34 years’ duration of poikilodermatous lesion
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Poikilodermatous mycosis fungoides (MF) is a rare clinical variant of patch-stage MF and is characterized by deep-red or brownish plaques with scaling, mottled dyspigmentation, atrophy, and telangiectasia affecting the trunk and extremities. The author has recently seen a patient with 34 years’ duration of the poikilodermatous lesion. To the best of my knowledge, this is the longest duration of the poikilodermatous lesion reported in the English literature.

A 68-year-old male was referred to us for evaluation of a 34-year history of widespread poikilodermatous patches over the trunk and extremities. The patient noticed the first appearance of scaly erythematous patches on his chest 34 years before. Later, it had gradually turned into poikiloderma and had progressed to involve the whole trunk and extremities over a period of 2 years. Similarly, his chin and lateral cheeks had been affected since 1 year earlier. This caused much cosmetic embarrassment to him. Before this, he had not received any medical treatment, although he had experienced slight itching.

On examination, generalized, erythematous, and poikilodermatous patches and thin plaques covered 80% of the body surface, including the trunk, flexural surfaces, and extremities. The lesions were typically atrophic, telangiectatic, and intermingled with mottled hyperpigmentation and hypopigmentation. Whole-body computed tomography (CT) scanning revealed no evidence of lymph node or visceral involvement. A lesional skin biopsy showed necrotic keratinocytes and focal epidermotropism of atypical lymphocytes without spongiosis. There were vacuolar alterations of the basal layer, scattered melanophages, intermittent fibrosis of the collagen, and lymphocytic infiltration in the papillary dermis. Immunohistochemically, the epidermotropic lymphocytes were positive for CD3, CD4, and CD45RO but were negative for CD8, CD20, CD79, TIA-1, and granzyme B. Gene rearrangement analysis showed the presence of monoclonal-type T cells. The results of blood tests for cell counts and the chemistry panel were within normal limits. Based on the aforementioned findings, poikilodermatous MF was diagnosed. The patient was treated with narrow-band UVB, and his skin manifestations improved gradually.