Topical corticosteroids for mycosis fungoides. Experience in 79 patients.
OBJECTIVE
To determine the effectiveness of topical corticosteroids in the management of mycosis fungoides.


METHODS
Prospective study.


METHODS
Academic referral center, Veterans Affairs Medical Center, and private practice.


METHODS
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.


METHODS
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.


METHODS
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 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.


CONCLUSIONS
Topical corticosteroids, especially class I compounds, are an effective treatment for patch-stage mycosis fungoides.
Department of Dermatology, University of California, San Francisco, USA.
H S
HS
Zackheim
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M
Kashani-Sabet
S
S
Amin
D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001623:Betamethasone / Q000031:analogs & derivatives / Q000627:therapeutic use; D001624:Betamethasone Valerate / Q000627:therapeutic use; D002990:Clobetasol / Q000031:analogs & derivatives / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D005447:Fluocinonide / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D009182:Mycosis Fungoides / Q000188:drug therapy* / Q000473:pathology; D009367:Neoplasm Staging; D009779:Occlusive Dressings; D011446:Prospective Studies; D012074:Remission Induction; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D000970:Antineoplastic Agents; D005447:Fluocinonide; D001623:Betamethasone; D001624:Betamethasone Valerate; C064466:halobetasol; D002990:Clobetasol; D014222:Triamcinolone Acetonide; C014477:diflorasone; D006854:Hydrocortisone