Cutaneous Pseudolymphoma Clinical Presentation

Updated: Jun 14, 2021
  • Author: Gauri Panse, MBBS, MD; Chief Editor: William D James, MD  more...
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Patients with B-cell pattern pseudolymphoma present with a nodule or a group of discrete nodules, usually with minimal associated symptoms. Occasionally, patients present with pruritus or pain. Patients with a T-cell pattern of cutaneous pseudolymphoma usually present with broader patches, which are often asymptomatic.

The onset of drug-induced pseudolymphoma is insidious. Most patients present with a single slowly enlarging papular, nodular, or plaquelike lesion several weeks following the initiation of implicated medications. However, several patients have demonstrated drug-induced pseudolymphoma after more than 5 years of therapy.


Physical Examination

Examination of patients with a B-cell pattern of pseudolymphoma usually reveals a single nodule, from one to several centimeters in diameter. Although the lesions may be soft, they are more often firm. Typically, the lesions are red to purple in color, but they may show no coloration. Approximately three quarters of cases of cutaneous pseudolymphoma are localized. The remaining cases usually show grouped papules in a single defined region. More disseminated cases are rare. The most common site of involvement in cutaneous pseudolymphoma is the face (70%), followed by the chest and the upper extremities. Cutaneous pseudolymphoma lesions are infrequent below the waist.

Sites of predilection for borrelial pseudolymphoma include the earlobe, the nipple, the areola, the nose, and the scrotum (sites of low skin temperature). [9]

Patients with T-cell pattern pseudolymphoma typically present with broad, erythematous patches and/or plaques. Pseudolymphomatous actinic reticuloid affects sun-exposed areas. Lymphomatoid contact dermatitis demonstrates lesions in areas where the inciting agent has come in contact with the skin. [25]

Erythematous patches, similar to mycosis fungoides (MF), may be seen, but, in contrast to MF, they may be more localized and not restricted to sun-protected sites. [4] Frequently, a small number of erythematous indurated papules, plaques, or nodules are seen. Rarely, a solitary tumor may appear.