Indian Journal of Dermatology
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Year : 2013  |  Volume : 58  |  Issue : 2  |  Page : 163
Steroid-resistant localized lymphomatoid papulosis treated with local bath-puva therapy


Department of Dermatology, San Carlo Hospital, Potenza, Italy

Date of Web Publication5-Mar-2013

Correspondence Address:
Enzo Errichetti
Department of Dermatology, San Carlo Hospital, Potenza
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.108109

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How to cite this article:
Errichetti E, Piccirillo A, Ricciuti F, Ricciuti F. Steroid-resistant localized lymphomatoid papulosis treated with local bath-puva therapy. Indian J Dermatol 2013;58:163

How to cite this URL:
Errichetti E, Piccirillo A, Ricciuti F, Ricciuti F. Steroid-resistant localized lymphomatoid papulosis treated with local bath-puva therapy. Indian J Dermatol [serial online] 2013 [cited 2019 Jun 24];58:163. Available from: http://www.e-ijd.org/text.asp?2013/58/2/163/108109


Sir,

Lymphomatoid papulosis (LyP) is a rare, chronic, recurrent, benign skin disease belonging to the spectrum of the CD30+ cutaneous lymphoproliferative disorders. The histologic types of LyP can resemble Hodgkin disease (HD) (type A), mycosis fungoides (type B), or anaplastic large-cell lymphoma (type C). The causes of LyP are unknown. [1] In 5 to 24 per cent of cases, it may precede the development of malignant lymphoproliferative disorder. LyP generally affects elderly adults with a peak incidence in the fifth decade of life. [2] However, albeit rarely, it may occur in children. Clinically, LyP presents with recurrent crops of reddish-brown papules and/or nodules scattered on the trunk and extremities in a generalized pattern. [1],[2] Anyhow, to date, 16 cases of localized LyP have been reported in detail in the literature. Also, in localized form, there is potential to develop malignancy. In fact, one patient has developed lymphoma and one has developed mycosis fungoides. Like generalized LyP, the localized variant predominantly affects males. However, its age of onset is earlier than the classic form. In fact, localized LyP usually occurs in children and young adults with a mean age of 28 years. [2] An 11-year-old girl presented to our department with a 2-month history of asymptomatic crops of reddish-brown papules, ranging from 2 to 5 mm in diameter, localized to her right knee [Figure 1]a. No other significant skin or mucosal lesions were seen. Routine blood exams were normal. Excision of one of the papules was made for histological examination, which showed a scattered dermal infiltrate of large-sized atypical lymphoid cells [Figure 2]a, b, which were CD30-positive. On the basis of the clinical and histological data, we made a diagnosis of localized LyP type A. The patient was treated with topical clobetasol propionate 0.05% (Twice-daily for 28 days) without significant signs of improvement. Therefore, we decided to carry out local bath-PUVA therapy. The affected skin was dipped for 15 minutes in warm water containing 8-methoxypsoralen (1 mg/L) and, immediately after, it was irradiated with UVA. The starting dose of UVA was 0.25 J/cm 2 , and exposure was increased in increments of 0.25 J/cm 2 per week. The frequency of treatment was twice-a-week. After 8 weeks, the lesions regressed [Figure 1]b, and there was no recurrence after 24 months of follow-up. Treatment was well-tolerated, and no side-effects were observed. Considering the possibility to develop malignant lymphoproliferative disorder, we recommended to the patient a cautious long-term follow-up. There are no codified guidelines for the treatment of localized LyP. In some patients, a spontaneous resolution of lesions has been reported, while in other cases, topical steroids, injections of gamma-interferon, oral minocycline, radiation therapy, and anti-histamines have been used with various degrees of success. [2] The clinical improvements and the good tolerability observed in this report suggest that a protocol based on local bath-PUVA therapy, as the one exposed here, should be considered as a new option for treatment of localized LyP, especially of steroid-resistant forms.
Figure 1: (a) Crops of reddish-brown papules, ranging from 2 to 5 mm in diameter, localized to right knee of the girl. (b) After 8 weeks of treatment with local bath-PUVA therapy

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Figure 2: Dermal infiltrate of large-sized atypical lymphoid cells (2a and 2b, H and E; original magnification: (a) ×40; (b) ×400

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   References Top

1.Nijsten T, Curiel-Lewandrowski C, Kadin ME. Lymphomatoid papulosis in children: A retrospective cohort study of 35 cases. Arch Dermatol 2004;140:306-12.  Back to cited text no. 1
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2.Hsu YJ, Su LH, Hsu YL, Tsai TH, Hsiao CH. Localized lymphomatoid papulosis. J Am Acad Dermatol 2010;62:353-6.  Back to cited text no. 2
[PUBMED]    


    Figures

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