Caring for Cutaneous Lymphoma Lesions

Primary cutaneous lymphomas are cancers that affect the skin—though they are not themselves skin cancers. Cutaneous lymphomas are cancers of lymphocytes, also known as T-cells or B-cells. These unusual cancers cause red, scaly, itchy, painful lesions on the skin. Indeed, cutaneous T-cell lymphoma can have a profoundly negative effect on quality of life.1 For most patients with cutaneous lymphoma, skin and wound care is the most important thing they can do on a daily basis to manage their disease.

Treatment for itchy cutaneous lymphoma lesions

Itchy cutaneous T-cell lymphoma lesions are very common. Nearly nine out of ten people with cutaneous T-cell lymphoma have itchy skin lesions.1,2 A dermatologist is often the best specialist to consult for itchy cutaneous lymphoma lesions. A dermatologist may recommend or prescribe moisturizers, nonirritating creams, topical corticosteroids, and/or antihistamines. Some patients find relief from their pruritis (itchiness) by taking doxepin or gabapentin. In more severe cases, aprepitant, naltrexone or mirtazapine may be tried. Some patients benefit from phototherapy, i.e. light therapy, psoralen plus ultraviolet A (PUVA) therapy. In the most serious and treatment-resistant cases of cutaneous T-cell lymphoma, prednisone may be the only thing that can control the pruritis.

What to do when itchiness becomes infection

It can be challenging to tell the difference between a typical cutaneous lymphoma lesion and one that has become infected. The disease itself can cause the skin to become scaly, develop cracks and ulcers, and produce fluid; however, these are also signs of skin infection. Patients should note when skin lesions get acutely worse, that is, worse over a period of several hours. Worsening could be a sudden increase in pain or itchiness, or perhaps the lesion simply looks worse than it did a few hours previous. Cutaneous lymphoma lesions that suddenly produce more fluid, feel warm, or are surrounded by additional redness may be infected. If this occurs, your doctor can perform a skin culture to be sure, and prescribe specific treatment.

Skin care for cutaneous lymphoma

While it is important to keep skin clean, excessive cleaning can dry the skin. Dry skin can make cutaneous lymphoma lesions worse. That is why the choice of soap is important. Avoid soaps that have harsh detergents or change the pH of the skin. Good choices are beauty bathing bars that are intended for sensitive skin. Baby shampoos are usually the best choice for hair care.

Types of skin moisturizers

Skin care is an important part of managing cutaneous lymphoma lesions. Patients should keep their skin well-hydrated. Occlusive moisturizers (e.g. petroleum jelly) keep moisture next to the skin by preventing evaporation. Humectants such as glycerin attract and hold onto water molecules. Emollients like jojoba oil and ceramide-based moisturizers penetrate the top layer of skin (stratum corneum) and create a barrier to moisture loss. Each type can effectively moisturize the skin.3 Your dermatologist can help you decide which moisturizer is right for you, though most people find their favorite through trial and error.

Caring for cutaneous lymphoma wounds

One of the most effective ways to keep lesions moist is to cover them with non-adhesive, occlusive pads.4 Examples include hydrogels (i.e. colloidal hydrogels) or silicone dressings. Once these dressings are in place, they can be covered with sterile gauze, retention bandages, or polyurethane film dressings.4 

The choice of medical tape is critical. Patients never want to place adhesives directly on the lesion for the simple reason that when the tape is removed, it can traumatize the wound. Instead, tape should be applied over the dressing and directly on unbroken, relatively healthy skin. Since even relatively healthy skin can be sensitive to trauma and adhesives, select a medical tape that holds firm, but releases gently and is safe for sensitive skin. Hy-Tape is an excellent choice for cutaneous lymphoma lesions because its adhesive is zinc-oxide based, which is soothing to skin. It is also latex-free so that it does not contribute to latex allergy. Since people with cutaneous lymphoma lesions require frequent dressing changes, a medical tape like Hy-Tape provides maximum skin protection.

Tips for dressing changes

Dressing changes can be uncomfortable and even painful. Talk to your doctor about topical anesthetics. Topical anesthetics can provide short-term relief from pain—just about the length of time it takes to change a dressing. 

Remember that it takes several minutes for the anesthetic to work, so give the anesthetic plenty of time to reach maximum effect. Once the area is numb, work swiftly but carefully.

Gently remove the medical tape from the borders of the dressing. Hy-Tape should release easily and without leaving sticky residue. 

If using a dry covering, make sure it is not adhered to the wound. If the dry dressing sticks to the wound, place a wet washcloth on top to moisten the bandage (warm water, not hot). You will know the dressing is moist enough when it pulls away easily and completely from the wound. 

The non-adherent dressing underneath should pull away cleanly. If not, you may not be using the correct base dressing—choose a non-adherent dressing type (e.g. Tefla pad).

Once the wound is exposed to air, it needs to be cleaned—gently. Use mild soap and water or irrigate the wound with saline. Dead tissue should be removed, but leave living tissue intact. 

If using an ointment, apply a thin layer to the wound. Then cover the wound with a non-adherent dressing, followed by dry dressing held in place with an appropriate medical tape (e.g. Hy-Tape).

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References

1. Demierre MF, Gan S, Jones J, Miller DR. Significant impact of cutaneous T-cell lymphoma on patients’ quality of life: results of a 2005 National Cutaneous Lymphoma Foundation Survey. Cancer. 2006;107(10):2504-2511. 10.1002/cncr.22252

2. Demierre M-F. Mycosis fungoides and Sézary syndrome: the burden of pruritus. Community Oncology. 2010;7(9):399-404. 10.1016/s1548-5315(11)70414-4

3. Lindh JD, Bradley M. Clinical Effectiveness of Moisturizers in Atopic Dermatitis and Related Disorders: A Systematic Review. Am J Clin Dermatol. 2015;16(5):341-359. 10.1007/s40257-015-0146-4

4. Edmonds M. Best practice guidelines: wound Management in Diabetic Foot Ulcers. Wounds International. 2013.