Strategies to Optimize Adherence in Patients with Mycosis Fungoides

Patient adherence to medications for common skin conditions has been extensively studied over the past two decades, and suboptimal adherence is a primary contributor to treatment failure. The impact of sub-par adherence in cutaneous T-cell lymphoma (CTCL) patients has been largely unexplored, and promoting adherence in this patient population may represent a promising area of consideration for improving treatment outcomes. We apply patient adherence strategies that have been studied in dermatology to CTCL and provide concrete examples of how these strategies can be used to improve adherence in the CTCL setting. Through the implementation of small changes in how we present and counsel about therapeutic options to our patients, we can maximize patient adherence, which has the potential to optimize therapy regimens and reduce treatment failure.

Contemporary Treatment Patterns and Response in Relapsed/Refractory Cutaneous T-Cell Lymphoma (CTCL) across Five European Countries

The treatment pattern of cutaneous T-cell lymphoma (CTCL) remains diverse and patient-tailored. The objective of this study was to describe the treatment patterns and outcomes in CTCL patients who were refractory or had relapsed (R/R) after a systemic therapy. A retrospective chart review study was conducted at 27 sites in France, Germany, Italy, Spain and the United Kingdom (UK) of patients who received a first course of systemic therapy and relapsed or were refractory. Data were collected longitudinally from diagnosis to first-, second- and third-line therapy. The study included 157 patients, with a median follow-up of 3.2 years. In total, 151 proceeded to second-line and 90 to third-line therapy. In the first line (n = 147), patients were treated with diverse therapies, including single- and multi-agent chemotherapy in 67 (46%), retinoids in 39 (27%), interferon in 31 (21%), ECP in 4 (3%), corticosteroids in 3 (2%) and new biological agents in 3 (2%). In the second line, the use of chemotherapy and retinoids remained similar to the first line, while the use of new biologics increased slightly. In sharp contrast to the first line, combination chemotherapy was extremely diverse. In the third line, the use of chemotherapy remained high and diverse as in the second line. From the time of first R/R, the median PFS was 1.2 years and the median OS was 11.5 years. The presented real-world data on the current treatments used in the management of R/R CTCL in Europe demonstrate the significant heterogeneity of systemic therapies and combination therapies, as expected from the European guidelines.

Granulomatous Slack Skin with Hypercalcemia Indolently Mimicking Sarcoidosis

<p class="abstract">Granulomatous slack skin is a rare variant of cutaneous T-cell lymphoma characterized by lax skin and granulomatous infiltrate with loss of elastic fibers on histology. We report a unique case of a female presenting with CD30-granulomatous slack skin complicated by hypercalcemia, initially diagnosed, and managed as sarcoidosis. Interestingly, she had a history of previously treated CD30+ cutaneous T-cell lymphoma. Granulomatous slack skin can frequently mimic other benign and malignant cutaneous diseases, prompting the need for clinical vigilance from dermatologists.</p>

Hydroa Vacciniforme-Like Cutaneous T-Cell Lymphoma

Hydroa vacciniforme (HV)-like cutaneous T-cell lymphoma (HVLL) is a controversial skin pathology because some cases appear as hydroa vacciniforme, whereas others progress to cutaneous T-cell lymphoma with or without angiocentricity. It is usually associated with infections of Epstein Barr viruses and NK-cell lymphomas and typically affects the pediatric population. Symptoms include facial edema, papules, vesicles, and blisters in the facial region, arms, legs, and areas exposed to sunlight that leave varioliform scars. There may be infiltration of the lips, eyelids, and nose, usually accompanied by comorbid infections and hypersensitivity to insect bites. Frequency is rare, but HVLL more commonly affects patients from South America and Asia. Its clinical management can be difficult and accompanied by a high index of malignancy, thus early diagnosis is essential for effective and timely management.