A 54-year-old African American woman with a long history of a skin rash.

    Clinical findings. This is a 54-year-old African American woman who has a long history of a skin rash since 1992, which started as an erythematous to brownish patch approximately the size of a palm on her right anterior thigh. She started triamcinolone cream in 1995 for a presumed diagnosis of psoriasis. In 1996, the rash worsened and spread down, covering the feet, up over her back, and into the stomach area. At that point, she was treated with oral steroids and triamcinolone. The rash continued to worsen; and a skin biopsy was obtained in October 1999, which revealed MF. At that time, she had multiple lymph node enlargement and erythematous macules and plaques with significant scale over about approximately 65% of her body surface area with sparing of the popliteal and antecubital fossa bilaterally and the palms and soles. Many of these areas have a reticulate appearance with alternating hyper- and hypopigmented areas. After extensive skin-directed treatment, she has relapsed with hypopigmented skin lesions on the posterior thighs and buttocks in 2004. In March 2010, she developed also new hyperpigmented patches, mostly on the posterior trunk and posterior thigh and leg, as well as ichthyosis on the legs.

    Pathologic findings. The initial skin biopsy from the abdomen performed in 2000 demonstrated an atypical lymphoid infiltrate present at the dermal-epidermal junction and in the superficial dermis surrounding blood vessels with multifocal epidermotropism. Immunohisto- chemical studies revealed that neoplastic cells were T-cells of a helper cell lineage, positive for CD4 and negative for CD8. In 2009, a skin biopsy from the left lateral thigh revealed compact and thick hyperkeratosis with a thinned granular cell layer consistent with ichthyosis as well as a subtle epidermotropic atypical lymphoid infiltrate.

    Molecular findings. Molecular tests were not performed

    Staging, treatment, and follow-up. The patient was diagnosed as having MF, stage IIA, and ichthyosis induced by MF. The patient has previously been treated with psoralen–UVA, interferon, total body surface electron beam, nitrogen mustard, triamcinolone, and tazarotene creams. She also was diagnosed with breast cancer in June 2009, and she completed 12 cycles of chemotherapy in December 2009. In the last follow-up (March 2010), she had few patches, mostly on the posterior trunk and posterior thigh and leg. She had also persistent ichthyosis on the lower legs. She is currently applying topical nitrogen mustard and triamcinolone.

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