Campolmi, P

Cappugi, Pietro

Mavilia, L

Mori, M

Pimpinelli, Nicola

Rossi, R

English

Florence Research

consider mycobacterial infections and inquire aboutrecent pedicures in patients with apparent lower-extremity furunculosis. Tissue cultures and sensitiv-ity studies should be performed to guide treatment,given the widespread antibiotic resistance of myco-bacteria species. Early recognition of the organismsand institution of appropriate therapy are critical.Physicians and the public need to be educated aboutthe possibility of infections following pedicures, andphysicians should inquire about pedicures whenfaced with nonhealing furunculosis of the lower legs.Public health measures should be explored to pro-tect against such infections given the recent increasein popularity of the nail care industry.REFERENCES1. Wallace RJ, Brown BA, Griffith DE. Nosocomial outbreaks/pseudo outbreaks caused by nontuberculous mycobacteria.Annu Rev Microbiol 1998;52:453-90.2. Palenque E. Skin disease and nontuberculous atypical myco-bacteria. Int J Dermatol 2000;39:659-66.3. Winthrop KL, Abrams M, Yakrus M, Schwartz I, Ely J, Gillies D,Vugia DJ. An outbreak of mycobacterial furunculosis associatedwith footbaths at a nail salon. N Engl J Med 2002;346:1366-71.4. Sniezek PJ, Graham BS, Busch HB, Lederman ER, Lim ML,Poggemyer K, et al. Rapidly growing mycobacterial infectionsafter pedicures. Arch Dermatol 2003;139:629-34.5. Gira AK, Reisenauer AH, Hammock L, Nadaminte U, Macy JT,Reeves A, et al. Furunculosis due to Mycobacterium mager-itense associated with footbaths at a nail salon. J ClinMicrobiol 2004;42:1813-7.6. Vugia DJ, Jang Y, Zizek C, Ely J, Winthrop KL, Desmond E, et al.Mycobacteria in nail salon whirlpool footbaths, California.Emerg Infect Dis 2005;11:616-8.7. Rotman DA, Blauvelt A, Kerdel FA. Widespread primarycutaneous infections with Mycobacterium fortuitum. Int JDermatol 1993;32:512-4.8. Winthrop KL, Albridge K, South D, Albrecht P, Abrams M,Samuel MC, et al. The clinical management and outcome ofnail salon-acquired Mycobacterium fortuitum skin infection.Clin Infect Dis 2004;38:38-44.9. Wallace RJ Jr, Glassroth J, Griffith DE, Olivier KN, Cook JL,Gordin F. Diagnosis and treatment of disease caused bynontuberculous mycobacteria: American Thoracic SocietyStatement. Am J Respir Crit Care Med 1997;156(Suppl):S1-25.10. Brown BA, Wallace RJ Jr, Onyi GO, De Rosas V, Wallace RJ 3rd,et al. Activities of four macrolides, including clarithromycin,against Mycobacterium fortuitum, Mycobacterium chelonae,and M. chelonae-like organisms. Antimicrob Agents Chemo-ther 1992;36:180-4.J AM ACAD DERMATOLMARCH 2006524 Brief reportsTopical photodynamic therapy for primarycutaneous B-cell lymphoma: A pilot studyMoira Mori, MD,b Piero Campolmi, MD,b Luciano Mavilia, MD,b Riccardo Rossi, MD,bPietro Cappugi, MD,b and Nicola Pimpinelli, MDaFlorence, ItalyPhotodynamic therapy (PDT) is a treatment based on the accumulation of a photosensitizer in the targetcells and their selective destruction by irradiation with visible light. In the past 10 years, several patientswith cutaneous T cell lymphoma have been successfully treated. The use of PDT in cutaneous B celllymphoma has not been reported to date. We report the successful PDT treatment of 3 patients with earlyprimary cutaneous B cell lymphoma. ( J Am Acad Dermatol 2006;54:524-6.)From the Department of Dermatological Sciencesa and the Phys-ical Therapy Unit,b University of Florence Medical School.Funding sources: Supported by the Ministero dell’Istruzione,Universita` e Ricerca (MIUR) and the Ente Cassa di Risparmiodi Firenze.Conflicts of interest: None identified.Reprint requests: Nicola Pimpinelli, MD, Department of Derma-tological Sciences, University of Florence, Via della Pergola,58/64, 50121 Florence, Italy. E-mail: pimpi@unifi.it.0190-9622/$32.00ª 2006 by the American Academy of Dermatology, Inc.doi:10.1016/j.jaad.2005.10.016Indolent primary cutaneous B-cell lymphomas(CBCL), that is, follicular center and marginalzone lymphoma according to the EuropeanOrganization for Research and Treatment of Cancer1(EORTC) and the recent consensus World HealthOrganizationeEORTC classification,2 are character-ized by mostly local or regional extension and verygood prognosis (rare extracutaneous spread, despiterelatively frequent cutaneous relapses, and 5-yearsurvival rate [95%). Both types are highly res-ponsive to local radiotherapy (RT).2 Small, isolatedJ AM ACAD DERMATOLVOLUME 54, NUMBER 3Brief reports 525lesions can be surgically excised, with or withoutadditional RT.2 The treatment with multiple-agentchemotherapy should be restricted, at presentation,to the definitely occasional patients with dissemi-nated lesions, to those refractory to or with multiplerelapses after RT.2 Other treatment modalities, suchas intralesional cisplatin-epinephrine gel3 and anti-CD20 monoclonal antibody,2 has been reported asbeing of possible help in specific circumstances.Photodynamic therapy (PDT) is a treatment mo-dality based on the administration of a photosensitiz-ing compound that accumulates in the target cells,followed by selective irradiation of the lesion withvisible light. The combination of two individuallynontoxic elements, drug and light, is responsible forPDT-mediated response (reviewed in Kalka, Merk,and Mukhtar4), presumably via apoptotic cell deathas a major mechanism5 with minimal or no necroticchanges. The most widely used photosensitizer isaminolevulinic acid (ALA), first proposed in 1978by Dougherty et al6 for the treatment of mycosisfungoides (MF). To date, other case series of MFpatients (both in plaque and tumor stages) and 2patients with CD301 cutaneous T-cell lymphoma(CTCL) successfully treated with PDT have beenreported.7-15To date, no reports are available concerningthe use of systemic or local PDT in the treatment ofCBCL. We report herein about the successful ALA-PDT treatment of 3 patients with early CBCL.PATIENTS AND METHODSThree patients with CBCL, whose data are sum-marized in Table I, were treated with PDT. Thediagnosis was established by routine histopath-ology and immunophenotyping according to theWHO-EORTC classification.2 In two patients (1 and2; Table I), skin lesions (thin plaques) had neverbeen treated. In patient 3, the treated lesion hadrelapsed 6 months after complete remission obtainedby orthovolt RT.ALA 20% (oil-in-water emulsion) was appliedtopically to the lesion and to adjacent skin underan occlusive and light-shielding dressing for 4 hoursin patients 1 and 3. In patient 2, the methyl ester ofAbbreviations used:ALA: aminolevulinic acidCBCL: cutaneous B-cell lymphomaCTCL: cutaneous T-cell lymphomaEORTC: European Organization for Research andTreatment of CancerMF: mycosis fungoidesPDT: photodynamic therapyRT: radiotherapyALA (Metvix; Photocure, Oslo, Norway and Galderma,Paris, France) was applied. The red fluorescence ofporphyrins was visualized with Wood’s light beforetreatment. Fluorescence was seen in all cases. TheALA-treated areas were then exposed to incoherentlight using a light-emitting diode lamp (Aktilite PDT,model CL128; Photocure ASA, Oslo, Norway) at awavelength of 630 nm and a light dose of 37 J/cm2with light intensity of 70 to 100 mW/cm2. It illumi-nates areas from 80 to 180 mm at a distance from 50 to80 mm. The patients were examined after 1 week,and, depending on the clinical results, the treatmentwas repeated (patient 3). Four-millimeter punchbiopsy specimens were taken before treatmentand after clinical remission. Clinical evaluation wasperformed monthly after PDT, with an 8- to24-month follow-up.RESULTSThe treatment was well tolerated by all patientswithout local anesthetics. The results are summarizedinTable I. All patientsunderwent complete remission,defined as clinical and histologic complete remission,with a maximum of two treatment sessions at 1-weekintervals. Two patients (1 and 2) were in completeremission after 1 week from the first (and only) PDTsession. Patient 3 underwent complete remission after1 week from the second PDT session (Fig 1).DISCUSSIONPDT consists of the application of a photosensitiz-ing agent and irradiation with noncoherent lightFig 1. Patient 3. A, Plaque on right flank, relapsingimmediately outside border of previous radiotherapy field.B, One week after the second (and last) PDT session.J AM ACAD DERMATOLMARCH 2006526 Brief reportsTable I. Summary of results in 3 patients with indolent primary cutaneous B-cell lymphomaPatient no. Age (y)/sex Disease/stage Previous tx PDT sessions Photosensitizer Results Follow-up (mo)1 62/F CBCL (FCL) None 1 ALA CR 172 38/F CBCL (MZL) None 1 Metvix CR 83 56/M CBCL (MZL) RT 2 ALA CR 24ALA, Aminolevulinic acid 20%, oil-in-water emulsion; CBCL, cutaneous B-cell lymphoma; CR, complete response; FCL, follicle centerlymphoma; Metvix, methyl ester of ALA; MZL, marginal zone lymphoma; PDT, photodynamic therapy; RT, orthovolt radiotherapy (20 Gy);tx, therapy.sources. Photoactivation of photosensitizing porphy-rins, which selectively accumulate in tumor cells,induces healing with minimal or nonecrotic changes.PDT has been successfully used in CTCL (MF andCD301 CTCL).7-12We treated 3 patients with early CBCL, withcomplete remission achieved in all 3 after a maxi-mum of two PDT sessions. The successful use ofALA-PDT in indolent CBCL, to our knowledge re-ported herein for the first time, suggests a possiblerole of PDT in the treatment of localized, thinplaques as an alternative to local RT, which has tobe considered the treatment of choice. Additionalstudies on larger series will hopefully contribute toclarify this issue.REFERENCES1. Willemze R, Kerl H, Sterry W, Berti E, Cerroni L, Chimenti S,et al. EORTC classification for primary cutaneous lymphomas.A proposal from the Cutaneous Lymphoma Study Group ofthe European Organization for Research and Treatment ofCancer (EORTC). Blood 1997;90:354-71.2. Willemze R, Jaffe E, Burg G, Cerroni L, Berti E, Swerdlow SH,et al. WHO-EORTC classification of primary cutaneous lym-phomas. Blood 2005;105:3768-85 Epub 2005 Feb 3.3. Kempf W, Dummer R, Schmid MH, Fritz T, Wuthrich B, Burg G.Intralesional cisplatin for the treatment of cutaneous B-celllymphoma. Arch Dermatol 1988;134:1343-5.4. Kalka K, Merk H, Mukhtar H. Photodynamic therapy in derma-tology. J Am Acad Dermatol 2000;42:389-413.5. Agarwal ML, Clay ME, Harvey EJ, Evans HH, Antunez AR,Oleinick NL. Photodynamic therapy induces rapid celldeath by apoptosis in L5178Y mouse lymphoma cells.Cancer Res 1991;51:5993-6.6. Dougherty TJ, Kaufman JE, Goldfarb A, Weishaupt KR, Boyle D,Mittleman A. Photoradiation therapy for the treatment ofmalignant tumors. Cancer Res 1978;38:2628-35.7. Forbes IJ, Cowled PA, Leong AS, Ward A, Black RB, Blade AJ,et al. Phototherapy of human tumours using haematopor-phyrin derivative. Med J Aust 1980;2:489-93.8. Wolf P, Fink-Puches R, Cerroni L, Kerl H. Photodynamic therapyfor mycosis fungoides after topical photosensitization with5-aminolevulinic acid. J Am Acad Dermatol 1994;31:678-80.9. Boehncke W-H, Koenig K, Rueck A, Kaufmann R, Sterry W.In vitro and in vivo effects of photodynamic therapy incutaneous T cell lymphoma. Acta Derm Venereol 1994;74:201-5.10. Stables GI, Stringer MR, Robinson DJ. The treatment ofcutaneous T cell lymphoma by topical aminolevulinic acidphotodynamic therapy. Br J Dermatol 1997;137(Suppl 50):51.11. Orenstein A, Haik J, Tamir J, Winkler E, Trau H, Malik Z,et al. Photodynamic therapy of cutaneous lymphoma using5-aminolevulinic acid topical application. Dermatol Surg2000;26:765-9.12. Markham T, Sheahan K, Collins P. Topical 5-aminolevulinic acidphotodynamic therapy for tumour-stage mycosis fungoides.Br J Dermatol 2001;144:1262-3.13. Edstrom DW, Portwit A, Ros AM. Photodynamic therapy withtopical 5-aminolevulinic acid for mycosis fungoides: clinicaland histological response. Acta Derm Venereol 2001;81:184-8.14. Umegaki N, Moritsugu R, Katoh S, Harada K, Nakano H, TamaiK, et al. Photodynamic therapy may be useful in debulkingcutaneous lymphoma prior to radiotherapy. Clin Exp Dermatol2004;29:42-5.15. Coors EA, von den Driesch P. Topical photodynamic therapyfor patients with therapy-resistant lesions of cutaneous T-celllymphoma. J Am Acad Dermatol 2004;50:363-7.

Topical photodynamic therapy for primary cutaneous B-cell lymphoma: a pilot study.

https://flore.unifi.it/bitstream/2158/770881/1/Topical%20photodynamic%20therapy%20for%20primary%20cutaneous%20B-cell%20lymphoma.pdf

Topical photodynamic therapy for primary cutaneous B-cell lymphoma: a pilot study.

Abstract

Similar works

Full text

Available Versions

Florence Research