A Patient’s Guide to Understanding
Cutaneous Lymphoma
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involvement require systemic therapies. More aggressive therapies become
necessary later in the disease, when malignant T-cells depend less on the
skin and the disease moves beyond the skin. The therapies most commonly
employed in the management of cutaneous lymphomas are described on
the pages that follow.
SKIN-DIRECTED THERAPIES
Topical Corticosteroids
These are the cornerstone of treatment for a host of skin conditions.
Topical steroids are not cosmetic – they actually kill lymphocytes. These
agents possess multiple immune surveillance and anti-inflammatory
effects. In early-stage disease, topical corticosteroids can induce and
maintain clinical clearing of lesions for extended periods of time. Itching
is often markedly improved with the use of these agents. Topical steroids
are packaged in a variety of ways including creams, ointments, lotions,
solutions and gels. Pulse topical steroids refer to the application of a strong
topical steroid (Group I) twice daily for 2 weeks alternating with a lesser
mid-potency agent (Group III or IV) applied twice daily for 2 weeks. This
pattern is repeated for up to 12 weeks.
Phototherapy
One of the most widely recommended treatments for cutaneous lymphoma
is ultraviolet light therapy (phototherapy). Patients with more extensive
skin involvement (more than 30% of total body surface) are often prescribed
phototherapy when topical treatments might be impractical. Phototherapy
is delivered in the form of ultraviolet B (UVB-broad or narrow band) or
PUVA (psoralen medication + ultraviolet A).
• UVB refers to a shorter spectrum of ultraviolet light that causes
sunburns. In a controlled environment, UVB phototherapy can
produce marked improvement in patch and plaque stage lesions as
well as control symptoms of itch. This form of UV light treatment
does not require the administration of an oral medication. UVB
can be delivered in private dermatology practices or hospital
settings. Most patients receive 3 treatments per week, increasing
length of time from a few seconds to a few minutes. As the
disease improves and remission is reached, the frequency of UVB
treatments diminishes over time to 1 per week.
• PUVA refers to ultraviolet A (the longer spectrum of ultraviolet
