Clearance of folliculotropic and tumor mycosis fungoides with topical 5% imiquimod.

MF: mycosis fungoides INTRODUCTION Mycosis fungoides (MF), the most common form of cutaneous T-cell lymphoma, is composed of skin-homing mature effector T lymphocytes. Limited patch or plaque disease generally follows an indolent course with little, if any, effect on overall survival; therefore, skin-directed therapies are preferred and include corticosteroids, nitrogen mustard, phototherapy, and radiotherapy. Systemic interferon alfa has long been used in the treatment of more generalized disease by enhancing cytotoxic helper T cell (Th)1 lymphocyte and natural killer cell responses and suppressing Th2 differentiation, but is not used for limited disease secondary to its side-effect profile and method of administration. Imiquimod is a topical immunomodulator that stimulates a Th1 response through activation of toll-like receptor 7 on plasmacytoid dendritic cells, leading to production of interferon alpha, tumor necrosis factor alfa, and interleukin-12. Production of this cytotoxic cytokine milieu is thought to be the driving force in the treatment of condyloma, molluscum contagiosum, superficial basal cell carcinomas, lentigo maligna, and cutaneous lymphomas. Several reportswerepublishedon the effectiveness of topical imiquimod in early-stage MF. We present 2 cases highlighting the effectiveness of topical imiquimod in the treatment of folliculotropic and tumor MF.