Fungal mycosis: a study on the effectiveness of photochemotherapy with psoralen

Mycosis fungoides is the most common type of cutaneous T-cell lymphoma, accounting for about two-thirds of all cutaneous T-cell lymphomas and nearly 50% of all primary cutaneous lymphomas. It is characterized by a progressive evolution of erythematous patches, plaques and tumors over many years, eventually leading to metastasis.

In the early stages of the disease, malignant T cells represent a minority of infiltrating T cells in inflammatory cells. The affected skin is characterized by the presence of small to medium-sized T cells with CD3+, CD4+ and CD45RO+ memory immunophenotypes and, in most cases, a clonal rearrangement of the T-cell receptor (TCR)

gene.

Mycosis fungoides is initially treated with skin-directed therapy, which may include corticosteroids, chemotherapy, bexarotene, radiation therapy, and phototherapy with ultraviolet A and psoralen (PUVA — psoralen + UVA) .

In the article estet-portal.com you can learn in detail the effectiveness of PUVA prescription in mycosis fungoides at the stage from IA to IIA.

A randomized trial of the efficacy of therapy for mycosis fungoides

Photochemotherapy Psoralen — UV-A (PUVA) is the standard first-line treatment for early stage mycosis fungoides. However, much remains unknown about the therapeutic mechanisms of PUVA, the optimal duration and frequency of treatment, dose escalation, or use as maintenance therapy.

A prospective randomized clinical trial with a defined dosing regimen of PUVA was conducted at 5 centers (Graz, Vienna, Hietzing, Innsbruck and Salzburg) throughout Austria. Patients with mycosis fungoides from stage IA to IIA (n = 27) were included in the study starting March 13, 2013, the last patient was enrolled on March 21, 2016

A clinical case of difficult diagnosis of skin T-cell lymphoma. Part 1

Patients received oral 8-methoxypsoralen followed by twice-weekly exposure to UV-A for 12 to 24 weeks or clinical response.

Patients with a clinical response were randomized to PUVA maintenance therapy for 9 months (14 total exposures) or no treatment.

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Mycosis fungoides: therapeutic response to PUVA has been found

This randomized clinical trial analyzed 27 patients with mycosis fungoides, 70% of patients had a complete response after 12-24 weeks of treatment with psoralen-UV-A, maintenance therapy prolonged disease-free remission and reduced serum levels of several inflammatory mediators.

Low-dose, low-frequency oral psoralen-UV-A treatment followed by maintenance treatment has been shown to be safe and effective and can be used to treat early-stage mycosis fungoides, and potential biomarkers to assess therapeutic response to PUVA have also been identified.

Thank you for staying with estet-portal.com. Read other interesting articles in the "Practice" section. You may be interested in Clinical case of complex diagnosis of skin T-cell lymphoma. Part 2