A Man With a Rash on Nearly Half of His Body for 8 Years

Richard Harold Flowers IV, MD; Stephany Lynn Vittitow, BA; Corina Rusu, MD, PGYIII


August 25, 2020

No cure exists for MF, and treatment is aimed at relieving pruritus and pain, improving clinical appearance, and potentially preventing progression.[7] Management of MF varies according to the stage and extent of the disease.

Skin-directed treatments are preferred in the early stages of MF and include topical agents, phototherapy, and radiation. The first-line treatment for limited-stage MF is topical corticosteroids, particularly ultrapotent corticosteroids, with the chemotherapeutic agent mechlorethamine used as an alternative. Topical toll-like receptor (TLR) agonists, such as imiquimod (TLR7 agonist) and resiquimod (TLR7/8 agonist), have also demonstrated efficacy in patients with limited-stage MF.[5]

Phototherapy results in high complete remission rates and may be used alone or in conjunction with topical therapies for any stage of MF. Specifically, narrowband ultraviolet (UV) B light is recommended for patch or thin-plaque stages, whereas psoralen plus UVA (PUVA) light photochemotherapy is recommended for thicker plaques.[7] Localized radiotherapy may also be used for all stages of MF, and total skin electron beam radiation is used for more widespread patches or plaques.

Treatment for advanced stages of MF varies and includes bexarotene, interferon alfa, histone deacetylase inhibitors, extracorporeal photopheresis, allogeneic stem cell transplantation, conventional systemic chemotherapy, single-agent chemotherapy, and monoclonal antibodies directed against CD52, CD30, and chemokine receptor 4.[3] Bexarotene is a topical retinoid that can be effective in treating refractory and persistent disease.[5]

Because of the failure of topical corticosteroids in this patient, twice-weekly PUVA therapy was initiated. He experienced a gradual improvement in his symptoms and a decrease in the thickness and number of plaques.


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