Sean Klepper M.D.
Stephen Lyle, M.D., ...
- Patients often have an underlying disturbance of immune regulation, such as lymphoma, HIV or autoimmune disease.
- Presents as a solitary or multiple plaques, which may resemble mycosis fungoides, or nodules
- May be quite difficult to distinguish from lymphoma, and may evolve into true lymphoma
- The most commonly implicated drugs are:
- ACE inhibitors
- Alpha antagonists
- Beta blockers
- Calcium channel blockers
- Histamine antagonists
- Sex steroids
- Mycosis fungoides-like pattern:
- Upper dermal infiltrate of mildly atypical T-cells
- If epidermotropism is present, it is usually mild, tending to mainly affect the suprapapillary plates and adnexae.
- Basal vacuolar alteration
- Spongiosis to vesiculation
- Necrotic keratinocytes
- Papillary dermal edema
- Lymphomatoid vascular reaction pattern:
- Perivascular and transmural infiltrates of mildly atypical lymphocytes that obscure the vessel architecture
- Usually no fibrinoid necrosis of the vessel walls