Sir, Mycosis fungoides is a primary cutaneous T–cell lymphoma, secondary clonal proliferation of mature skin-homing T cells, mostly CD4-positive, with a predilection for involving the epidermis. It is an indolent lymphoma that progresses over several years and represents 50% of primary cutaneous T-cell lymphomas [1]. Its clinical presentation is variable, thus leading to several clinical variants. Herein, we describe a rare variant of mycosis fungoides: pityriasis lichenoid-like mycosis fungoides. A 45-year-old female was referred to our department with a papular rash evolving for the last year without regression. The patient had a history of breast carcinoma in complete remission for two years. A clinical examination revealed erythematous, scaly, non-itchy papules covering the entire body but sparing the face (Figs. 1 and 2). There was no scalp involvement or associated lymphadenopathy. Based on the clinical presentation, the suggested diagnosis was pityriasis lichenoid. A histological examination revealed Pautrier’s microabscesses, atypical lymphocyte infiltration along the basal layer and papillary dermis, and prominent epidermotropism (Fig. 3). There was pilotropism without mucin. Besides, hyperkeratosis with focal parakeratosis and perivascular infiltrate were noted. An immunohistochemical analysis revealed infiltrates of T cells expressing CD3, CD2, CD5, and a predominance of CD4-positive T cells in the epidermis compared to CD8-positive T cells. CD7 and CD30 were, however, negative. These findings were consistent with pityriasis lichenoid-like mycosis fungoides. The patient was classified as a IB stage and received UVB phototherapy with good progress.
Sir, Prurigo pigmentosa is a rare inflammatory disease first reported in 1971 by Nagashima et al. as a “peculiar pruriginous dermatosis with gross reticular pigmentation” in Japan [1], where the largest number of such cases have been described, with only several cases having been described elsewhere. Herein, we report a new case of prurigo pigmentosa. A 32-year-old Moroccan female presented at our dermatology department with a several-week-old history of pruritic eruptions on the chest, abdomen, lumbosacral area, and neck. According to the patient, the onset was marked by itchy papules coalescing to plaques, secondarily becoming hyperpigmented reticulated macules. The patient was treated with antifungal drugs without improvement. Additionally, the patient had recently been diagnosed with type II diabetes and was treated by oral antidiabetics. A physical examination revealed hyperpigmented macules arranged in a reticulate pattern, mainly on the chest, abdomen, lumbosacral area, and neck (Figs. 1 and 2). She had no acanthosis nigricans or other associated symptoms. The main diagnoses considered were pityriasis versicolor, confluent and reticulated papillomatosis of Gougerot–Carteaud, and prurigo pigmentosa. A histological examination revealed a discreetly atrophic epidermis surmounted by compact orthokeratotic hyperkeratosis and slight basal pigmentation. The dermis was the site of perivascular mononuclear infiltrates associated with a small number of melanophages. Periodic acid–Schiff staining was negative. This was consistent with the diagnosis of prurigo pigmentosa.
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