Ointment-based mechlorethamine treatment for mycosis fungoides

Abstract

The treatment of skin disease with topical mechlorethamine has been restricted because of the frequent development of contact dermatitis. A series of 43 patients with mycosis fungoides in Stages 1A (17), IB (22), II (2), and III (2) were treated with an ointment‐based mechlorethamine, prepared by an anhydrous method. Complete clearing occurred in 26 patients over a 42‐month evaluation period. The incidence of contact dermatitis was very low. Only 1 of 31 patients exposed to mechlorethamine for the first time, and only 3 of 12 patients with a history of previous hypersensitivity to mechlorethamine, developed contact dermatitis to the ointment‐based mechlorethamine. Cancer 52:22140‐2219, 1983.

Skin-Directed Therapies in Cutaneous T-Cell Lymphoma

“…31 Two articles related to this subject are not included in Table 1 because these patients were included in the 2003 retrospective report by Kim and colleagues. 31,37,38 In 2003, Kim and colleagues evaluated a total of 195 patients with stage T1 or T2 Nguyen & Bohjanen disease; 158 of these patients applied topical nitrogen mustard ointment and 28 applied an aqueous preparation of topical nitrogen mustard. Patients either received total-body application if disease was extensive or lesional application if disease was limited as their initial and only treatment of MF.…”

“…43 The most common cause of therapy cessation is a delayed allergic contact dermatitis that can range from mild erythema to bullae formation. 29,[34][35][36]38,41 Irritant and allergic contact dermatitis have been reported in up to 80% of patients treated with the aqueous formulation, 29% with ointment, and 40% with the gel. 30,37 However, therapy discontinuation can usually be prevented by application of topical steroids, prior desensitization in the case of an allergic contact dermatitis, or decreasing the concentration of the medication or frequency of application in cases of irritant dermatitis.…”

“…In a follow-up study, only 3 of 9 (33%) patients with prior hypersensitivity to nitrogen mustard developed hypersensitivity after receiving adjuvant electron beam radiation with nitrogen mustard ointment therapy. 38 None of the 16 patients without prior history of hypersensitivity treated in the same manner had an adverse cutaneous reaction. It was hypothesized that electron beam radiation depresses the immunologic response, thus leading to a lower incidence of cutaneous reactions.…”

“…31,[33][34][35][36] Ointment preparations are made by mixing 10 mg of Mustargen first with 95% alcohol to remove the powder in the vial and then in 100 g of Aquaphor (a nonpolar and anhydrous vehicle with a low incidence of sensitization) to a final concentration of 0.2 mg/mL, which can be applied once daily to the whole body in generalized disease or to lesional skin in localized disease. 31,37,38 It is recommended that application of the medication should occur on dry skin 4 hours before or 30 minutes after showering. Patients should also wash their hands completely with soap and water after application.…”

Cutaneous T-cell lymphoma/leukemia

“…The median time to remission in this study was 4.4 months for T1 disease and 20.4 months for T2 disease. Ointment-based nitrogen mustard has been associated with less cutaneous sensitivity [15]. Cost effectiveness Excellent.…”