Topical corticosteroids for mycosis fungoides. Experience in 79 patients

Zackheim, H.S.; Kashani-Sabet, M.; Amin, S.

Archives of Dermatology 134(8): 949-954

1998


ISSN/ISBN: 0003-987X
PMID: 9722724
Document Number: 1284
Objective: To determine the effectiveness of topical corticosteroids in the management of mycosis fungoides. Design: Prospective study. 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 1 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 TI 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 TI 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 specimens 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.

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Topical corticosteroids for mycosis fungoides. Experience in 79 patients