Mycosis-fungoides-Type Cutaneous T Cell Lymphoma of the Hands and Soles: A Variant Causing Delay in Diagnosis and Adequate Treatment of Patients with Palmoplantar Eczema

Abstract

Background: The etiopathology of chronic eczematous lesions of the palms and/or soles remains elusive in a considerable proportion of patients. Accumulating evidence suggests that a rare variant of mycosis fungoides (MF)-type cutaneous T cell lymphoma (CTCL) restricted to the palms and/or soles may mimic common palmoplantar dermatoses. Objective: In the present study, we analyzed the clinical and histological characteristics of 3 adult patients with preexisting nonclassified chronic palmoplantar eczema poorly responding to standard therapies. Palmar and/or plantar MF was eventually diagnosed. Methods: The course of the disease, response to previous therapies and dermatological features are described, results of histochemical and immunohistochemical analyses are reported, including T cell receptor γ gene rearrangement where obtainable. Results: Onset of cutaneous lesions with broad clinical variation was experienced 2–10 years prior to diagnosis; conventional therapies led to short-time or partial remission only; except for 1 patient, the epidermotropic infiltrate was predominantly composed of CD4-positive cells; topical photochemotherapy seems to result in more durable responses. Conclusion: As therapeutic strategies for this disease variant differ from symptomatic standard treatment regimens, awareness of MF-type CTCL as a relevant differential diagnosis of palmoplantar eczema should be expanded to prevent delay in diagnosis and adequate therapy.

Clinicopathologic features and T-cell receptor gene rearrangement findings of mycosis fungoides palmaris et plantaris

“…It is quite difficult to diagnose MFPP just by its clinical features, but MFPP may be diagnosed with histopathologic findings and TCR gene rearrangement study. 5 There were also no clinical features distinctive to MFPP in this study.…”

Reflectance Confocal Microscopy as New Diagnostic Tool in Folliculotropic Mycosis Fungoides

“…FMF can imitate a wide variety of otherwise benign dermatoses and thus pose major diagnostic obstacles both for the dermatologist as well as the dermatopathologist [7]. In such cases, associated dermatopathological findings may also closely imitate its benign counterpart, i.e., psoriasiform epidermal hyperplasia in psoriasis vulgaris-like variants of mycosis fungoides, subepidermal blisters in bullous pemphigoid-like presentations, interstitial histiocytes and giant cells in granuloma annulare-like mycosis fungoides, or interface dermatitis in mycosis fungoides with lichen planus-like skin lesions [8,9].…”

Drug-Induced Lichenoid Dermatitis with Histopathologic Features of Mycosis Fungoides in a Patient with Psoriasis

“…Although involvement of the palms and soles is not unusual in patients with disseminated lesions of mycosis fungoides, cases involving lesions limited to the palmoplantar region are rare. [11][12][13] The presence of mycosis fungoides was later refuted with immunohistochemical analysis. Clinicians should be aware that although features of mycosis fungoides may initially be present in drug eruptions induced by etanercept, immunohistopathology may be necessary to confirm this finding.…”