Reply to Correspondence to “Itch in patients with cutaneous T-cell lymphoma as a quality of life indicator”

To the Editor: First of all, we thank Joshi and Duvic1Joshi T.P. Duvic M. Understanding itch in cutaneous T cell lymphoma: exploring the impact of comorbidities, treatment regimens, and racial differences on quality of life.JAAD Int. 2023; 10: 55-56Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar for their critical review and reaction of our paper regarding itching and the quality of life (QoL) in patients with cutaneous T-cell lymphoma.2Ottevanger R. van Beugen S. Evers A.W.M. Willemze R. Vermeer M.H. Quint K.D. Itch in patients with cutaneous T-cell lymphoma as a quality of life indicator.JAAD Int. 2022; 9: 57-64Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar This will help us to gain more attention for this underexposed subject in cutaneous lymphoma research. Although we agree that the Charlson Comorbidity Index has its limitations since it only includes the most common and severe comorbidities, it is currently the most validated method of assessing comorbidities in QoL research.3Kobayashi Y. Miura K. Hojo A. et al.Charlson comorbidity index is an independent prognostic factor among elderly patients with diffuse large B-cell lymphoma.J Cancer Res Clin Oncol. 2011; 137: 1079-1084Crossref PubMed Scopus (61) Google Scholar We are aware that other comorbidities may also occur and not all patients experience the comorbidities as the same burden. However, their example of vitiligo does not match with our experience. Given the similarities between vitiligo and hypopigmented mycosis fungoides, one wonders if this association may be due to misclassification of hypopigmented mycosis fungoides as vitiligo.4Kim J.C. Kim Y.C. Hypopigmented mycosis fungoides mimicking vitiligo.Am J Dermatopathol. 2021; 43: 213-216Crossref PubMed Scopus (5) Google Scholar The suggestion that vitiligo has a higher impact on QoL than other comorbidities is not substantiated by published reports and deserves further study.5Ottevanger R. van Beugen S. Evers A.W.M. Willemze R. Vermeer M.H. Quint K.D. Quality of life in patients with Mycosis Fungoides and Sézary Syndrome: a systematic review of the literature.J Eur Acad Dermatol Venereol. 2021; 35: 2377-2387Crossref PubMed Scopus (15) Google Scholar The treatment regimens of our patients were not included as part of the study as it does not directly affect the outcome. It is acknowledged that the type of treatment may affect QoL. However, drug-induced itch suppression will result in a better itch score and (itch-related) QoL. Patients in our cohort were not treated with histone deacetylase inhibitors, which are not registered on the Dutch medicine market, or extracorporeal photopheresis, and had not received total skin electron beam therapy recently. Recording ethnicity routinely is not allowed in the Netherlands, but Fitzpatrick skin types V and VI are estimated to represent <5% of Dutch patients with cutaneous T-cell lymphoma. Again, we thank Joshi and Duvic1Joshi T.P. Duvic M. Understanding itch in cutaneous T cell lymphoma: exploring the impact of comorbidities, treatment regimens, and racial differences on quality of life.JAAD Int. 2023; 10: 55-56Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar for their critical review and we wholeheartedly agree that better measuring tools are necessary. Future research indeed needs to focus on developing and validate dedicated tools for patients with cutaneous T-cell lymphoma to optimize QoL measurements for implementation in daily practice. None disclosed. Understanding itch in cutaneous T-cell lymphoma: Exploring the impact of comorbidities, treatment regimens, and racial differences on quality of lifeJAAD InternationalVol. 10PreviewTo the Editor: We read with interest the paper by Ottevanger et al,1 which explores the impact of itch on the quality of life (QoL) of patients with cutaneous T-cell lymphoma (CTCL). The investigators show pruritus to have a significant impact on the QoL of patients with CTCL. Importantly, the authors show more advanced CTCL to be associated with poorer QoL, extending our previous work on this topic.2 Here, we wish to point out some limitations of the study and highlight areas for further research. Full-Text PDF Open Access