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Skin Directed Therapies

An Overview of Skin-Directed Therapies

An Overview of Skin-Directed Therapies

In most clinical situations, treatment of cutaneous T-cell lymphoma (CTCL) is tailored to the stage and particular features of the disease, general health concerns, and lifestyle considerations. Patients with disease limited to the skin (stages 1 and II) can often achieve clinical response with one of the readily available skin-directed therapies.

Topical Therapy: Topical Corticosteroids

Topical corticosteroids (or steroids) are used to treat a host of skin disorders including patch/plaque stage CTCL.

Topical Therapy: Bexarotene Gel (Targretin®)

Bexarotene is a retinoid, a type of synthetic vitamin A, used in the treatment of early stage CTCL (Stage I-A, I-B, and II-A). Bexarotene activates a specific type of retinoid receptor (known as RXR) and influences cell growth and differentiation. Bexarotene gel is applied to affected lesions between 1-4 times per day.

Topical Chemotherapy: Mechlorethamine (Mustargen®)

Brand name: Mustargen® Nitrogen mustard (NM) is an anti-cancer drug that inhibits DNA replication. Originally developed as an intravenous cancer chemotherapy, its topical application to the skin has been shown to be an effective treatment of early stage (Stage I-A, I-B, and II-A) CTCL.

Topical Chemotherapy: Carmustine (BCNU)

Carmustine is a cancer chemotherapy and works by the same mechanisms as NM. Topical application of carmustine has also been shown to be effective in the treatment of patch/plaque CTCL. Usually, Carmustine is applied only to affected lesions. Topical Carmustine is usually prescribed in 12-week courses.

Phototherapy: UVB – Broad & Narrow Band and PUVA

Phototherapy involves the use of ultraviolet light to treat the skin. Ultraviolet light is the same rays that are in sunlight. Patients with more extensive skin involvement are often prescribed phototherapy when topical treatments prove impractical or ineffective. There are different types of phototherapy based on the different wavelengths of ultraviolet light used during treatment. These include ultraviolet B (UVB- Broad or Narrow Band) or PUVA (Psoralen medication+UVA).

Radiation Therapy: Local & Total Skin Electron Beam Conventional Radiation Therapy

Radiation therapy uses X-rays and electrons to treat the skin. In fact, the mycosis fungoides variant of CTCL may have been the first type of cancer treated with radiation therapy only a few years after X-rays were discovered at the end of the 19th century. Today, radiation therapy can be used to treat individual CTCL lesions (local) or the entire skin surface (total skin).