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August 16, 2010

Lymphomatoid Contact Dermatitis to Baby Wipes

Author Affiliations

Author Affiliations: Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts.†Deceased.

Arch Dermatol. 2010;146(8):918-935. doi:10.1001/archdermatol.2010.169

Numerous histologic mimickers of mycosis fungoides (MF) have been reported in the literature. Lymphomatoid contact dermatitis (LCD), which presents as treatment-responsive allergic contact dermatitis (ACD) that histologically resembles MF, is another entity appropriately placed in this category. Numerous allergens have been implicated in this rare variant of ACD, but to our knowledge, there have been no reported cases of LCD in reaction to preservatives found in baby wipes.

A 44-year-old woman was seen with a recent diagnosis of MF. She reported a 2-year history of an intensely pruritic eruption that involved the buttocks and groin. While the initial impression was inverse psoriasis, treatments with topical steroids, etanercept, and eventually infliximab were all ineffective. A biopsy specimen revealed chronic dermatitis with prominent epidermotropism and minimal spongiosis and eosinophils (Figure 1), findings suggestive of early MF despite negative results from gene rearrangement studies. Analyses of specimens from repeated biopsies showed more evidence of MF, including more epidermotropism and less spongiosis.

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