Cutaneous T-Cell Lymphoma: Information on Causes, Diagnosis & Treatments

Red Clothes Under Skin Non Hodgkins Cutaneous T-Cell Lymphoma (CTCL) is categorized as a subset form of non-Hodgkin lymphoma affecting white blood cells (lymphocytes) primarily in the skin. Unlike the less common form of cutaneous B-cell lymphoma, cutaneous T-cell lymphoma often displays itself as thick plaques of the skin or scaly, red patches of skin that mimics chronic dermatitis or eczema. As the condition worsens, it is often complicated by infections and itchy skin accompanied by ulcerating skin, the formation of tumors, and exfoliation where dead epidermis skin sheds from the body.

T-lymphocytes cells are crucial to the body’s immune system in fighting off infections, however, when the white T cells begin to grow at too rapid a pace, the older cells do not die off and instead accumulate in the body leading to lymphoma cancer. This form of non-Hodgkin lymphoma is often mistaken for other skin conditions including eczema. Misdiagnosing the disease may be life-threatening to the patient if the doctor recommends nothing more than treating a mild skin condition instead of the actual problem.

Who Is at Risk for Cutaneous T-Cell Lymphoma?

Approximately one out of every six non-Hodgkin lymphoma cases in America involve cutaneous T-cell lymphoma. Many of these cases are diagnosed when the doctor takes a biopsy believing the condition is a different skin formation. Individuals between the ages of 40 years and 60 years are most at risk for developing cutaneous T-cell lymphoma. Additionally, men are more likely to acquire the condition compared to women. Other risk factors associated with CTCL include:

  • Ethnicity – Individuals of African-Caribbean descent are more likely to develop all forms of skin lymphoma types compared to Caucasians.

  • HTLV-1 (Human Lymphotropic Virus 1) Infections – The virus that causes HTLV-1 tend to develop in parts of Asia, Japan, and the Caribbean.

However, medical science has yet to determine the exact cause of cutaneous T-cell lymphoma. That said, like all forms of cancer, CTCL is not contagious, meaning the infection cannot be passed between individuals.

Many individuals develop cutaneous T-cell lymphoma will ever have serious complications. Usually, scaly skin patch might or might not cause an itching sensation.

Coping with the Condition

There are steps that every individual suffering from CTCL can take to minimize the symptoms and signs associated with the condition. Some of these include:

  • Gentle Skin Practices – Bathing or showering lukewarm water and using frequent free or alcohol-free skin cleansers can minimize aggravated itching. This includes avoiding after bath powders or bubble bath solutions that could dry out the skin and exacerbate the symptoms associated with lymphoma.

  • Minimizing Sun Exposure – Many patients notice a definite improvement in the rashes and scaly patches on their skin during the summer months. However, certain precautions must be taken when exposing the skin to sun rays. This includes wearing a brim hat, applying sufficient amounts of sunscreen and avoiding intense sunlight is essential to protect the skin from the damaging effects of the Sun.

  • Maintaining a Symptoms Diary – Journalizing every action that is taken throughout the day and how it affects the skin provides insight for developing an effective skin care plan to determine what worked well and what did not work at all and relieving many of the symptoms associated with cutaneous T-cell lymphoma.

Diagnosing Cutaneous T-Cell Lymphoma

Unfortunately, early detection of cutaneous T-cell lymphoma can be difficult because most of the cells in the affected area appear as psoriasis or eczema, making it indistinguishable from healthy cells.

The diagnostician will check the patient’s skin and take a small skin sample (biopsy) of skin from the affected area that will be examined by a pathologist under a microscope looking for abnormal cells. In addition, the doctor will check the patient’s lymph nodes to look for any signs of swelling and order blood tests that can identify abnormal (cancers) lymphocytes in the bloodstream.

The doctor may also recommend a CT (computerized tomography) scan, MRI (magnetic resonance imaging) scan and/or x-rays. These imaging tests can provide detailed information on the internal organs and lymph nodes to help determine if the lymphoma has metastasized (spread) to other areas of the body. If the doctor detects swollen lymph nodes, he may recommend a biopsy where the large node is removed and examined in a laboratory setting.

Some individuals must have a bone marrow biopsy, usually performed as an outpatient procedure, where a local anesthetic is injected by the doctor in the patient’s skin by the hip bone. The sample is removed using a long, fine aspiration needle where a tiny amount of bone marrow is removed to be analyzed under a microscope.

Accurately diagnosing of cutaneous T-cell lymphoma is essential to ensure that the patient receives the best form of treatment. Once the condition of verified, the doctor will stage the lymphoma to determine its progression and whether it has spread to other areas of the body. These stages include:

  • Stage I – At this initial stage, the lymphoma displacys itself as red raised plaques (patches) on the skin. The doctor will stage it as Stage IA, meaning that 10% or less of the skin is affected by the condition, or Stage IB, meaning 10% or more of the surface of the skin is affected.

  • Stage II – If the lymphoma is allowed to progress, it can develop into Stage IIA, meaning there are enlarged lymph nodes that have become swollen do not contain lymphoma cells, or stage IIB, where at least one tumor and possibly one lymph node is affected.

  • Stage III – This advancing stage, more than 80% of the skin involves erythroderma (red appearance) and one or more lymph nodes might be affected.

  • Stage IVA – At this most advanced stage, the symptoms on the skin have spread to other areas of the body including the liver or other organs. The cancer cells may have metastasized to the bloodstream or lymph nodes.

Treating the Condition

The doctor has a number of options for treating cutaneous T-cell lymphoma, including “watchful waiting” where the doctor will wait to see if the disease before providing treatment that may not be effective in its early stage. In its initial stages, the doctor may prescribe one or more treatments including:

  • Steroid creams

  • Topical chemotherapy

  • Radiotherapy

  • PUVA (photochemotherapy ultraviolet radiation treatment)

  • Interferon

  • Stem Cell Transplant

The treatments may involve oral therapy and prescribed as tablets or injected under the skin or into a vein to be easily absorbed into the bloodstream. The doctor may recommend a bone marrow or stem cell transplant as an effective high-dose treatment for managing cutaneous T-cell lymphoma. Usually, this recommendation is provided for the young and fit in individuals who can physically cope with the difficult treatment.

Destroying cancer cells in the bone marrow and replacing it with new stem cells can help develop healthy red blood cells, platelets, and white blood cells to ensure the body survives. Usually, the stem cells are acquired from a healthy donor. Additionally, ongoing clinical trials are being conducted to better manage and cure cases involving cutaneous T-cell lymphoma. This includes the use of monoclonal antibodies and other biological therapies including inhibitors that block enzymes the cause the condition to progress.

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Sources:

https://www.clfoundation.org/treatment/treatment-centers/usa/midwest

http://www.mayoclinic.org/diseases-conditions/cutaneous-t-cell-lymphoma/home/ovc-20179742

https://www.cancer.org/cancer/non-hodgkin-lymphoma/treating/t-cell-lymphoma.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4965697/

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