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The Cutting Edge: Challenges in Medical and Surgical Therapies
May 2012

Subcutaneous Interferon Alfa for the Treatment of Cutaneous Pseudolymphoma

Arch Dermatol. 2012;148(5):572-574. doi:10.1001/archdermatol.2011.1016

Herein we report a case of recalcitrant cutaneous pseudolymphoma (CPL) treated with subcutaneous interferon.

An otherwise healthy 28-year-old white woman had onset of skin disease in 2001 when she developed red, tender pruritic nodules on her right ear and preauricular area. She had no history of an arthropod bite and was not taking any medications. Results of a biopsy of one of the nodules suggested pseudolymphoma. She was treated with clobetasol propionate, a class I topical corticosteroid, and had complete resolution of the lesions. Three years later, she presented with diffuse erythematous papules and an erythematous well-circumscribed plaque on the palm, which were preceded by sore throat, muscle aches, and fever. Results of a biopsy of a specimen from the back showed a superficial and mild perivascular infiltrate of lymphocytes and histiocytes, which was consistent with a viral exanthem. At a follow-up visit 2 weeks later, she had a new erythematous plaque on her right ear along with tender cervical adenopathy. A biopsy specimen of this plaque showed a dense dermal and subcutaneous infiltrate of small lymphocytes and occasional large pleomorphic cells. There was no epidermal involvement; however, the infiltrate was found around adnexal structures. Immunohistochemical analysis revealed the infiltrate was predominately CD3+ T lymphocytes. Staining for CD30 was essentially negative. Immunophenotyping by flow cytometry showed 97% CD2+, 96% CD3+ without loss of CD5 or CD7, and a normal CD4 to CD8 ratio of 2:1. Results of a T-cell receptor gene rearrangement clonality study of formalin-fixed tissue from the ear were negative.

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