14th July 2026

Management

Aim to improve symptoms, cure is rarely achieved. 

Skin-directed therapies include topical medications: corticosteroids, imiquimod, chlormethine, retinoids (bexarotene), phototherapy, and localised radiotherapy

Systemic therapies include photopheresis, chemotherapy (methotrexate), and biological or immunological therapy (interferon-alpha)

First-line treatment: 

• Stage IA: 
  • 1st line – skin-directed therapies
  • 2nd line – systemic therapy
• Stage IB-IIA:
  • 1st line – skin-directed therapies
  • Predominantly plaque disease: PUVA or UVA1 
  • 2nd line – systemic therapy
• Stage IIB 
  • 1st line – skin-directed therapies AND systemic therapy, adjunct local radiotherapy 
• Stage III:
  • 1st line – skin-directed therapies AND systemic therapy AND antibiotics (due to increased risk of secondary infection)
• Stage IV: 
  • Systemic therapy, adjunct radiotherapy 
  • 2nd line – allogeneic haematopoietic cell transplant 

Complications

High likelihood: cutaneous ulceration 

Medium likelihood: cutaneous/systemic infections, secondary malignancy, therapy-related cutaneous malignancy (increased risk of non-melanoma and melanoma)

Low likelihood: complications related to erythroderma (heart failure, renal impairment), CNS involvement

References

• https://bestpractice.bmj.com/topics/en-gb/1025 
• https://ashpublications.org/blood/article/110/6/1713/24087/Revisions-to-the-staging-and-classification-of