[Narrow-band UV-B treatment in the early stages of mycosis fungoides].

Skin-directed therapies are used for early-stage mycosis fungoides, and include topical corticosteroids, carmustine, and nitrogen mustard, psoralen with UV-A (PUVA) photochemotherapy and, more recently, narrowband UV-B phototherapy.1-4 We performed a retrospective study of patients with early-stage (IA and IIB) mycosis fungoides who were treated with narrowband UV-B in the Dermatology Department of Hospital de León between 2005 and 2009. A total of 11 patients, 5 men and 6 women, with a mean age of 66.3 years, were included in the study; 6 had stage IA disease and 5 had stage IIB disease. Mean disease duration from diagnosis to treatment commencement was 4.7 years (range, 6 months to 10 years); 7 and 4 of the patients had skin phototypes II and III, respectively. All the patients received 3 weekly phototherapy sessions, with dose adapted to skin phototype (Table). Following therapy, 10 of the patients achieved complete remission (no lesions), whereas lesions in the remaining patient worsened. The patients underwent an average of 31 phototherapy sessions (between 17 and 61 sessions), and the mean cumulative dose was 22.6 J/cm2. During the follow-up period (median, 2 years), 6 of 8 patients experienced a relapse. We have no information on relapse for the remaining 3 patients in the study, as 1 withdrew from therapy, another left the city, and the third died from a heart disorder. Two patients are in remission after 3 years of follow-up. The mean disease-free period was 5.3 months. Phototherapy began to be used as a treatment for mycosis fungoides about 30 years ago, following the observation that mycosis fungoides lesions developed in areas of the skin not exposed to sunlight.5 As a skin-directed treatment with minimal systemic side effects, phototherapy in various forms—PUVA (320400 nm), topical PUVA, UV-B, and narrowband UV-B (311313 nm)—has been used to treat early-stage (IA and IIB) mycosis fungoides with no systemic involvement. UV-B irradiation of the Langerhans cells prevents antigen presentation, modulates cytokine expression, and induces apoptosis of malignant T-lymphocytes.5 UV-B radiation has a number of advantages over PUVA therapy, primarily that it is equally effective for early-stage disease, has a remission rate of 50% to 100%, and has none of the disadvantages associated with psoralen intake, such as the risk of damage to the eyes and skin cancer.6,7 The disadvantages of UV-B radiation are that recurrence occurs earlier (mean, 6 months), and that it may be difficult for active patients to visit the hospital for the treatment. To overcome the drawback of early relapse associated with UV-B therapy, some authors recommend a maintenance schedule8; however, this is more difficult than with PUVA therapy, as the risk of post-session erythema grows when the interval between irradiation sessions is increased to 7 up to 15 days. To overcome the second drawback, some authors propose home-based phototherapy.9 The results of our study are consistent with those of previous studies5,10: narrowband UV-B is an effective therapy for early-stage mycosis fungoides when the lesions are not infiltrated, and especially for lighter skin phototypes.