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Abstract
Goeckerman technique (GT) has been used effectively as a therapeutic modality for psoriasis as evidenced by clinical improvement of lesions as well as long remission period. Follow up biopsies of responding cases of psoriasis revealed marked depletion of lymphocytes when compared to pre-treatment biopsies. Accordingly we hypothesized that modified Geockerman technique can deplete epidermotropic as well as upper dermal lymphocytes in early stage mycosis fungoides (MF) lesions. This study aimed to assess and compare the efficacy of modified GT (in which UVA is used instead of UVB) in the management of early stage cutaneous T-cell lymphoma to that of photochemotherapy [psoralen and UVA (PUVA)]. Thirty patients diagnosed with early stage cutaneous T-cell lymphoma (MF, stages: Ia, Ib and IIa) were recruited in the current work. All patients were randomly assigned to treatment by either modified GT (Group A, n=15) or photochemotherapy (psoralen and UVA [PUVA], Group B, n=15). All patients were assessed on clinical and histopathological basis at baseline and after cessation of therapy (after 3 months). The results were analysed using Mann Whitney U, Chi square (c2 ), McNemar and Exact tests. Both therapeutic modalities (modified GT and PUVA) yielded comparable results with insignificant difference either clinically or histopathologically (p-value = 0.833 and 0.958, respectively). Modified Goeckerman technique represents a potentially effective and safe therapeutic alternative to PUVA for early stage MF.
Highlights
William Goeckerman was the first to acknowledge the efficacy of utilization of coal tar followed by exposure to ultraviolet (UV) radiation in the treatment of psoriasis [1]
Thirty participants diagnosed as early stage Mycosis Fungoides [MF] signed an informed written consent prior to their enrollment in this trial
Modified Goeckerman technique yielded comparable results to the established PUVA regimen for the management of early stage mycosis fungoides [MF] as evidenced by the results demonstrated in the present study
Summary
William Goeckerman was the first to acknowledge the efficacy of utilization of coal tar followed by exposure to ultraviolet (UV) radiation in the treatment of psoriasis [1]. The mechanism by which topical coal tar induce amelioration of psoriatic lesions has not been clearly elucidated. The following effects have been postulated: reduction of the hyperproliferative state of the epidermis, modulation of pro-inflammatory cytokines, depletion of T-lymphocytes and inhibition of angiogenesis [2]. The use of conventional Goeckerman technique is based on the use of broadband UVB after tar application [3]. The absorption spectrum of UVB (280-320nm) is not consistent with the action spectrum of tar which lies between (330-350nm). The use of UVA which has an absorption spectrum extending from 320nm to 340nm would be more
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