To the Editor: First of all, we thank Joshi and Duvic1 for their critical review and reaction of our paper regarding itching and the quality of life (QoL) in patients with cutaneous T-cell lymphoma.2 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.3 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.4 The suggestion that vitiligo has a higher impact on QoL than other comorbidities is not substantiated by published reports and deserves further study.5
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 Duvic1 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.
Conflicts of interest
None disclosed.
Footnotes
Funding sources: none.
IRB approval status: Not applicable.
References
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