在欧洲,氯甲因凝胶被许可用于治疗所有阶段的霉菌病患者。然而,关于频率和给药以及联合治疗和维持治疗的最佳方案尚未完全确定.
来自德国的十位在皮肤T细胞淋巴瘤的研究和管理方面经验丰富的专家,奥地利,和瑞士(DACH地区)被要求以书面形式报告氯甲芬凝胶的适应症,使用频率,监测,伴随治疗,不利影响,疾病后期的联合疗法,维持治疗,并坚持使用这种治疗真菌肉芽肿的方法。在协商一致的会议上讨论了结构化的答案,并提出了建议。
使用氯甲辛凝胶治疗的必要方法是个体化和以症状为导向的管理。由于局部给药的氯甲因凝胶缺乏全身吸收,系统性不良事件不太可能发生.过敏性或刺激性毒性接触性皮炎很常见,但可以通过调整治疗方案来控制。行政中断,和特定症状的支持性测量。每隔一天使用一次氯甲因凝胶的初始方法与更好的耐受性相关。特别是如果它与局部皮质类固醇交替使用。
氯甲辛凝胶在治疗霉菌病中的应用通常受到伴随的接触性皮炎的限制。适当的治疗方案和不良反应的管理可以排除不必要的停药,从而使更多的患者可以从这种治疗选择中受益。
BACKGROUND: In Europe chlormethine gel is licensed for the management of patients with mycosis fungoides of all stages. However, the optimal regimen regarding frequency and dosing as well as combination and maintenance therapy is not well established.
METHODS: Ten experts experienced in research and management of cutaneous T-cell lymphomas from Germany, Austria, and Switzerland (DACH region) were asked in written form to report on indication for chlormethine gel, frequency of use, monitoring, concomitant therapies, adverse effects, combination therapies in later stages of the disease, maintenance therapy, and adherence to this therapy for mycosis fungoides. The structured answers were discussed in a
consensus conference and recommendations were developed.
RESULTS: Essential for therapy with chlormethine gel is an individualized and symptom-oriented management. Because of the lack of systemic resorption of topically administered chlormethine gel, systemic adverse events are unlikely. An allergic or irritative-toxic contact dermatitis is common but manageable with adaptation of the regimen, interruption of administration, and symptom-specific supportive measurements. A step-up initial approach with application of chlormethine gel every other day is associated with a better tolerability, especially if it is alternated with topical corticosteroids.
CONCLUSIONS: The use of chlormethine gel in the management of mycosis fungoides is often limited by a concomitant contact dermatitis. An adequate therapeutic regimen and the management of adverse effects can preclude an unnecessary withdrawal of therapy so that more patients can benefit from this treatment option.