title: T cell lymphomatoid contact dermatitis: a challenging case and review of the literature.
abstract: Lymphomatoid contact dermatitis is a pseudolymphoma with clinical and histological features of allergic contact dermatitis and cutaneous T cell lymphoma. Incorrect diagnosis may lead to unnecessary testing, unnecessary treatment, or patient harm. The objective of this study is to present a case to demonstrate the diagnostic challenge and overlap between allergic contact dermatitis and cutaneous T cell lymphoma in a patient with lymphomatoid contact dermatitis caused by methylchoroisothiazolinone/methylisothiazolinone and paraben mix, and to review the existing literature in order to summarize the demographics, clinical features, allergens and treatments reported for lymphomatoid contact dermatitis. A search of major scientific databases was conducted for English-language articles reporting cases of lymphomatoid contact dermatitis or additional synonymous search headings. Nineteen articles with a total of 23 patients were analysed. Lymphomatoid contact dermatitis was more common in men, with an average age of 58.5 years. Fourteen unique allergens were identified and confirmed by patch testing. However, no single test or study was diagnostic of lymphomatoid contact dermatitis. Allergen avoidance was the most useful management tool, but selected patients required topical or systemic immunosuppression. In conclusion, without specific diagnostic features, evaluation for lymphomatoid contact dermatitis should include a thorough history and examination, patch testing, and biopsy with immunohistochemistry and clonality studies.
authors.affiliation: Section of Dermatology, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03766, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Knackstedt
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Zug
mesh_terms: D001706:Biopsy; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology*; D003937:Diagnosis, Differential; D006801:Humans; D007150:Immunohistochemistry; D016399:Lymphoma, T-Cell / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010328:Patch Tests; D019310:Pseudolymphoma / Q000175:diagnosis* / Q000276:immunology*; D012878:Skin Neoplasms / Q000175:diagnosis; D013601:T-Lymphocytes; D013844:Thiazoles / Q000009:adverse effects
chemical_list: D013844:Thiazoles; C011506:2-methyl-4-isothiazolin-3-one; C011421:5-chloro-2-methyl-4-isothiazolin-3-one
keywords: allergic contact dermatitis; allergic contact pseudolymphoma; cutaneous T cell lymphoma; lymphomatoid contact dermatitis; mycosis fungoides; patch testing