Topical Corticosteroids for Mycosis Fungoides

Abstract

Setting: Academic referral center, Veterans Affairs Medical Center, and private practice.Patients: Seventy-nine patients with patch or plaque stage of mycosis fungoides. Fifty-one were stage T1 (less than 10% of skin involved) and 28 were stage T2 (10% or more of skin involved). Seventy-five had patch-stage and 4 had plaque-stage disease as determined by histological examination. Intervention: Patients were treated with topical class I to III corticosteroids. Of the stage T1 patients, all used class I corticosteroids, and 4 (8%) also used class II or III corticosteroids. Of the stage T2 patients, 19 (68%) used class I and 12 (43%) used class II or III compounds. Some patients used more than 1 class of corticosteroid. Applications were almost always twice daily. Three stage T1 and 2 stage T2 patients used plastic film occlusion. Baseline and monthly morning serum cortisol levels were obtained during treatment. Main Outcome Measures: Response to treatment and side effects.Results: The median follow-up period was 9 months. Thirty-two (63%) of stage T1 patients achieved complete remission and 16 (31%) achieved partial remission, for a total response rate of 48 (94%). The comparable figures for stage T2 patients were 7 (25%), 16 (57%), and 23 (82%), respectively. Responses were determined by clinical examination. Thirty-nine patients achieved clinical clearing. In 7 of these, posttreatment biopsy speciments were obtained, and all showed histological clearing. Reversible depression of serum cortisol levels occurred in 10 (13%). Minor skin irritation occurred in 2 patients and localized, reversible skin atrophy in 1. Conclusion:Topical corticosteroids, especially class I compounds, are an effective treatment for patch-stage mycosis fungoides.

Comparison of the efficacy of treatment with clobetasol propionate or bexarotene in early-stage mycosis fungoides

“…Of 28 stage T2 patients, 25% achieved complete remission, 57% achieved PR, total response rate (CCR + PR) was 82%. 15 In the present study, patients with T1, 2 MF had 50% CCR and 45% PR, and the total response rate was 95% which was in line with the findings of the study by Zackheim et al 15 …”

Treatment of Early-Stage Mycosis Fungoides With Twice-Weekly Applications of Mechlorethamine and Topical Corticosteroids

“…18 The present study was thus designed to test the hypothesis that a therapeutic regimen of twice-weekly applications of mechlorethamine and topical corticosteroids could be an effective treatment for patients with early-stage MF while decreasing the incidence of severe cutaneous intolerance reactions. 20 Our results demonstrated the efficacy of this regimen in the treatment of early-stage MF: the 58% rate of CR observed in the present study appeared close to those reported in other studies using daily applications of mechlorethamine ( Table 1). The 61% and 58% rates of CR that we observed in patients with stage IA and stage IB MF, respectively, were close to the rates reported in different studies of the literature, which ranged from 50% to 80% and 26% to 68% in patients with stage IA and stage IB MF, respectively.…”

Treatment of mycosis fungoides/Sezary syndrome: the University of California, San Francisco (UCSF) approach

“…Overall, we are pleased with our results with topical CSs in patch stage MF. As of this writing, over 100 T1 and approximately 50 T2 patients have been treated with results comparable to those reported in the 1998 study 3 . Response rates are as good as those obtained with other modalities.…”