eMedicine Specialties > Dermatology > Lymphoma and Related Processes

Lymphomatoid Papulosis: Follow-up

Author: John A Zic, MD, Director of VU Cutaneous Lymphoma Clinic, Assistant Professor of Medicine Dermatology, Vanderbilt University Medical Center
Contributor Information and Disclosures

Updated: Dec 16, 2009

Follow-up

Further Outpatient Care

  • Patients with lymphomatoid papulosis (LyP) require long-term follow-up, preferably twice yearly, to monitor the disease and evaluate for the development of associated lymphoma.
  • Patients on systemic therapy or PUVA phototherapy require closer monitoring for adverse effects.

Prognosis

  • The prognosis of lymphomatoid papulosis is good because most patients have a chronic, indolent course. A recent retrospective cohort analysis found that no patients with lymphomatoid papulosis died of the disease, and the overall survival rate was 92% at 5 and 10 years.
  • Physicians are guardedly optimistic about the prognosis because estimates indicate that as many as 10-20% of patients have a history of associated malignant lymphoma (ALCL, HD, MF) prior to, concurrent with, or subsequent to the diagnosis of lymphomatoid papulosis.25 Unfortunately, no clinical or histologic factors analyzed to date are predictive of worse outcomes in persons with lymphomatoid papulosis. A study suggested that fascin expression is increased in lymphomatoid papulosis cases associated with a malignant lymphoma.26 Alterations in transforming growth factor-beta signaling are hypothesized to play a role in the progression of lymphomatoid papulosis to malignant lymphoma. Additionally, data have shown an increased risk of associated lymphomas in lymphomatoid papulosis cases with CCR3+ atypical cells or the 30M362 allelic form of the CD30 promotor.

Patient Education

  • Instruct patients that they are not an infectious risk to others.
  • Instruct patients about local wound care of open crusted lesions. Lesions should be cleaned with mild soap and water twice daily, and topical antibiotic ointment should be applied to prevent infection. Crusted lesions should be covered with a loose adhesive bandages until healed.
  • Instruct patients to contact their physician if any of the following symptoms or signs develop that may herald the onset of infection or associated malignancy:
    • Fever, chills, night sweats, or weight loss
    • Persistent skin nodules or patches that do not regress over a 2- to 3-month period
    • Enlarged lymph node glands in the groin or axillae

Miscellaneous

Medicolegal Pitfalls

  • Failure to inform patients of their small increased risk for developing malignancy
  • Failure to periodically monitor patients with lymphomatoid papulosis

Special Concerns

  • Patients require long-term follow-up, preferably twice yearly, to monitor the disease and to evaluate for the development of an associated lymphoma.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, and previous author, Kristina Collins, MD, to the development and writing of this article.



More on Lymphomatoid Papulosis

Overview: Lymphomatoid Papulosis
Differential Diagnoses & Workup: Lymphomatoid Papulosis
Treatment & Medication: Lymphomatoid Papulosis
Follow-up: Lymphomatoid Papulosis
Multimedia: Lymphomatoid Papulosis
References
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Further Reading

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Keywords

lymphomatoid papulosis, Macaulay disease, Macaulay's disease, LyP, T-cell lymphoma, T cell lymphoma, cutaneous lymphoma, mycosis fungoides, MF, Hodgkin disease, Hodgkin lymphoma, Hodgkin's disease, Hodgkin's lymphoma, HD, lymphoproliferative disease, lymphoproliferative disorder, LPD, anaplastic large cell lymphoma, ALCL, primary cutaneous anaplastic large cell lymphoma, pcALCL

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Contributor Information and Disclosures

Author

John A Zic, MD, Director of VU Cutaneous Lymphoma Clinic, Assistant Professor of Medicine Dermatology, Vanderbilt University Medical Center
John A Zic, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Gregory J Raugi, MD, PhD, Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle
Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Daniel S Loo, MD, Associate Professor of Dermatology, Residency Program Director, Department of Dermatology, Tufts Medical Center
Daniel S Loo, MD is a member of the following medical societies: American Academy of Dermatology and Association of Professors of Dermatology
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis  investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

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