title: 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 gamma 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Zentrum der Dermatologie, Klinikum der J W Goethe-Universität, Frankfurt am Main, Deutschland.
authors.forename: Konstanze
authors.initials: K
authors.lastname: Spieth
authors.forename: Marcella
authors.initials: M
authors.lastname: Grundmann-Kollmann
authors.forename: Ulf
authors.initials: U
authors.lastname: Runne
authors.forename: Gyde
authors.initials: G
authors.lastname: Staib
authors.forename: Christian
authors.initials: C
authors.lastname: Fellbaum
authors.forename: Manfred
authors.initials: M
authors.lastname: Wolter
authors.forename: Roland
authors.initials: R
authors.lastname: Kaufmann
authors.forename: Jens
authors.initials: J
authors.lastname: Gille
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D005528:Foot / Q000473:pathology; D006225:Hand / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009182:Mycosis Fungoides / Q000175:diagnosis* / Q000188:drug therapy; D011701:PUVA Therapy; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000188:drug therapy