Statement of clinical problem

Mycosis Fungoides is the most common form of Cutaneous T cell lymphomas with approximately 1000 new cases in the United States each year. This disease poses a great challenge for wound care nurses responsible for managing various stages of wound and skin care issues within this population.   

Description of past management

A fifty three-year old black female diagnosed one year ago with T-cell lymphoma. Skin issues included a combination of patch, plaque and tumor stage lesions including ulcerations over entire body surface. Previous treatment included bexarotene; cyclophosphamide, vincristine and prednisone chemotherapy; electron beam therapy and multiple antibiotic treatments. Wound care consisted of dry gauze dressings and silver sulfadiazine cream to open lesions.

Current clinical approach

Limiting dressing changes to once per day accomplished the goal of care to minimize pain, caregiver burden and restriction of daily activities. Topical treatment was determined by the lesion stage. General skin care consisted of a daily shower with mild soap. Patches and intact skin were moisturized liberally with petrolatum. Open lesions were covered with petrolatum dressings that were non-adherent, cost effective and easy to apply.  Highly exuding lesions were irrigated with normal saline and covered with absorptive dressings.  Suspected infectious lesions were treated with silver hydrogel dressings.  Tape was avoided. Analgesics were administered prior to dressing changes.

Patient Outcomes

Patient expressed improved comfort, effective management of wound drainage and improved quality of life. Despite the occurrence of bacterial infections, most lesions were managed in a clean, well cared for state. Several of the open, infected wounds healed within a couple months, but relapsed with disease progression.

Conclusions

Mycosis Fungoides is a disease that requires complex nursing management. A variety of treatments must be implemented to effectively manage symptoms and improve quality of life.