Understanding cutaneous T-cell lymphomas (CTCL)

CTCL is a complicated disease

Malignant T cells

Cutaneous T-cell lymphomas (CTCL) are characterized by the presence of malignant T cells in chronically inflamed skin lesions.1

Mycosis fungoides make up 54-72% of all cases

Mycosis fungoides (MF) is the main manifestation of the disease, making up 54%-72% of all cases.1

Identifying CTCL

MF presents as erythematous skin patches that are often confused for immune-related diseases like eczema, psoriasis, parapsoriasis, or pityriasis lichenoides.1

CTCL or Eczema slider
CTCL or Eczema slider
CTCL or Psoriasis slider
CTCL or Psoriasis slider
CTCL or Parapsoriasis slider
CTCL or Parapsoriasis slider
Pityriasis lichenoides
CTCL or Pityriasis lichenoides  slider
CTCL or Pityriasis lichenoides slider

Testing for CTCL

Early MF is often diagnosed through clinical, histopathologic, and immunopathologic methods including2:

Physical exam

Physical exam

Complete skin examination and palpation of peripheral lymph node regions

Blood test

Blood testing

To check for the presence of malignant T-cells



Of skin and/or lymph node for pathology

Imaging test

Imaging tests

Such as CT or MRI scans

Testing equipment
Histologic evaluation of an enlarged node can also be used to confirm the type and stage of CTCL2

Identifying stages of CTCL

Mycosis fungoides presents as skin patches resembling benign inflammatory dermatoses.1

Patient with early stage CTCL
Early stages of CTCL

Early stages of CTCL show as limited patches or plaques. If diagnosed early, prognosis is favorable with management and the disease is considered non-life-threatening.

A majority of CTCL cases will not progress beyond this stage.1

Patient with later stage CTCL
Later stages of CTCL

For the approximately one-third of patients that may progress to later stage CTCL, the skin lesions start to spread and noticeable tumors and skin redness may develop.1

Patient with later stage CTCL
Later stages of CTCL

For the approximately one-third of patients that may progress to later stage CTCL, the skin lesions start to spread and noticeable tumors and skin redness may develop.1

T cells
For early stage patients, topicals can lead to complete remission3
T cells
For progressing cases of CTCL, systemic therapy may be appropriate to manage patients’ disease2
T cells
For progressing cases of CTCL, systemic therapy may be appropriate to manage patients’ disease2

Important safety information

Indication and usage

TARGRETIN® (bexarotene) capsules and gel are indicated for the treatment of cutaneous manifestations of cutaneous T-cell lymphoma (only stages 1A and 1B for gel) in patients who are refractory to at least one prior systemic therapy.

Important Safety Information

Birth defects

Because of the risk of fetal harm, TARGRETIN capsules and gel must not be given to a woman who is pregnant or who intends to become pregnant. If a woman becomes pregnant during treatment with TARGRETIN, treatment must be stopped immediately, and the woman provided appropriate counseling about the risks.

To prevent pregnancy, effective contraception must be used for one month prior to the initiation of TARGRETIN therapy, during therapy and for at least one month following discontinuation of therapy; it is recommended that two reliable forms of contraception be used simultaneously unless abstinence is the chosen method. Male patients with sexual partners who are pregnant, possibly pregnant or who could become pregnant must use condoms during treatment and for at least one month after the last dose of drug.

No more than a one month supply of TARGRETIN should be given to the patient so that the results of pregnancy testing can be assessed and counseling regarding avoidance of pregnancy and birth defects can be reinforced.


TARGRETIN capsules and gel are contraindicated in patients with a known serious hypersensitivity to bexarotene or other components of the product.

Warnings and precautions

Hyperlipidemia is present in most patients treated with TARGRETIN capsules. Obtain baseline values, monitor during treatment, and manage elevations during therapy.

Acute pancreatitis, including a fatal case, has been reported in patients treated with TARGRETIN capsules. Interrupt treatment and evaluate if suspected.

Hepatotoxicity, cholestasis, and hepatic failure TARGRETIN capsules had a dose-related effect on liver chemistry tests in clinical trials, including incidence of cholestasis and liver failure.

Hypothyroidism TARGRETIN capsules induce hypothyroidism in about half of all patients; obtain baseline thyroid function tests and monitor patients during treatment.

Neutropenia Leukopenia and neutropenia occurred in clinical trials with TARGRETIN capsules; obtain complete blood counts at baseline and periodically during treatment.

Cataracts Although a causal relationship has not been established, cataracts have been observed in animal and clinical studies with TARGRETIN capsules. Refer patients who experience visual difficulties for ophthalmologic evaluation.

Hypoglycemia in Diabetes TARGRETIN capsules may cause hypoglycemia in patients using insulin, agents enhancing insulin secretions, or insulin-sensitizers.

Nursing: Discontinue nursing during treatment with TARGRETIN.

Laboratory tests including CBC, fasting lipid profile, liver function tests, and thyroid profile should be obtained prior to treatment.

CA125 assay values in ovarian cancer patients may be elevated by treatment.

Capsules and Gel

Vitamin A Patients should be advised to limit Vitamin A intake to avoid potential additive toxicity.

Photosensitivity Advise patients to minimize exposure to sun and artificial sunlight during treatment.


Patients who are applying TARGRETIN gel should not concurrently use products that contain DEET, a common component of insect repellent products.

For nursing women, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Adverse reactions

The most common adverse reactions (>10%) include hyperlipidemia, hypercholesteremia, headache, hypothyroidism, asthenia, leukopenia, rash, nausea, infection, peripheral edema, abdominal pain, and dry skin.


The most common adverse events reported in TARGRETIN gel clinical trials with an incidence at the application site of at least 10% were: rash, pruritus, skin disorder, and pain.

To report SUSPECTED ADVERSE REACTIONS contact customer service at 1-800-321-4576 or FDA at 1-800-FDA-1088 or visit fda.gov/medwatch.

Click here for full Prescribing Information, including Boxed Warning for TARGRETIN capsules.

Click here for full Prescribing information for TARGRETIN gel.

  1. Krejsgaard T, Lindahl LM, Mongan NP, et al. Malignant inflammation in cutaneous T-cell lymphoma—a hostile takeover. Semin Immunopathol. 2017;39(3):269-282.
  2. National Organization for Rare Disorders website. Rare Disease Database: Cutaneous T-Cell Lymphomas. www.rarediseases.org/cutaneous-t-cell-lymphomas. Accessed August 5, 2021.
  3. Galper SL, Smith BD, Wilson LD. Diagnosis and management of mycosis fungoides. Oncology (Williston Park). 2010;24(6):491-501.