Phototherapyphotochemotherapy

Ultraviolet (UV) light of different wavelengths has been used for many years. UVA (320-400 nm) and UVB (290-320 nm) are most common. Treatment combination with UVA and photosensitizing compounds (psoralens) is termed PUVA. PUVA has been used since 1976 in the treatment of various dermatological diseases including CTCL, and is one of our preferred treatment options in early stage MF.29 It is extremely effective at clearing patch and plaque disease; however, the impact of maintenance therapy remains uncertain. Several studies confirm high remission rates in early stages of MF, with reported complete remissions in up to 71.4% of patients.29-32 Long-term remissions have been reported for PUVA. We evaluated follow-up data of 66 patients with early stage disease who achieved CR after PUVA monotherapy, and showed that 50% of the patients maintained CR with a median of 84 months, and 50% of the patients relapsed with a median disease-free interval of 39 months. Median follow-up time was 94 months.32 Reported short-term side effects were most commonly nausea and erythema. About 30% of patients developed skin malignancies, such as squa-mous or basal cell carcinoma.

The efficacy of UVB is more limited to patch stage, while PUVA is also effective in clearing plaques. The effects of UVB phototherapy were retrospectively evaluated in 37 patients with MF limited to patch/plaque disease.33 Seventy-one percent achieved a CR, with a median duration of 22 months. Eighty-three percent of patients with disease limited to patches achieved remission, whereas none of the patients with plaque disease achieved remission. Narrowband (NB)-UVB is considered to be less carcinogenic and may be an alternative treatment option in early stage MF. In three small retrospective analyses, patients with clinical stage IA/IB and parapsoriasis and treated with NB-UVB showed CR rates between 54.2 and 83%.34-36 However, remission times were short and a maintenance schedule has been difficult to establish. Long-wave ultraviolet A (UVA1) has likewise shown efficacy in single case reports.37

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