The Treatment of Mycosis Fungoides With Ointment-Based Mechlorethamine

A Prospective Study of Cutaneous Intolerance to Topical Mechlorethamine Therapy in Patients With Cutaneous T-Cell Lymphomas

“…1 Initial treatments for these patients include topical mechlorethamine, topical carmustine, topical corticosteroids, PUVA, UV-B radiation, and total skin electron beam radiation therapies. All are effective in treating MF [1][2][3]6,14,16,[18][19][20][21] ; however, because topical mechlorethamine can be easily prepared at home, it is frequently used, especially in elderly patients, in France.…”

“…19,20 It is one of the safest therapies currently used to treat the early stage of MF. It is used as a 0.02% dilution of an aqueous solution, which has been shown to have an acceptable therapeutic risk-benefit ratio.…”

“…6 Because of the inconvenience to the patient, this method has been largely abandoned. In addition, the use of mechlorethamine ointment to reduce the frequency of CIM also has been proposed by Price et al 18,20 In one study, 18 only 3 of the 12 patients with a history of CIM developed contact dermatitis and none of the patients who were exposed for the first time to mechlorethamine developed CIM. Price et al 18 hypothesize that patients with hypersensitivity to the aqueous solution of mechlorethamine have developed sensitivity to components produced from the breakdown of the product while in solution and that the ointment preparation may preserve the mechlorethamine molecule in its original state.…”

“…Price et al 18 hypothesize that patients with hypersensitivity to the aqueous solution of mechlorethamine have developed sensitivity to components produced from the breakdown of the product while in solution and that the ointment preparation may preserve the mechlorethamine molecule in its original state. [18][19][20]25 Nevertheless, the French and the American preparations of mechlorethamine are different and it is not technically possible to mix the French mechlorethamine in an anhydrous vehicle. 26 The use of mechlorethamine ointment has not been officially recommended for use in France, and, currently, the aqueous solution is the only form that may be used to treat patients with cutaneous disorders.…”

“…In addition, short-term application of mechlorethamine probably could help reduce irritant dermatitis, but its effectiveness at preventing allergic dermatitis has yet to be demonstrated. This decreased effectiveness is due to mechlorethamine's rapid breakdown into its ionized form which cross-reacts in hypersensitivity reactions, 19,20,25 when dissolved in water. Vonderheid 19 observed that excessive irritation led to discontinuation of the treatment in only 10% of the patients.…”