Lymphomatoid Papulosis Treatment & Management

Updated: Oct 29, 2018
  • Author: John A Zic, MD; Chief Editor: William D James, MD  more...
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Treatment

Medical Care

Localized mildly pruritic skin lesions may be treated with mid- to high-potency topical steroids to hasten resolution. Some authorities are more inclined to treat widespread lesions with systemic or more aggressive topical therapies, including phototherapy, to suppress the disease and the possibility of progression to Hodgkin disease (HD), anaplastic large cell lymphoma (ALCL), or mycosis fungoides (MF).

Low-dose weekly methotrexate (MTX) [33, 34, 35, 36] is a safe and effective treatment for suppressing lymphomatoid papulosis (LyP) [37, 38] ; however, the disease recurs within 1-2 weeks after discontinuing the medication.

Oral psoralen plus UVA (PUVA) phototherapy also effectively treats and suppresses the disease.

One report describes successful treatment of recalcitrant lymphomatoid papulosis in using PUVA-bath photochemotherapy in a pediatric patient. [39]

A few reports also have found that topical carmustine, topical nitrogen mustard, topical MTX, topical imiquimod cream, [40] intralesional interferon, low-dose cyclophosphamide, chlorambucil, medium-dose UVA-1 therapy, excimer laser therapy, [41] photodynamic therapy, [42] and dapsone help disease suppression.

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Consultations

Consultation with a dermatologist is recommended for evaluating clinical findings and obtaining skin biopsy specimens of appropriate lesions. Ideally, consult a dermatologist with experience in the management of cutaneous lymphomas.

Consultation with a dermatopathologist is recommended for histologic evaluation of skin biopsy specimens, with occasional consultation by a hematopathologist for patients with borderline biopsy results.

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Activity

Lymphomatoid papulosis mandates no activity restrictions.

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Long-Term Monitoring

Patients with lymphomatoid papulosis (LyP) require long-term follow-up, preferably twice yearly, to monitor the disease and evaluate for the development of associated lymphoma.

Patients on systemic therapy or PUVA phototherapy require closer monitoring for adverse effects.

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