Treatment for cutaneous T-cell lymphoma CTCL

Skin creams (or topical treatments) are drugs that are put directly onto the area where they are needed. Your doctor may prescribe steroid or chemotherapy cream to treat areas of your skin. 

Your doctor, a nurse or a pharmacist will explain how to use the cream. It is important to follow the instructions they give you.

Steroids are drugs that help reduce redness and swelling. A steroid cream may be the only treatment you need to control early-stage CTCL.

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. Your doctor or nurse will explain exactly how to use a chemotherapy cream and which areas of skin to use it on. You must wear gloves to protect your hands when you use it.

Some people may have a reaction to skin creams. Tell your doctor if you have any side effects, such as redness or a burning sensation in the area.

PUVA (sometimes called photochemotherapy) is mainly used to treat skin symptoms during early CTCL. It uses a drug called psoralen (P), which makes your skin sensitive to ultraviolet light (UVA). You can take psoralen as a tablet or you can soak in a bath with psoralen liquid.

The tablets are usually taken 2 hours before the UVA light treatment. This is to allow enough time for the drug to reach your skin. If you have psoralen in a bath, you usually have to soak your body for 15 minutes.

Once the drug has had time to collect in your skin, you go into an enclosed, air-conditioned cabinet to have the ultraviolet light treatment. You may have this treatment a few times a week over several weeks until your skin improves. Sometimes, PUVA can be used again if your skin symptoms come back.

PUVA treatment causes similar skin side effects to UVB therapy. It also increases the risk of developing other types of skin cancer. You should check your skin regularly after treatment for signs of skin cancer. During your treatment, the drug psoralen will make you very sensitive to the sun. It is important to cover up and protect your skin from the sun to avoid sunburn. Do not use a sunbed or sun lamp.

You need to take extra precautions for 24 hours after taking the psoralen. During this time, you should protect your skin from sunlight even through windows. If you took psoralen as tablets, you should wear sunglasses to protect your eyes outdoors or near fluorescent lights.

Psoralen tablets can make you feel sick. It can help to take your tablets with food. If you feel sick, your doctor can give you anti-sickness (anti-emetic ) drugs to help. Sometimes they may change the psoralen to a different drug. We have information to help you manage nausea and vomiting.

During your course of PUVA, your skin may become itchy or red, like a mild sunburn. Tell your doctor or nurse if this happens. They can give you advice about creams that may help.

Chemotherapy may be given to help control CTCL. It is used if there are lots of tumours on the skin or if the lymph nodes or other organs are affected. It may also be used if other treatments are not controlling the CTCL.

Chemotherapy may be given by injection into a vein or as a tablet. You may be given a single drug or a combination of drugs.

Chemotherapy drugs used to treat CTCL include:

• chlorambucil
• methotrexate
• gemcitabine
• pentostatin
• pegylated liposomal doxorubicin.

Targeted therapies are drugs that use unique features of the cancer to find and treat cancer cells. A drug called brentuximab vedotin may be used if there are still signs of CTCL or it comes back after other treatments.

ECP is a type of PUVA treatment for the blood. ECP treatment is used when there is a high level of abnormal lymphocytes in the blood. This may also help improve any skin symptoms caused by CTCL.

You have a needle placed in each arm and these are connected to a machine. The machine takes a small amount of your blood from one arm. It collects some white blood cells (which include the abnormal lymphocytes) and returns the rest of the blood to your other arm.

When enough white blood cells have been collected, a drug called psoralen is added to them. This makes the cells sensitive to ultraviolet light (UVA). The white blood cells are treated with ultraviolet light and are then returned to your body.

After ECP, the drug psoralen will make you very sensitive to the sun. For the next 24 hours, you should protect your skin from sunlight even through windows. You should also wear sunglasses to protect your eyes outdoors or near fluorescent lights.

ECP can take several hours. You usually have treatment over 2 consecutive days as an outpatient. This is repeated every few weeks for several months. ECP is only available in some hospitals. Your doctor or nurse will give you more information.