Zackheim H S, Kashani-Sabet M, Amin S
Department of Dermatology, University of California, San Francisco, USA.
Arch Dermatol. 1998 Aug;134(8):949-54. doi: 10.1001/archderm.134.8.949.
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.
确定外用皮质类固醇激素治疗蕈样肉芽肿的有效性。
前瞻性研究。
学术转诊中心、退伍军人事务医疗中心及私人诊所。
79例蕈样肉芽肿斑块期或斑片期患者。51例为T1期（皮肤受累小于10%），28例为T2期（皮肤受累10%或更多）。经组织学检查，75例为斑片期疾病，4例为斑块期疾病。
患者接受I至III级外用皮质类固醇激素治疗。在T1期患者中，所有患者均使用I级皮质类固醇激素，4例（8%）还使用II级或III级皮质类固醇激素。在T2期患者中，19例（68%）使用I级，12例（43%）使用II级或III级化合物。一些患者使用了不止一类皮质类固醇激素。用药几乎均为每日两次。3例T1期和2例T2期患者使用了塑料薄膜封包。治疗期间获取基线及每月早晨血清皮质醇水平。
对治疗的反应及副作用。
中位随访期为9个月。T1期患者中，32例（63%）达到完全缓解，16例（31%）达到部分缓解，总缓解率为48例（94%）。T2期患者的相应数字分别为7例（25%）、16例（57%）和23例（82%）。通过临床检查确定反应情况。39例患者实现临床清除。其中7例获取了治疗后活检标本，均显示组织学清除。10例（13%）出现血清皮质醇水平可逆性降低。2例患者出现轻微皮肤刺激，1例出现局限性、可逆性皮肤萎缩。
外用皮质类固醇激素，尤其是I级化合物，是治疗蕈样肉芽肿斑片期的有效方法。
