clobetasol and Mycosis-Fungoides

Pagetoid reticulosis (PR) is a rare lymphoproliferative disorder with indolent behavior considered a variant of mycosis fungoides. It is characterized by marked epidermotropism of the neoplastic lymphocytes. Since its original description, five cases have been reported in children. We report a new case of PR with an immunohistochemical profile not previously described in children.

Topics: Administration, Topical; Adolescent; Biopsy; Child; Child, Preschool; Clobetasol; Female; Glucocorticoids; Humans; Immunohistochemistry; Immunophenotyping; Lymphocytes; Lymphoproliferative Disorders; Male; Mycosis Fungoides; Pagetoid Reticulosis; Skin; Skin Neoplasms; Treatment Outcome

Mycosis fungoids can present with various clinical and histological features, with only a few of them being recognized as distinct entities in the current WHO and EORTC classifications. Histologically, mycosis fungoids (MF) usually show a superficial perivascular or band-like lymphocytic infiltrate with epidermotropism. We here report two cases of a rare histological variant of MF, called interstitial in the literature. Our first patient, a 71-year-old male, had a previously diagnosed MF, which clinically evolved towards nodules, showing histologically an interstitial lymphocytic infiltrate without epidermotropism and without large cell transformation. The second patient was a 64-year-old female with widespread plaques and nodules. Histologically, a dense dermal interstitial infiltrate was observed, with foci of epidermotropism, without large cell transformation. At relapse after treatment, she presented with plaques, papules and nodules, histologically showing a slight interstitial lymphocytic infiltrate that resembled granuloma annulare or inflammatory morphea. In both patients, clinical aspect suggested MF and a dominant T-cell clone was found in lesional skin. Nodules in MF are not always the hallmark of large cell transformation, but may correspond to unusual interstitial lesions. Diagnosis of such rare variant may be difficult and requires a good clinical pathological correlation together with the search for foci of epidermotropism on skin biopsy and for a dominant cutaneous T-cell clone.

Topics: Aged; Anti-Inflammatory Agents; Antirheumatic Agents; Arthritis, Rheumatoid; Biopsy; Clobetasol; Female; Humans; Immunophenotyping; Male; Methotrexate; Middle Aged; Mycosis Fungoides; Neoplasm Recurrence, Local; PUVA Therapy; Skin Neoplasms; T-Lymphocyte Subsets

Topics: Administration, Topical; Adult; Biopsy, Needle; Child; Clobetasol; Female; Hospitals, University; Humans; Male; Middle Aged; Mycosis Fungoides; Neoplasm Staging; Photopheresis; Prognosis; PUVA Therapy; Radiotherapy; San Francisco; Sezary Syndrome; Skin Neoplasms; Treatment Outcome; Ultraviolet Therapy

Topics: Administration, Cutaneous; Aged; Biomarkers, Tumor; Biopsy; Clobetasol; Humans; Ichthyosis; Immunohistochemistry; Male; Mycosis Fungoides; Ointments; Skin; Skin Neoplasms; Treatment Outcome

Topical superpotent class I corticosteroids (CSs) are highly effective in the treatment of early-stage mycosis fungoides (MF) and are readily available, easily applied, and have minor side effects compared to other topical therapeutic options. Because MF is a chronic disease, prolonged treatment is needed, raising the concern of CS-induced cutaneous adverse effects (AEs). In this observational study, we aimed to evaluate the risk for skin AEs of clobetasol propionate cream 0.05% in patients with early-stage MF. Thirteen consecutive patients with MF were treated with clobetasol propionate cream 0.05% once or twice daily as monotherapy and were followed for 4 to 17 months. One participant was lost to follow-up, and the remaining 12 participants responded to treatment with topical clobetasol propionate with minimal side effects. With proper education and monitoring, topical CSs are a safe and effective mainstay of treatment for patches and flat plaques in patients with early-stage localized MF.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Atrophy; Clobetasol; Female; Glucocorticoids; Humans; Hypopigmentation; Male; Middle Aged; Mycosis Fungoides; Prospective Studies; Skin; Skin Cream; Skin Neoplasms

Hypopigmented mycosis fungoides (HMF) is the most common variant of mycosis fungoides (MF) in children. Large-cell transformation in HMF has never been reported. Herein we report a case of HMF in an 8-year-old boy who presented with a 6-year history of hypopigmented patches on the bilateral arms, lower back, buttocks, posterior thighs, and lower legs. Biopsy revealed an abnormal CD8

Topics: Biopsy; Cell Transformation, Neoplastic; Child; Clobetasol; Glucocorticoids; Humans; Hypopigmentation; Male; Mycosis Fungoides; Skin; Skin Neoplasms; T-Lymphocytes; Ultraviolet Therapy

A 9-year-old girl visited the department of Dermatology with an asymptomatic hypopigmented skin eruption on her upper legs, groins and trunk since 7 years. Histopathological analysis established the diagnosis of hypopigmented mycosis fungoides, a rare subtype of cutaneous T-cell lymphoma which is most commonly seen at younger age. The lesions are successfully treated with clobetasol 0.05% ointment 4 days a week.

Topics: Child; Clobetasol; Female; Glucocorticoids; Humans; Hypopigmentation; Mycosis Fungoides; Skin Neoplasms; Treatment Outcome

Topics: Clobetasol; Diuretics; Female; Humans; Hydrochlorothiazide; Middle Aged; Mycosis Fungoides

Cutaneous syringotropic T-cell lymphoma is a rare form of lymphoma. We report a case involving a misleading cutaneous presentation on the sole of the foot.. A 55-year-old woman presented discrete coalescent papules on her left foot, having an anhidrotic appearance, for which a number of antifungal treatments had been given without success. The skin biopsy revealed CD4+ T lymphocytic dermal infiltrate, mainly near the sweat glands, with syringotropism. The diagnosis of syringotropic T-cell lymphoma was reinforced by the presence of dominant cutaneous T-lymphocyte clone in the skin biopsy. Staging tests were negative. Treatment was initiated with an extremely potent (class IV) dermal corticosteroid.. Syringotropic T-cell lymphoma is an extremely rare form of cutaneous lymphoma similar in presentation to mycosis fungoides, characterised by the mainly perisudoral and syringotropic nature of the lymphocytic infiltrate. The value of this case report lies in the extremely mild nature of the misleading skin lesions, which could only be diagnosed through biopsy. Treatment for this condition is not as yet codified due to the extremely low number of cases reported in the literature.

Topics: Carmustine; Clobetasol; Dermatomycoses; Diagnostic Errors; Female; Foot Diseases; Humans; Middle Aged; Mycosis Fungoides; Ointments; Skin Neoplasms; Sweat Glands

Visceral involvement usually occurs in the late stages of mycosis fungoides (MF). Small bowel involvement in MF is uncommon. When involved, it could cause significant morbidity and mortality. In this study, the authors present an 89-year-old woman diagnosed with T1, N0, B1, M0; stage 1A MF, treated with topical temovate with good response who presented 3 months later with small bowel obstruction due to biopsy-proven localization of MF in the gastrointestinal tract.

Topics: Administration, Cutaneous; Aged, 80 and over; Anti-Inflammatory Agents; Clobetasol; Fatal Outcome; Female; Glucocorticoids; Humans; Intestinal Neoplasms; Intestinal Obstruction; Intestine, Small; Mycosis Fungoides; Neoplasm Staging; Skin Neoplasms

Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma. In early stages of the disease many different clinicopathologic variants have been observed. Currently, a papular variant of MF which is characterized by a good prognosis has been described.. Because only seven cases have been reported in the literature, clinical and morphological data of this variant are not well established. We report the clinical and histopathological characteristics of two new patients with papular mycosis fungoides and review the previous cases reported in the literature.. The two cases of this early variant of MF were characterized by the presence of papules which, unlike the papules of lymphomatoid papulosis, did not show a tendency for spontaneous resolution. Histologic examination confirmed the diagnosis of MF in all cases. Immunohistochemical staining for CD30 was negative in all two cases. Follow-up data of our two patients confirmed the non-aggressive behavior of the disease, confirming that the lesions were not manifestations of advanced MF.. Papular MF is a new variant of early MF characterized by a good prognosis in the long term follow- up. Thus, it should be added to the long list of clinicopathologic subtypes of MF.

Topics: Clobetasol; Female; Glucocorticoids; Humans; Immunohistochemistry; Middle Aged; Mycosis Fungoides; PUVA Therapy; Skin Neoplasms; Treatment Outcome

To determine the effectiveness of topical corticosteroids in the management of mycosis fungoides.. Prospective study.. Academic referral center, Veterans Affairs Medical Center, and private practice.. 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.. 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.. Response to treatment and side effects.. 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.. Topical corticosteroids, especially class I compounds, are an effective treatment for patch-stage mycosis fungoides.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Antineoplastic Agents; Betamethasone; Betamethasone Valerate; Clobetasol; Drug Administration Schedule; Female; Fluocinonide; Follow-Up Studies; Humans; Hydrocortisone; Male; Middle Aged; Mycosis Fungoides; Neoplasm Staging; Occlusive Dressings; Prospective Studies; Remission Induction; Skin Neoplasms; Treatment Outcome; Triamcinolone Acetonide