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Cutaneous Pseudolymphoma Treatment & Management

  • Author: Christine J Ko, MD; Chief Editor: William D James, MD  more...
 
Updated: May 17, 2016
 

Approach Considerations

When the offending agent is known, its removal results in resolution of the cutaneous pseudolymphoma. Cases of cutaneous pseudolymphoma documented to occur as a result of infection should be appropriately treated. In idiopathic cases of cutaneous pseudolymphoma, treatment is not mandatory. Cures may be effected via surgical removal, cryosurgery, or local irradiation. Some reports have noted a response to topical or injected corticosteroids and topical immunomodulators such as tacrolimus.[26]

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Medical Care

Patients with presumed pseudolymphoma in whom the possibility of lymphoma cannot be excluded should be evaluated for the possibility of concurrent extracutaneous disease and followed for possible emergence of lymphoma.

When the diagnosis of pseudolymphoma is suspected, all implicated drugs should be discontinued. Because lesions are typically asymptomatic, no additional medical treatment is required. A short course of topical or intralesional steroids may be attempted to hasten regression. The time course for lesion regression can range from 1-3 months. Careful follow up is prudent because a nonresolving lesion should prompt concern for a malignant process.

Case reports have suggested the efficacy of imiquimod.[27] Antibiotics have been reported helpful in some reported cases associated with Borrelia infection.[3] Subcutaneous injection of interferon-alfa has also cleared cutaneous pseudolymphoma.[28, 29] Photodynamic therapy has also been used.[30]

The Medscape Skin Cancer Resource Center may be of interest.

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Surgical Care

In cutaneous pseudolymphoma, simple excision of the involved site can be curative in some cases.

Cryosurgery may be effective in some cases of lymphocytoma cutis.

Lesions that interfere with function or are cosmetically undesirable may be surgically removed. No recurrence of excised lesions has been seen after withdrawal of the causative drugs. In cases of incomplete regression, external radiation therapy has also been reported to be successful. Successful treatment of tattoo pigment–induced pseudolymphoma with fractional resurfacing and subsequent Q-switched Nd:YAG 532-nm laser treatments has been reported.[31]

The Medscape Dermatologic Surgery Resource Center may be of interest.

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Long-Term Monitoring

Because malignant lymphomas have been reported following clearance of pseudolymphoma, patients should be continually monitored for constitutional signs of lymphoma.

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Contributor Information and Disclosures
Author

Christine J Ko, MD Associate Professor, Departments of Dermatology and Pathology, Yale University School of Medicine

Christine J Ko, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, International Society of Dermatopathology

Disclosure: Nothing to disclose.

Coauthor(s)

Earl J Glusac, MD Professor, Departments of Pathology and Dermatology, Yale University School of Medicine

Earl J Glusac, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Jon H Meyerle, MD Assistant Professor, Department Dermatology, Uniformed Services University of the Health Sciences; Assistant Professor, Department of Dermatology, Johns Hopkins University School of Medicine; Chief, Immunodermatology, Walter Reed National Military Medical Center

Jon H Meyerle, MD is a member of the following medical societies: American Academy of Dermatology, Sigma Xi

Disclosure: Nothing to disclose.

Inbal Braunstein, MD Assistant Professor, Department of Dermatology, Johns Hopkins University School of Medicine

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Donald Belsito, MD Professor of Clinical Dermatology, Department of Dermatology, Columbia University Medical Center

Donald Belsito, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Dermatology Foundation, New York County Medical Society, New York Dermatological Society, Noah Worcester Dermatological Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Inbal Braunstein University of Pennsylvania School of Medicine

Disclosure: Nothing to disclose.

Günter Burg, MD Professor and Chairman Emeritus, Department of Dermatology, University of Zürich School of Medicine; Delegate of The Foundation for Modern Teaching and Learning in Medicine Faculty of Medicine, University of Zürich, Switzerland

Günter Burg, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, International Society for Dermatologic Surgery, North American Clinical Dermatologic Society, and Pacific Dermatologic Association

Disclosure: Nothing to disclose.

Dirk M Elston, MD Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Jacqueline M Junkins-Hopkins, MD Associate Professor, Director, Division of Dermatopathology and Oral Pathology, Department of Dermatology, Johns Hopkins Medical Institutions

Jacqueline M Junkins-Hopkins, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and American Society of Dermatopathology

Disclosure: Nothing to disclose.

Michael S Lehrer, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Michael S Lehrer, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, and American Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

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.

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

References
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This localized example of pseudolymphoma shows an ill-defined, thin, erythematous plaque.
Pseudolymphomatous drug eruption due to captopril, marked by erythematous to purple papules, patches, and plaques.
This erythrodermic pseudolymphoma (T-cell pattern) typifies drug-induced pseudolymphoma, which is most often secondary to anticonvulsant therapy.
Biopsy specimens of pseudolymphoma vary substantially, but they most often exhibit a mixed inflammatory infiltrate with prominent lymphoid follicle formation.
This example of lymphocytoma cutis shows a localized, erythematous-to-brown, ill-defined plaque.
Lymphocytoma cutis of the shoulder, composed of flesh-colored or erythematous nodules in small groups.
This photograph of lymphocytoma cutis caused by an arthropod bite shows an erythematous scaling patch of the scalp with localized secondary alopecia.
A mixed inflammatory infiltrate with germinal centers is indicative of lymphocytoma cutis.
Well-developed lymphoid follicles in a background of mixed inflammatory cells with small lymphocytes are typical of lymphocytoma cutis.
 
 
 
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