL is used either as monotherapy or as an adjuvant to systemic therapy, demonstrating efficacy in many cases that equal or surpass systemic medications. Despite its utility and duration of use, the current practice of using UVL guidelines for psoriasis to treat patients with MF/SS is problematic because the goals of prolonging survival and preventing disease progression are unique to CTCL compared to psoriasis. OBJECTIVES We sought to develop separate guidelines for phototherapy for MF/SS for both clinical practice and for clinical trials. METHODS Literature review and cutaneous lymphoma expert consensus group recommendations. RESULTS This paper reviews the published literature for UVB and UVA/PUVA in MF/SS and suggests practical standardized guidelines for their use. LIMITATIONS New standardization of phototherapy. CONCLUSIONS These guidelines should allow the comparison of results with phototherapy in MF/SS across different stages of patients, centers, and in combination with other agents in practice and in clinical trials.
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Affiliation(s)
- Elise A Olsen
- Departments of Dermatology and Medicine, Duke University Medical Center, Durham, North Carolina.
| | - Emilia Hodak
- Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Thomas Anderson
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - Joi B Carter
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Marsha Henderson
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Kevin Cooper
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
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Abstract
Primary cutaneous CD30⁺ lymphoproliferative disorders (LPDs) account for approximately 25% of cutaneous lymphomas. Although these LPDs are clinically heterogeneous, they can be indistinguishable histologically. Lymphomatoid papulosis rarely requires systemic treatment; however, multifocal primary cutaneous anaplastic large cell cutaneous lymphoma and large cell transformation of mycosis fungoides are typically treated systemically. As CD30⁺ LPDs are rare, there is little published evidence to support a specific treatment algorithm. Most studies are case reports, small case series, or retrospective reviews. This article discusses various treatment choices for each of the CD30⁺ disorders and offers practical pearls to aid in choosing an appropriate regimen.
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Affiliation(s)
- Lauren C Hughey
- University of Alabama at Birmingham, 1530 3rd Avenue South, EFH 414, Birmingham, AL 35294, USA.
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Huang CH, Hsu CK, Lee JYY. Lymphomatoid papulosis in association with mycosis fungoides: A clinical and histopathologic review of five Taiwanese cases. DERMATOL SIN 2014. [DOI: 10.1016/j.dsi.2013.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Khan M, Scarisbrick JJ. Pediatric cutaneous lymphomas: rare diseases requiring expert diagnosis and management. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17469872.2013.838041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
Mycosis fungoides is a candidate for skin-directed therapies in its initial stages. In recent years, therapeutic options outside of the normal treatment recommendations such as topical imiquimod, topical tazarotene, topical methotrexate, excimer light sources, and photodynamic therapy have been published with variable results. These alternatives have been useful in cases of localized mycosis fungoides that do not respond to routine treatments; nevertheless, more studies on these methods are still needed. This article summarizes the literature and data that are known so far about these treatments.
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Li JY, Horwitz S, Moskowitz A, Myskowski PL, Pulitzer M, Querfeld C. Management of cutaneous T cell lymphoma: new and emerging targets and treatment options. Cancer Manag Res 2012; 4:75-89. [PMID: 22457602 PMCID: PMC3308634 DOI: 10.2147/cmar.s9660] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cutaneous T cell lymphomas (CTCL) clinically and biologically represent a heterogeneous group of non-Hodgkin lymphomas, with mycosis fungoides and Sézary syndrome being the most common subtypes. Over the last decade, new immunological and molecular pathways have been identified that not only influence CTCL phenotype and growth, but also provide targets for therapies and prognostication. This review will focus on recent advances in the development of therapeutic agents, including bortezomib, the histone deacetylase inhibitors (vorinostat and romidepsin), and pralatrexate in CTCL.
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Affiliation(s)
- Janet Y Li
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Poligone B, Heald P. Innovative therapy of cutaneous T-cell lymphoma: beyond psoralen and ultraviolet light and nitrogen mustard. Dermatol Clin 2010; 28:501-10. [PMID: 20510760 DOI: 10.1016/j.det.2010.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cutaneous T-cell lymphoma is a malignancy of skin-homing T cells. This unique population of lymphocytes requires alternative therapies to those used in nodal lymphomas. Although phototherapy and nitrogen mustard have been standard treatments for decades, newer therapies have been arriving with increased frequency. Moreover, some therapies, currently used to treat other diseases, have been used with good effect. These innovative therapies are discussed, with review of current data and examples of how these therapies may be used today.
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Affiliation(s)
- Brian Poligone
- Department of Dermatology, University of Rochester School of Medicine, Rochester, NY, USA.
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Jin S, Jeon Y, Cho K, Chung J. Excimer laser therapy (308 nm) for mycosis fungoides palmaris et plantaris: a skin-directed and anatomically feasible treatment. Br J Dermatol 2010; 163:651-3. [DOI: 10.1111/j.1365-2133.2010.09793.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hegyi J, Frey T, Arenberger P. The treatment of unilesional mycosis fungoides with methyl aminolevulinate-photodynamic therapy. J Eur Acad Dermatol Venereol 2008; 22:1134-5. [DOI: 10.1111/j.1468-3083.2007.02554.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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