Topical treatments for early-stage mycosis fungoides using Grading Recommendations Assessment, Development and Evaluation (GRADE) criteria: A systematic review

Abstract

Background Mycosis fungoides (MF) is a cutaneous lymphoma; most patients present with early, skin-limited disease and are managed by dermatologists. Objective The purpose of this study was to systematically review and assess the evidence on topical treatments for early-stage (IA, IB, IIA) MF. Methods We performed a literature search via MEDLINE, Embase, Web of Science, and Cochrane databases. Grading Recommendations Assessment, Development and Evaluation (GRADE) criteria were used to assess the certainty of the data. Results Two searches yielded 1252 references; 26 met the inclusion criteria and included literature on nitrogen mustard, retinoids, corticosteroids, carmustine, fluorouracil, methotrexate-laurocapram, hexadecylphosphocholine, peldesine, ingenol mebutate, topical methotrexate with oxygen flow-assisted LP3 carrier, and resiquimod. Most studies were single intervention, observational series. Nitrogen mustard, with the most published reports, was effective with 12%-82% early-stage MF patients (total n > 1000) achieving complete remission (CR) (low certainty evidence). Clinical CR was achieved among 10%-60% treated with topical retinoids (low certainty evidence). Two moderate-sized retrospective case series on topical steroids had 18%-63% CR (low certainty evidence). Only single studies were available for the other therapies. Conclusions For most outcomes of interest, the GRADE certainty for topical therapies for early-stage MF was low. Further randomized controlled trials and inclusion of quality of life indicators are needed.

Efficacy and tolerance of photodynamic therapy with methyl‐aminolevulinic acid in early‐stage mycosis fungoides: A real‐life retrospective study

“…Eventually, even though it appears as a valuable option in early‐stage MF lesions management with satisfying cosmetic outcomes and fewer sessions than phototherapy, the specific interest of PDT as monotherapy in oligolesional MF or as a complementary treatment of refractory lesions in patients receiving systemic therapies remains to be established by direct comparative studies with other skin‐directed procedures before being fully integrated into current guidelines 18,19 …”

“…Eventually, even though it appears as a valuable option in early-stage MF lesions management with satisfying cosmetic outcomes and fewer sessions than phototherapy, the specific interest of PDT as monotherapy in oligolesional MF or as a complementary treatment of refractory lesions in patients receiving systemic therapies remains to be established by direct comparative studies with other skin-directed procedures before being fully integrated into current guidelines. 18,19 AUTHOR CONTRIBUTIONS Olivier Dereure, Chloé Barrachin and Aurélie Du Thanh designed the study, obtained ethical approval, reviewed patients' files, collected and analysed data, wrote the manuscript and approved its final version. Chloé Barrachin, Diane Labau, Andréa Kolontee and Anca Debu performed PDT, collected data, reviewed patients' files, had full access to analysed data, reviewed the manuscript and approved its final version.…”

Frühe Mycosis fungoides: Skin directed Therapie oder – Wie würden Sie entscheiden?

“…78% errechnet [3, 4]. Die Auswertungen der Publikation sind in Hinblick auf die Empfehlungen in unserer aktuellen deutschen Leitlinie und einer aktuellen Evaluation der topischen Behandlungsmodalitäten in frühen Stadien der MF interessant [1, 5].…”

“…Nicht zuletzt die aktuellen Daten von Solvetti et al, die an Melanom Patienten im nicht betroffenen inguinalen Bereich erhoben wurden, sprechen dagegen [9]. Hinsichtlich der SDT zeigte die Untersuchung von Wennberg und Mitarbeitern, dass die unterschiedlichen Arten von topischen Therapien nicht gut wissenschaftlich abgesichert sind [5]. Weil im PROCLIPI Register beispielsweise nicht erfasst wurde welche Behandler-spezifischen Faktoren (z.B.…”

Vitamin D3 and deconvoluting a rash

“…In the present study, we aimed to investigate whether a single intervention of high-dose oral VitD 3 affected an experimentally induced rash at both the clinical and molecular levels in healthy human adults. The rash-inducing agent was nitrogen mustard (NM), a topical irritant and FDA-approved chemotherapeutic agent with well-known potential to cause systemic inflammatory reactions and contact dermatitis in high doses ( 12 ). We first applied NM to all participants without VitD intervention to establish a comprehensive clinical and molecular inflammatory profile for the NM reaction alone.…”