Department of Dermatology and Venereology, HELIOS Klinikum Krefeld, Krefeld, Germany.
Department of Dermatology and Venereology, University Hospital Hamburg- Eppendorf, Hamburg, Germany.
J Dtsch Dermatol Ges. 2022 May;20(5):579-586. doi: 10.1111/ddg.14688. Epub 2022 Apr 15.
In Europe chlormethine gel is licensed for the management of patients with mycosis fungoides of all stages. However, the optimal regimen regarding frequency and dosing as well as combination and maintenance therapy is not well established.
Ten experts experienced in research and management of cutaneous T-cell lymphomas from Germany, Austria, and Switzerland (DACH region) were asked in written form to report on indication for chlormethine gel, frequency of use, monitoring, concomitant therapies, adverse effects, combination therapies in later stages of the disease, maintenance therapy, and adherence to this therapy for mycosis fungoides. The structured answers were discussed in a consensus conference and recommendations were developed.
Essential for therapy with chlormethine gel is an individualized and symptom-oriented management. Because of the lack of systemic resorption of topically administered chlormethine gel, systemic adverse events are unlikely. An allergic or irritative-toxic contact dermatitis is common but manageable with adaptation of the regimen, interruption of administration, and symptom-specific supportive measurements. A step-up initial approach with application of chlormethine gel every other day is associated with a better tolerability, especially if it is alternated with topical corticosteroids.
The use of chlormethine gel in the management of mycosis fungoides is often limited by a concomitant contact dermatitis. An adequate therapeutic regimen and the management of adverse effects can preclude an unnecessary withdrawal of therapy so that more patients can benefit from this treatment option.
在欧洲，氯苯丁胺凝胶被批准用于治疗各期蕈样真菌病患者。然而，关于频率和剂量、联合治疗和维持治疗的最佳方案尚未得到很好的确定。
德国、奥地利和瑞士（DACH 地区）的 10 位在皮肤 T 细胞淋巴瘤的研究和管理方面有经验的专家以书面形式报告了氯苯丁胺凝胶的适应症、使用频率、监测、联合治疗、不良反应、疾病后期的联合治疗、维持治疗以及对蕈样真菌病的治疗依从性。对结构化的答案进行了共识会议讨论，并制定了建议。
氯苯丁胺凝胶治疗的关键是个体化和症状导向的管理。由于局部给予的氯苯丁胺凝胶几乎不会被全身吸收，因此不太可能发生全身不良反应。过敏或刺激性毒性接触性皮炎很常见，但通过调整方案、中断给药和针对症状的支持性措施是可以管理的。每天应用氯苯丁胺凝胶进行初始逐步治疗与更好的耐受性相关联，特别是如果与局部皮质类固醇交替使用时。
氯苯丁胺凝胶在蕈样真菌病治疗中的应用常因并发接触性皮炎而受限。适当的治疗方案和不良反应管理可以避免不必要的停药，从而使更多的患者受益于这种治疗选择。
