Fernandez-de-Misa R, et al. - This study encompassed the investigation of the routine clinical practice approach to lymphomatoid papulosis (LyP) and the response to first-line therapies. The available epidemiological, clinical and pathological findings validated the previous results. The most frequently prescribed first-line treatments were topical steroids, phototherapy and methotrexate. The complete response (CR) and cutaneous relapse rates did not vary between them. However, phototherapy achieved a longer disease-free survival (DFS). A connection was brought to light between the presence of Type A LyP and use of topical steroid or methotrexate with an increased risk of early relapse.

Methods

• A retrospective study was pursued on 252 patients with LyP.

Results

• The most common first-line treatments were topical steroids, methotrexate and phototherapy, prescribed for 35%, 20% and 14% of the patients, respectively.
• 48% of treated patients reported complete response (CR).
• A substantial rise was found in the relative risk (RR) of not achieving CR (RR = 1.76; 95% CI 1.16–2.11) by the eczematous lesions.
• Overall median time to CR was 10 months (95% CI 6-13 months), and 78% of complete responders illustrated cutaneous relapse.
• Similar results were yielded by both, for all treatment groups (P > 0.05).
• Overall estimated median disease-free survival (DFS) was 11 months (95% CI 9-13 months).
• Nevertheless, DFS for patients treated with phototherapy was 23 months (95% CI 10-36 months; P < 0.03).
• The presence of Type A LyP variant (RR = 2.04; 95% CI 0.96-4.30) and receiving a first-line treatment other than phototherapy (RR = 5.33; 95% CI 0.84-33.89) displayed a prominent connection with cutaneous early relapse.
• 31 (13%) patients presented with associated mycosis fungoides unrelated to therapeutic approach, type of LyP or T-cell receptor clonality, among the 252 patients.