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.
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.
Spieth
Konstanze
K
Zentrum der Dermatologie, Klinikum der J W Goethe-Universität, Frankfurt am Main, Deutschland.
Grundmann-Kollmann
Marcella
M
Runne
Ulf
U
Staib
Gyde
G
Fellbaum
Christian
C
Wolter
Manfred
M
Kaufmann
Roland
R
Gille
Jens
J
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