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Experience in 79 Patients

Herschel S. Zackheim, MD; Mohammed Kashani-Sabet, MD; Smita Amin, MD

Arch Dermatol. 1998;134:949-954.

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 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.

From the Cutaneous Oncology Division, Department of Dermatology, University of California, San Francisco (Drs Zackheim, Kashani-Sabet, and Amin), and the Veterans Affairs Medical Center, San Francisco (Dr Zackheim). Dr Amin is now with the Division of Dermatology, The Toronto Hospital–Western Division, University of Toronto, Toronto, Ontario.

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