Mycosis fungoides: A unusual clinical presentation

The Authors describe a case of a 69-year-old woman who presented by two years erythematous, markedly hyperkeratotic and pruritic plaques with sharp borders on the palms and soles. Were also presents in these plaques deep vesicopustolar lesions. The patient was evaluated by other dermatologists that diagnosticated allergic contact dermatitis: patch tests confirmed theirs diagnosis (positivity for nickel and other substances). Fungal culture was negative. The lesions were treated with daily topical applications of a corticosteroid treaitment having a partial resolution. In consequence of the interruption of the therapy, the dermatosis flared up again. The clinical features gave evidence for psoriasis. A biopsy specimen taken from the right palm showed marked parakeratosis, acanthosis and diffuse infiltrate in the papillary dermis. The dermal bandlike infiltrate was composed of lymphocites and cells with hyperchromatic irregurarly shaped nuclei (mycosis cells). Immunohistochemistry confirmed diagnosis of mycosis fungoides. Further examinations excluded visceral involvement. The patient was treated with daily topical applications of mechlorethamine (nitrogen mustard). Before establishing the diagnosis of mycosis fungoides palmoplantaris (MFPP) has been diagnosed as dermatophyte infection, contact dermatitis and palmoplantar psoriasis. In summary, MFPP is an expression of MF that sometime initially presents and mimics many common palmoplantar dermatoses. A biopsy is recommended in the evaluation of unresponsive, chronic palmoplantar lesions.