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Background Necrobiosis lipoidica (NL) is an uncommon granulomatous dermatosis that can occur in patients with or without associated diabetes mellitus (DM). Prior studies have attempted to determine distinctive histopathologic features of NL in patients with and without DM. Methods A retrospective review of 97 patients with NL was performed to determine the similar and distinctive histopathologic features in patients with DM and without DM. Results Of the 97 patients, 32% (n = 31) had DM. Epidermal acanthosis was seen more commonly in diabetics than nondiabetics (32.3% vs. 12.1%; p = 0.017). Naked (sarcoidal/tuberculoid) granulomas were more frequently observed in nondiabetics than diabetics (22.7% vs. 3.2%; p = 0.016). Eosinophils were more common in nondiabetics than diabetics (38.5% vs. 9.7%; p = 0.004), while neutrophilic infiltration was more common in diabetics than nondiabetics (45.2% vs. 17.5%; p = 0.004). Conclusions This study corroborates well‐documented histopathologic features of NL and shows distinctive histopathologic features of NL among patients with DM‐I, DM‐II, and without DM. These results support the hypothesis that there are different underlying drivers of NL between diabetics and nondiabetics.

Cutaneous T cell lymphomas (CTCLs) are a spectrum of diseases with varied clinical courses caused by malignant clonal proliferation of skin-tropic T cells. Most patients have an indolent disease course managed with skin-directed therapies. In contrast, others, especially in advanced stages of disease or with specific forms, have aggressive progression and poor median survival. Sézary syndrome (SS), a leukemic variant of CTCL, lacks highly consistent phenotypic and genetic markers that may be leveraged to prevent the delay in diagnosis experienced by most patients with CTCL and could be useful for optimal treatment selection. Using single-cell mRNA and T-cell receptor sequencing of peripheral blood immune cells in SS, we extensively mapped the transcriptomic variations of nearly 50 000 T cells of both malignant and nonmalignant origins. We identified potential diverging SS cell populations, including quiescent and proliferative populations shared across multiple patients. In particular, the expression of AIRE was the most highly upregulated gene in our analysis, and AIRE protein expression could be observed over a variety of CTCLs. Furthermore, within a single patient, we were able to characterize differences in cell populations comparing malignant T cells over the course of treatment with histone deacetylase inhibition and photopheresis. New cellular clusters after progression on the therapy notably exhibited increased expression of the transcriptional factor FOXP3, a master regulator of regulatory T cell function, raising the potential implication of an evolving mechanism of immune evasion.

Primary cutaneous CD30 + lymphoproliferative disorders (LPDs) are a spectrum of diseases of which lymphomatoid papulosis (LyP) is the most common. 1 Rarely, LyP can occur in children. 2 LyP is characterized by recurrent crops of papules and nodules that spontaneously resolve. 3 Half of patients experience symptoms of pain and/or pruritus. 4 The prognosis of LyP is excellent with a 10year overall survival of 92%. 5 LyP is associated with a 14%-51.7% risk of developing a second lymphoma, most commonly mycosis fungoides. 6-8 Despite its benign nature, individuals with LyP can develop disfiguring scarring and pigmentary changes which may significantly affect their quality of life. We present a case of resistant LyP with significant scarring in a pediatric patient successfully treated with photodynamic therapy (PDT) and narrowband ultraviolet B (nbUVB).

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