Zane Cristina, Venturini Maria, Sala Raffaella, Calzavara-Pinton Piergiacomo
Department of Dermatology, Spedali Civili, Brescia, Italy.
Photodermatol Photoimmunol Photomed. 2006 Oct;22(5):254-8. doi: 10.1111/j.1600-0781.2006.00246.x.
Mycosis fungoides (MF) is the most common primary cutaneous T-cell lymphoma (CTCL). Unilesional MF is characterized by a limited involvement of the skin and a chronical, though indolent course. If lesions are refractory to topical steroids, therapies such as localized chemotherapy, photochemotherapy and radiotherapy are available. However, they have several acute and chronic side-effects and toxicity may accumulate if repeated and protracted treatment cycles are delivered to refractory or relapsing lesions. The present study aims to assess the efficacy of photodynamic therapy (PDT) with topical methylaminolevulinate (MAL) in the treatment of unilesional MF.
Five patients were enrolled who had unilesional MF that did not respond to treatment with topical steroids, localized psoralen and UVA therapy or UVA1 phototherapies. A 20% MAL (Metvix cream) cream was applied under occlusive dressing for 3 h. Soon afterwards, skin was irradiated with 37.5 J/cm(2) of red light (635+/-18 nm) delivered by an Aktilite CL128 lamp (PhotoCure ASA) with an irradiance of 86 W/cm(2) at skin level. PDT was repeated once weekly until complete clearing of the lesions was obtained, or, in the case of partial clearing, the therapy was interupted when three successive treatments provided no further improvement. All patients underwent a skin biopsy before and after PDT.
A complete remission was observed in four patients and a partial improvement in one. The median number of treatments was six (range 1-9). In no cases was recurrence seen at follow-up (ranging from 12 to 34 months). Treatments were well tolerated and local anesthesia was never requested.
In conclusion, here, PDT was seen to be an effective and well-tolerated treatment option for unilesional MF.
蕈样肉芽肿（MF）是最常见的原发性皮肤T细胞淋巴瘤（CTCL）。单病灶MF的特点是皮肤受累局限，病程呈慢性，虽进展缓慢。如果皮损对局部类固醇治疗无效，可采用局部化疗、光化学疗法和放射疗法等治疗方法。然而，这些治疗方法有一些急性和慢性副作用，并且如果对难治性或复发性皮损进行重复和长期的治疗周期，毒性可能会累积。本研究旨在评估外用甲基氨基酮戊酸（MAL）光动力疗法（PDT）治疗单病灶MF的疗效。
纳入5例单病灶MF患者，这些患者对局部类固醇治疗、局部补骨脂素加紫外线A疗法或紫外线A1光疗法均无反应。将20%的MAL（Metvix乳膏）乳膏在封闭敷料下涂抹3小时。之后不久，用Aktilite CL128灯（PhotoCure ASA）以皮肤水平86 W/cm²的辐照度照射皮肤，给予37.5 J/cm²的红光（635±18 nm）。PDT每周重复一次，直到皮损完全清除，或者在部分清除的情况下，当连续三次治疗没有进一步改善时中断治疗。所有患者在PDT前后均进行了皮肤活检。
4例患者完全缓解，1例部分改善。治疗的中位数为6次（范围1 - 9次）。随访期间（12至34个月）均未见复发。治疗耐受性良好，从未要求局部麻醉。
总之，在此研究中，PDT被认为是治疗单病灶MF的一种有效且耐受性良好的治疗选择。
