Table 1: Treatment of LCH low-risk disease (single-system or multisystem)

Skin lesions

•    Steroids9 oral methotrexate (20 mg/m2) weekly for 6 months.

•    Oral thalidomide 50 to 200 mg nightly.

•    Topical application of nitrogen mustard is effective for cutaneous LCH that is resistant to oral therapies, but not for disease involving large areas of skin.

•    Psoralen and long-wave ultraviolet radiation (PUVA).

Skull lesions: Frontal, parietal, or occipital regions or single lesions of any other bone:

•    Spleen, liver, bone marrow or lung (may or may not include skin, bone, lymph node or pituitary gland).

•    Curettage only or curettage plus injection of methylprednisolone, complete excision.

•    Skull lesions in the mastoid, temporal or orbital bones, multiple bone lesions; or combinations of skin, lymph node or pituitary gland with or without bone lesions.

•    Among 6 to 12 months of vinblastine and prednisone.

•    Weekly vinblastine (6 mg/m2) for 7 weeks then every 3 weeks for good response.

•    Daily prednisone (40 mg/m2) for 4 weeks then tapered over 2 weeks .

Afterward, prednisone is given for 5 days at 40 mg/m2 every 3 weeks with the vinblastine injections.