The effect of phototherapy on progression to tumors in patients with patch and plaque stage of mycosis fungoides

BACKGROUND

Phototherapy has been a mainstay in the treatment of mycosis fungoides (MF). However, the recent findings of UV-induced p53 mutations in advanced MF suggest that phototherapy may contribute to disease progression.

OBJECTIVE

The objective of this study was to evaluate the effect of phototherapy on the time to tumor progression and overall survival in MF.

MATERIALS AND METHODS

Retrospective analysis of patients seen at the University of Pittsburgh Cutaneous Lymphoma Clinic from 1979 to 2016.

RESULTS

A total of 345 patients with MF were identified. 258 (74.8%) were diagnosed at stage IA or IB. 43 out of the 258 (16.6%) progressed to tumor stage. Before tumor development, 30 out of the 43 (69.8%) patients received phototherapy, and 13 (30.2%) did not. Patients who received phototherapy had a longer median time to tumor progression than those who did not: 3.5 years (interquartile range = 1.9-5.7) versus 1.2 years (0.2-2.3) (p = .001). Patients who received phototherapy also survived longer: 6.9 years (interquartile range = 4.3-9.5) versus 3.8 years (3.0-4.5) (p = .014).

LIMITATIONS

Limited information on specific phototherapy start dates, durations, and treatment protocols.

CONCLUSIONS

The therapeutic effects of phototherapy, with longer times to tumor progression and increased overall survival, appear to outweigh its potential adverse effects.

What'S new in urticaria?

Urticaria, a perplexing disease of ever-changing explanations, is being renovated almost everyday by newer facts and findings accumulated from different parts of the globe. Cost of the urticaria treatment gradually grows higher and higher whereas the ailment disturbs the quality of life very adversely. Disorder of coagulation cascade has recently thrown some new light into its mechanism. Non-allergic angioedema induced by bradykinin caused by genetic defects and ACE-inhibitors has also been noted. Role of H. pylori in the pathogenesis of urticaria has also been re-reviewed. Urticaria could sometimes mimic erythema multiforme and is termed urticaria multiforme. Skin biopsy showed features of vasculitis in good number of urticaria irrespective of clinical features. Contact sensitization showed positive results in certain cases thus proving contact urticaria. Topical clobetasol, systemic omalizumab and NB UVB have shown promising results in certain forms of urticaria.