Cutaneous T cell lymphoma

'Cause actually it was three times more compliant if you did it at home versus in the office, and that probably explains why it works so well.

But even outside of psoriasis, you know, atopic dermatitis, a CTCL, right? This is a great option for those patients that you're not sure is it psoriasis, eczema, CTCL, and you're worried about giving them a biologic that can maybe unmask or worsen it.

Phototherapy is great.

Uh, itch of unknown origin, right? You're always worried you're missing something.

For example, Layla, what is your what have you done research on or what is your kind of specialty or interest that you think you know really well?

CTCL, actually, which a lot of people know a lot about, but I saw it in a Middle Eastern patient.

And so I was basically like running down this rabbit hole of CTCL in the Middle East.

Oh, wow.

Wow.

Interesting.

Well, that's a very interesting topic, very rapidly advancing.

And so if I were to just talk to you for about five minutes about CTCL, I could learn so much from you.

Thoughts on either of these, Graham?

Yeah, so I mean, for, for the couple of years now, we've been seeing these case reports, case series, these publications that are not just hinting or, or warning about the, the connection that they seem to be finding between Dupixent and CTCL, but really very strongly stating that there potentially is not just a correlation but maybe even a causation.

I'm, I am really, really not a fan of this thought process.

I, I really don't think that people who are taking Dupixent are having CTCL because of their Dupixent.

Now, there may be something to having CTCL be unmasked in the sense that you had CTCL be misdiagnosed as atopic dermatitis, and that that's the reason why they got the Dupixent.

But I don't think that there is necessarily a causal relationship.

I, I also think that there have been...

I couldn't agree more.

everything was going according to plan until about April 2023.

And that is when Lando is diagnosed with cutaneous T-cell lymphoma, or CTCL.

It's a rare form of cancer, and it obviously requires her to take intermittent time off for treatments and doctor visits.

Naturally.

So suspect psoriasis, some things that can point you to psoriasis as the cause of erythroderma are clues of psoriasis elsewhere.

So do they have characteristic skin changes on some part of their body? Do they have thicker plaques on their knees or their elbows? Do they have the nail changes of psoriasis, things like the oil drops or the pitting? those things can point you towards more of a psoriasis over another cause of erythroderma like eczema, seborrheic dermatitis, CTCL, some of these other causes.

So look for those things.

And you can always take a biopsy too.