Studija slučaja
Ultra-high-frequency Ultrasound in the Objective Assessment of Chlormethine Gel Efficacy: A Case Report
Agata Janowska
orcid.org/0000-0002-2271-3859
; Department of Dermatology,University of Pisa, Pisa, Italy
Cristian Fidanzi
; Department of Dermatology,University of Pisa, Pisa, Italy
Marco Romanelli
; Department of Dermatology,University of Pisa, Pisa, Italy
Alessandra Michelucci
; Department of Dermatology,University of Pisa, Pisa, Italy
Matteo Bevilacqua
; Department of Dermatology,University of Pisa, Pisa, Italy
Valentina Dini
; Department of Dermatology,University of Pisa, Pisa, Italy
Sažetak
Mycosis fungoides (MF) represent the most frequent form of cutaneous T-cell lym-
phoma (CTCL). Chlormethine gel has been approved as first-line therapy in MF. The
classification of early forms of MF is clinically and histologically complex even for
experienced clinicians. Ultra-high-frequency ultrasound (UHFUS) is a new non-
invasive method that is capable of supporting clinical evaluation, thus providing
both a diagnostic guide for distinguishing different stages of the disease and a
therapeutic method in terms of monitoring the treatment. In our case report, we
clinically and ultrasonographically evaluated the efficacy of chlormethine gel treat-
ment on patches resistant to previous local treatments. A 63-year-old patient was
treated for MF stage 1B with cycles of topical clobetasol cream and PUVA and UVB
narrow-band phototherapy for 2 years, with a partial therapeutic response. Patches
remained at the level of the left and right hips and lower legs. The patient began
treatment with chlormethine gel 3 times a week for 2 months. We performed clinical
and ultrasound evaluations on the left hip at baseline and after 2 months. The ultra-
sound examination was performed using (VEVO MD, VisualSonics), both in B-mode
and C-mode, with a 70 MHz frequency probe. At baseline, we found a hypoechoic
band of 0.94 mm named the Subepidermal Low Echogenity Band (SLEB), localized
under the dermo-epidermal junction. Multiple dilated hair follicles with vascular
invasion, disrupting the dermo-epidermal junction, and numerous vascular lacu-
nae at the dermal level were found using C-mode. After 2 months of treatment, the
lesions had clinically healed with the persistence of a pigmentary outcome. UHFUS
identified minimal thickness of the SLEB and minimal vascularization. Chlorme-
thine gel was an effective and well-tolerated treatment in patches unresponsive to
other topical treatments. The use of a non-invasive diagnostic technique can allow
objective assessment of lesions with a better therapeutic approach.
Ključne riječi
cutaneous lymphoma; chlormethine gel; mycosis fungoides; non- invasive diagnostics; ultra-high-frequency ultrasound
Hrčak ID:
326853
URI
Datum izdavanja:
10.4.2024.
Posjeta: 509 *