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. [32]
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. [33] Antibiotics have been reported helpful in some reported cases associated with Borrelia infection. [3] Subcutaneous injection of interferon-alfa has also cleared cutaneous pseudolymphoma. [34, 35] Photodynamic therapy has also been used. [36] Thalidomide has been shown to achieve remission in a single case of refractory disease. [37]
The Medscape Skin Cancer Resource Center may be of interest.
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. [38]
The Medscape Dermatologic Surgery Resource Center may be of interest.
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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This localized example of pseudolymphoma shows an ill-defined, thin, erythematous plaque.
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Pseudolymphomatous drug eruption due to captopril, marked by erythematous to purple papules, patches, and plaques.
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This erythrodermic pseudolymphoma (T-cell pattern) typifies drug-induced pseudolymphoma, which is most often secondary to anticonvulsant therapy.
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Biopsy specimens of pseudolymphoma vary substantially, but they most often exhibit a mixed inflammatory infiltrate with prominent lymphoid follicle formation.
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This example of lymphocytoma cutis shows a localized, erythematous-to-brown, ill-defined plaque.
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Lymphocytoma cutis of the shoulder, composed of flesh-colored or erythematous nodules in small groups.
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This photograph of lymphocytoma cutis caused by an arthropod bite shows an erythematous scaling patch of the scalp with localized secondary alopecia.
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A mixed inflammatory infiltrate with germinal centers is indicative of lymphocytoma cutis.
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Well-developed lymphoid follicles in a background of mixed inflammatory cells with small lymphocytes are typical of lymphocytoma cutis.
