Volume 2 • Issue 3 • 1000167 Pigmentary Disorders ISSN: 2376-0427 JPD, hybrid open access journal Mateeva and Kadurina, Pigmentary Disorders 2015, 2:3 DOI: 10.4172/2376-0427.1000167 Case Report Open Access Clinical, Histological and Immunohistochemical Changes in Hypopigmented Mycosis Fungoides in Response to Narrow-Band UVB Phototherapy Valeria Mateeva* and Miroslava Kadurina Military Medical Academy Sofa, Bulgaria *Corresponding author: Valeria Mateeva, 3, Gueorgui Sofiski, 1606 Sofa, Bulgaria, Tel: +359898631210, E-mail: vali_mateeva@hotmail.com Received February 23, 2015; Accepted February 28, 2015; Published March 03, 2015 Citation: Mateeva V, Kadurina M (2015) Clinical, Histological and Immunohistochemical Changes in Hypopigmented Mycosis Fungoides in Response to Narrow-Band UVB Phototherapy. Pigmentary Disorders 2: 167. doi:10.4172/2376-0427.1000167 Copyright: © 2015 Mateeva V, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Case A 26- year old Caucasian woman of Bulgarian descent presented at our department with multiple disseminated hypopigmented macules on the trunk and extremities since more than 4 years (Figure 1A). Te diferential diagnosis included: vitiligo, pityriasis vesicolor and Mycosis fungoides- hypopigmented type. A punch biopsy was performed and histological examination revealed exocytosis of atypical lymphocytes with larger hyperchromic nuclei (Figure 1B). A punch biopsy from normally looking skin was taken and the histological and immunohistochemical examination showed pigment incontinence and epidermotropisme of single atypical, CD3+CD4+ lymphocytes. Clinical and histological diagnosis of Mycosis fungoides- hypopigmented variant has been established. A Narrow Band Ultraviolet B- Treatment (NB- UVB) has been initiated according to the phototherapy protocol at our clinic with 4 sessions/ weekly with initial dose of 0.3 J/cm 2 and incensement of the dose with 0,05 at each session. A total number of 27 sessions have been performed and complete clinical response (disappearance of all existing lesions for at least one month) has been achieved afer the 22 st session (Figure 1C). Total UV dose was 17.5 J/ cm 2 and complete clinical response was achieved at a dose of 11.85 J/ cm 2 . No maintenance phototherapy has been administered according to the protocol. Skin biopsy afer the end of the treatment taken from clinically cleared past lesion revealed fewer than initially, but still present, CD3+ T- cells, mostly CD4+, with large atypical hyperchromic nuclei in the epidermis (Figure 1D). Exocytosis of atypical lymphocytes with larger hyperchromic nuclei were still present in fewer numbers than initially, marking a partial histological response to the therapy. Te disease- free interval was 3,5 months. Te patient presented with multiple hypopigmented lesions on her tights. Discussion Te hypopigmented variant of Mycosis fungoides is rare among Caucasians and data about the efcacy and safety of NB- UVB treatment are scarce. Te lower cumulative dose (17.5 J/cm 2 ) and the rapid complete response to treatment (afer 22 sessions, or afer a dose of 11.85 J/cm 2 ) in comparison to previously published studies in the literature (from 27.1- 59.6 J/cm 2 ) [1]. Another study revealed even higher number of sessions required for complete remission of hypopigmented mycosis fungoides in Asian patients (average 40 sessions) [2]. Tis signifcant diference could possibly be associated with the Caucasian origin of the patient and the fare skin type III according to Fitzpatrick, which could be sensitive to lower doses UVB in comparison to the Asian population with hypopigmented mycosis fungoides. Te phototherapy protocol we used difers from the currently described protocol in Asians [1]. Te more ofen (4 times/ weekly compared to the previously published twice/ weekly) regiment could ofer more rapid remission at a lower cumulative UV- dose. Nevertheless the short remission time (3.5 months) compared to a previously reported (2 months 6 years) disease- free period suggests CD3 CD4 CD8 CD30 CD3 CD4 CD8 CD30 Figure 1: Clinical and histological response and change in immunohistochemical expression pattern following 22 procedures Narrowband UVN phototherapy- A-B: clinical and histological picture before treatment; C-D: complete clinical response following 22 procedures Narrow-band UVB phototherapy and partial histological response with reduction of the CD3CD4-positive epidermotropic lymphocytes. J o u r n a l o f P i g m e n t a r y D i s o r d e r s World Health Academy ISSN: 2376-0427 Journal of Pigmentary Disorders