NB-UVB phototherapy for a 70-year-old Filipino male with concomitant nonsegmental vitiligo and mycosis fungoides in patch-plaque stage, a case report

Authors: Stephanie Manuella Christianto MD, Benedicto dL. Carpio MD, FPDS, Eileen Regalado-Morales MD, FPDS, Armelia Andrea Lapitan-Torres MD, FPDS, Ma. May Jasmin Yason MD, FPDS, Amelita Tanglao-De Guzman MD, FPDS

Abstract

Introduction: Mycosis Fungoides is a peripheral T-cell lymphoma caused by skin-homing CD4+ T cells which may progress to involve the lymph nodes and viscera. It is uncommon among East Asians. Vitiligo is a chronic pigmentary disorder due to progressive autoimmune mediated melanocytic destruction. NB-UVB phototherapy is an effective treatment modality for both MF and vitiligo. However, the two conditions coexisting makes it complicated to determine effective dose of NB-UVB.

Case Summary: A 70-year-old male presented with 2-month history of intensely pruritic erythematous plaque on the forehead and bilateral extensor forearms, with previous history of chronic dermatitis. He also presented with non-segmental vitiligo over the anterior aspect of the chest, hands, lower back, genitals, thighs, and feet. Initially, he was managed as Allergic Contact Dermatitis with minimal response to topical steroids. Skin punch biopsy done revealed atypical lymphocytes with large cerebriform and irregularly shaped nuclei in the dermis suggestive of mycosis fungoides. He was treated with modified biphasic NBUVB to accommodate both the vitiliginous area at 140 mJ, and the MF skin at 296 mJ, twice a week. The patient responded after 4th session with clearing of most skin lesions and relief of pruritus. However, the patient eventually developed increased pruritus, erythema, and acral fissuring. Thus, discontinuance of phototherapy was warranted. Patient is currently maintained with antihistamines and topical steroids.

Conclusion: Modified biphasic NB-UVB has inconsistent results in treatment of concomitant vitiligo and Mycosis Fungoides.

 

Citation

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Keywords

Mycosis Fungoides with concomitant vitiligo, Cutaneous Lymphoma, nonsegmental vitiligo, NB-UVB phototherapy

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