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Phototherapy for mycosis fungoides.
Indian J Dermatol Venereol Leprol. 2015 Mar-Apr; 81(2):124-35.IJ

Abstract

BACKGROUND

Both phototherapy and photochemotherapy have been used in all stages of mycosis fungoides since they improve the symptoms and have a favourable adverse effect profile.

MATERIALS AND METHODS

We performed an extensive search of published literature using keywords like "phototherapy", "photochemotherapy", "NBUVB", "PUVA", "UVA1", "mycosis fungoides", and "Sezary syndrome", and included systematic reviews, meta-analysis, national guidelines, randomized controlled trials (RCTs), prospective open label studies, and retrospective case series. These were then arranged according to their levels of evidence.

RESULTS

Five hundred and forty three studies were evaluated, of which 107 fulfilled the criteria for inclusion in the guidelines.

CONCLUSIONS AND RECOMMENDATIONS

Photochemotherapy in the form of psoralens with ultraviolet A (PUVA) is a safe, effective, and well tolerated first line therapy for the management of early stage mycosis fungoides (MF), that is, stage IA, IB, and IIA (Level of evidence 1+, Grade of recommendation B). The evidence for phototherapy in the form of narrow-band UVB (NB-UVB) is less robust (Level of evidence 2++, Grade of recommendation B) but may be considered at least as effective as PUVA in the treatment of early-stage MF as an initial therapy. In patients with patches and thin plaques, NB-UVB should be preferentially used. PUVA may be reserved for patients with thick plaques and those who relapse after initial NB-UVB therapy. For inducing remission, three treatment sessions per week of PUVA phototherapy or three sessions per week of NB-UVB phototherapy may be advised till the patient achieves complete remission. In cases of relapse, patients may be started again on PUVA monotherapy or PUVA may be combined with adjuvants like methotrexate and interferon (Level of evidence 2+, Grade of recommendation B). Patients with early-stage MF show good response to combination treatments like PUVA with methotrexate, bexarotene or interferon-α-2b. However, whether these combinations hold a significant advantage over monotherapy is inconclusive. For late stage MF, the above-mentioned combination therapy may be used as first-line treatment (Level of evidence 3, Grade of recommendation C). Currently, there is no consensus regarding maintenance therapy with phototherapy once remission is achieved. Maintenance therapy should not be employed for PUVA routinely and may be reserved for patients who experience an early relapse after an initial course of phototherapy (Level of evidence 2+, Grade of recommendation B). Bath-water PUVA may be tried as an alternative to oral PUVA in case the latter cannot be administered as the former may show similar efficacy (Level of evidence 2-, Grade of recommendation C). In pediatric MF and in hypopigmented MF, both NB-UVB and PUVA may be tried (Level of evidence 3, Grade of recommendation D).

Authors+Show Affiliations

Department of Dermatology, Venereology and Leprology, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

25751327

Citation

Dogra, Sunil, and Rahul Mahajan. "Phototherapy for Mycosis Fungoides." Indian Journal of Dermatology, Venereology and Leprology, vol. 81, no. 2, 2015, pp. 124-35.
Dogra S, Mahajan R. Phototherapy for mycosis fungoides. Indian J Dermatol Venereol Leprol. 2015;81(2):124-35.
Dogra, S., & Mahajan, R. (2015). Phototherapy for mycosis fungoides. Indian Journal of Dermatology, Venereology and Leprology, 81(2), 124-35. https://doi.org/10.4103/0378-6323.152169
Dogra S, Mahajan R. Phototherapy for Mycosis Fungoides. Indian J Dermatol Venereol Leprol. 2015 Mar-Apr;81(2):124-35. PubMed PMID: 25751327.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Phototherapy for mycosis fungoides. AU - Dogra,Sunil, AU - Mahajan,Rahul, PY - 2015/3/10/entrez PY - 2015/3/10/pubmed PY - 2015/12/15/medline SP - 124 EP - 35 JF - Indian journal of dermatology, venereology and leprology JO - Indian J Dermatol Venereol Leprol VL - 81 IS - 2 N2 - BACKGROUND: Both phototherapy and photochemotherapy have been used in all stages of mycosis fungoides since they improve the symptoms and have a favourable adverse effect profile. MATERIALS AND METHODS: We performed an extensive search of published literature using keywords like "phototherapy", "photochemotherapy", "NBUVB", "PUVA", "UVA1", "mycosis fungoides", and "Sezary syndrome", and included systematic reviews, meta-analysis, national guidelines, randomized controlled trials (RCTs), prospective open label studies, and retrospective case series. These were then arranged according to their levels of evidence. RESULTS: Five hundred and forty three studies were evaluated, of which 107 fulfilled the criteria for inclusion in the guidelines. CONCLUSIONS AND RECOMMENDATIONS: Photochemotherapy in the form of psoralens with ultraviolet A (PUVA) is a safe, effective, and well tolerated first line therapy for the management of early stage mycosis fungoides (MF), that is, stage IA, IB, and IIA (Level of evidence 1+, Grade of recommendation B). The evidence for phototherapy in the form of narrow-band UVB (NB-UVB) is less robust (Level of evidence 2++, Grade of recommendation B) but may be considered at least as effective as PUVA in the treatment of early-stage MF as an initial therapy. In patients with patches and thin plaques, NB-UVB should be preferentially used. PUVA may be reserved for patients with thick plaques and those who relapse after initial NB-UVB therapy. For inducing remission, three treatment sessions per week of PUVA phototherapy or three sessions per week of NB-UVB phototherapy may be advised till the patient achieves complete remission. In cases of relapse, patients may be started again on PUVA monotherapy or PUVA may be combined with adjuvants like methotrexate and interferon (Level of evidence 2+, Grade of recommendation B). Patients with early-stage MF show good response to combination treatments like PUVA with methotrexate, bexarotene or interferon-α-2b. However, whether these combinations hold a significant advantage over monotherapy is inconclusive. For late stage MF, the above-mentioned combination therapy may be used as first-line treatment (Level of evidence 3, Grade of recommendation C). Currently, there is no consensus regarding maintenance therapy with phototherapy once remission is achieved. Maintenance therapy should not be employed for PUVA routinely and may be reserved for patients who experience an early relapse after an initial course of phototherapy (Level of evidence 2+, Grade of recommendation B). Bath-water PUVA may be tried as an alternative to oral PUVA in case the latter cannot be administered as the former may show similar efficacy (Level of evidence 2-, Grade of recommendation C). In pediatric MF and in hypopigmented MF, both NB-UVB and PUVA may be tried (Level of evidence 3, Grade of recommendation D). SN - 0973-3922 UR - https://www.unboundmedicine.com/medline/citation/25751327/Phototherapy_for_mycosis_fungoides_ DB - PRIME DP - Unbound Medicine ER -