Faculty Bibliography

We report an indigenous case of leprosy in New York City in an immunocompetent patient who was infected with a Mycobacterium leprae genotype that is consistent with an exogenous origin. Physicians in the eastern United States should be alerted that, although most patients who develop leprosy in the United States are foreign born, native-born Americans are also susceptible to the infection

Treatment objectives of cutaneous T-cell lymphoma can be achieved with a variety of modalities applied to the variable presentations of the disease. In this review, the goals of therapy are presented and each therapy is summarized in terms of its use to achieve those goals. After reviewing the modalities, the strategies are summarized in reference to each presentation of cutaneous T-cell lymphoma

A 51-year-old man presented with itchy, erythematous patches and plaques on his trunk, arms, and legs. A skin biopsy specimen showed mycosis fungoides. Initially the patient did not respond to PUVA photochemotherapy but later improved on NB-UVB phototherapy combined with bexarotene and interferon-alpha. The lesions progressed from erythematous patches and plaques to hyperpigmented patches with central depigmentation and localized areas of follicular repigmentation. The development of depigmentation after PUVA photochemotherapy for mycosis fungoides has been described in the literature and does not have associated prognostic implications. It is important to be cognizant of phototoxicity associated with PUVA photochemotherapy or NB-UVB phototherapy in patients with mycosis fungoides, who may be taking photosensitizing medications or have depigmented patches which renders them more sensitive to lower doses of ultraviolet light

A 72-year-old man presented with a 4-year history of asymptomatic erythematous plaques on his face, neck, and scalp. He had no systemic symptoms or lymphadenopathy. Histopathologic examination of a skin biopsy specimen showed a dense, diffuse infiltrate of lymphocytes and plasma cells, with epidermotropism and folliculotropism. T-cell receptor (TCR) gene rearrangement analysis performed on skin biopsy specimen showed a monoclonal cell population. A diagnosis of folliculotropic mycosis fungoides (MF) was made. This clinicopathologic variant of MF is usually associated with ordinary patch-plaque lesions. The prognosis of folliculotropic MF is best estimated using the TNM staging criteria. Many clinicians feel that this variant of MF portends a worse prognosis; however, there are no studies to support this idea. Folliculotropic MF may be more resistant to superficial therapies because of the depth of the neoplastic T-cells in the follicle

A 75-year-old woman presented with a 3-year history of progressive loss of her eyebrow hair and with frontal-parietal hairline recession. Multiple biopsy specimens supported a histopathologic diagnosis of lichen planopilaris. With these histolopathologic findings, and the patient's clinical presentation, a diagnosis of frontal fibrosing alopecia was made. Treatment to date with topical glucocorticoid preparations, intralesional triamcinolone injections, and tacrolimus ointment have been unsuccessful

A 63-year-old Chinese man presented with an eczematous dermatitis that progressed into a multifocal nodular eruption. Histopathologic examination demonstrated a nodular and diffuse infiltrate in the reticular dermis, which was composed of lymphocytes, macrophages with granulomatous inflammation, and numerous eosinophils. Reactive lymphoid follicles with germinal centers also were present. Immunohistochemistry showed CD30 and LCA. ALK-1 and CD20 were negative. A diagnosis of CD30+ cutaneous T-cell lymphoma was made, and the patient is currently undergoing staging of his disease. Treatment options include excision of nodules, radiation therapy, and systemic chemotherapy

A 62-year-old man with a 13-year history of mycosis fungoides presented with a 2-month history of alopecia of the scalp. The mycosis fungoides had remained untreated for the previous 3.5 years. A biopsy specimen from the scalp showed follicular mucinosis in association with mycosis fungoides