TOPICAL CORTICOSTEROIDS FOR MYCOSIS-FUNGOIDES - EXPERIENCE IN 79 PATIENTS

Objective: To determine the effectiveness of topical corticosteroids i n the management of mycosis fungoides. Design: Prospective study. Sett ing: Academic referral center, Veterans Affairs Medical Center, and pr ivate practice. Patients: Seventy-nine patients with patch or plaque s tage of mycosis fungoides. Fifty-one were stage T1 (less than 10% of s kin involved) and 28 were stage T2 (10% or more of skin involved). Sev enty-five had patch-stage and 4 had plaque-stage disease as determined by histological examination. Interventions: Patients were treated wit h topical class I to III corticosteroids. Of the stage T1 patients, al l used class I corticosteroids, and 4 (8%) also used class II or III c orticosteroids. 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. Ba seline and monthly morning serum cortisol levels were obtained during treatment. Main Outcome Measures: Response to treatment and side effec ts. Results: The median follow-up period was 9 months. Thirty-two (63% ) of stage T1 patients achieved complete remission and 16 (31%) achiev ed partial remission, for a total response rate of 48 (94%). The compa rable figures for stage T2 patients were 7 (25%), 16 (57%), and 23 (82 %), respectively. Responses were determined by clinical examination. T hirty-nine patients achieved clinical clearing. In 7 of these, posttre atment biopsy speciments were obtained, and all showed histological cl earing. Reversible depression of serum cortisol levels occurred in 10 (13%). Minor skin irritation occurred in 2 patients and localized, rev ersible skin atrophy in 1. Conclusion: Topical corticosteroids, especi ally class I compounds, are an effective treatment for patch-stage myc osis fungoides.