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Treatment of Low-Risk Disease (single or multisystem) Single or multiple bones Multisystem Skin Single bone (lymph nodes, gastrointestinal Central nervous system involvement, diabetes) Observation Curettage Chemotherapy Chemotherapy (vinblastine) + steroids (vinblastine) + steroids for 6 months for 6–12 months Topical steroids Radiation therapy Topical mechlorethamine Phototherapy Treatment of High-Risk Disease (multisystem) Multisystem (bone marrow, liver, spleen, lungs) Chemotherapy (vinblastine), steroids, 6-mercaptopurine ± methotrexate for 12 months. Many sufferers require treatment with myelosuppressive medicine such as hydroxyurea, an oral ribonucleotide reductase inhibitor. In addition, as kidney biopsy is never carried out in ately began in accordance with the preliminary stage (Fig womens health jan 2014 buy discount fosamax on line.

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