There are a number of treatments that can be used for CTCL. Sometimes a combination of treatments is used. Your specialist will discuss the options with you.
Doctors usually use treatments to treat the skin directly when CTCL is at an early stage. This includes using:
- a steroid cream
- a chemotherapy cream (topical chemotherapy)
Sometimes treatments that work throughout the body are used. These treatments may be given as tablets, or as an injection into a vein or under the skin. They are then absorbed into the blood and travel to all areas of the body. Your doctors may offer you these treatments if:
- CTCL doesn’t respond to direct skin treatments
- it is affecting the lymph nodes or other organs
- there are a lot of tumours on the skin.
Skin care is important for all stages of CTCL. Using moisturising creams regularly will help to make your skin less scaly and to feel more comfortable. Other preparations can be added to your bath water to keep your skin supple. Your specialist nurse and doctor can give you more advice on looking after your skin.
Creams for the skin (topical treatments)
Steroid cream applied to the skin may be the only treatment needed for early stage CTCL.
Chemotherapy creams may be used. Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It can be given as a cream that can be applied to the affected skin. You'll need to make sure you only put the cream on the area where you've been told to apply it, and you must wear gloves to protect your hands. Some people may have a reaction to the cream. Let your doctor know if you have any side effects, such as redness or a burning sensation, in the area.
Your doctor, a nurse or a pharmacist will explain how to use these creams. It's important to follow the instructions they give you.
PUVA (sometimes known as photochemotherapy) is an effective treatment for early CTCL, especially for treating plaques (raised red patches). It involves taking a drug called psoralen (P), which makes your skin sensitive to ultraviolet light (UVA).
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 done a few times a week over several weeks.
Side effects of PUVA
This treatment tans the skin and can cause early ageing of the skin. Sometimes the skin may become red, like mild sunburn. Over the period of your treatment, you'll need to be careful not to expose your skin to extra ultraviolet light from the sun to avoid getting sunburnt.
Exposure to ultraviolet light can increase the risk of developing other types of skin cancer. The number of treatments you have with PUVA is limited to reduce the risk of this happening, and your skin is carefully monitored. Your doctor or specialist nurse can discuss this with you. We have more information on taking care of your skin in the sun.
Psoralen makes the eyes more sensitive to ultraviolet light, so you will need to wear protective glasses for about 12 hours from the time you take the drug. The psoralen tablets can make you feel sick. If this happens, you can take anti-sickness drugs, or it may be possible to be prescribed a different tablet.
Other possible side effects of PUVA include itching, dizziness and headaches.
UVB light (ultraviolet light from wavelength B) can help slow down the growth of skin cells and may be used to treat CTCL. The treatment is delivered in a similar way to PUVA, using an air-conditioned cabinet containing ultraviolet lights. However, you don’t need to take a drug to make your skin more sensitive to light. Treatment may be given a few times a week.
Side effects of UVB therapy
UVB therapy causes similar skin side effects to PUVA.
Because ultraviolet light increases the risk of other types of skin cancer, you will also need to avoid exposing the skin to extra UV light from the sun. Your doctor or specialist nurse will discuss this with you.
Radiotherapy is the use of high-energy rays to destroy cancer cells. It's an effective treatment for early CTCL. Radiotherapy can also be used to ease skin symptoms in specific areas affected by CTCL. The side effects are redness of the skin and hair loss in the area being treated.
Total skin electron beam therapy (TSEBT)
TSEBT is a way of treating all of the skin with radiotherapy. It may be used if the disease hasn’t spread below the skin surface and other treatments directed to the skin haven’t been effective. The treatment can be repeated if necessary. It's only available at some specialist centres.
The side effects are mainly skin changes and hair loss. Sweat glands in treated areas may no longer work. Your doctor can give you more information about this treatment and its effects.
If CTCL is causing a lot of tumours on the skin, affecting the lymph nodes or other organs, or is not responding to other treatments, chemotherapy by injection into a vein, or as a tablet, may be given to help control it. You may be given a single drug or a combination of drugs. Chemotherapy drugs that may be used are gemcitabine, pentostatin or liposomal doxorubicin.
Interferon is a protein that occurs naturally in the body. A man-made version may be used to treat CTCL. It works by boosting the body’s immune system to control the lymphoma. It is injected under the skin (subcutaneously) and may be given on its own or with other treatments. The most common side effects of interferon are tiredness, aches and pains, fever and a low mood.
Bexarotene (Targretin ®) belongs to a group of drugs called retinoids. It may be used to treat CTCL that has come back after treatment. It is taken daily as a capsule and may be used with other treatments such as PUVA. Bexarotene can affect the fats in the blood and prevent the thyroid gland from working properly. You will be given other medicines with bexarotene to manage these side effects. You will need to have regular blood tests when you start the treatment.
Extra-corporeal photopheresis (ECP)
ECP may be used if there are abnormal lymphocytes in the blood. ECP is a type of PUVA treatment for the blood. It treats the whole body.
You are connected to a machine and some of your blood goes from your body into the machine. The blood is treated with ultraviolet light and drugs that become active when exposed to light. The treated blood is then returned to the body. The treatment continues until all of your blood has been treated by passing through the machine. This treatment is only available in some specialist centres. Your doctor or nurse will give you more information about the treatment.