Cutaneous Lymphoid Hyperplasia

A 51-year-old man presented with red, mildly pruritic papulonodules that had erupted on his face approximately 5 weeks earlier. The clinical appearance suggested cutaneous lymphoid hyperplasia. Dr Charles E. Crutchfield III and Kathryn Gehrig of St Paul confirmed the diagnosis with a biopsy.

Cutaneous lymphoid hyperplasia-also known as lymphocytoma cutis and pseudolymphoma-is a benign skin disorder that is characterized histologically by a dense collection of lymphocytes within the dermis. The presenting red or purple papule, nodule, or plaque commonly arises on the face; the eruption may consist of a single lesion or localized multiple lesions. The differential includes granulomatous processes, adnexal tumors, granuloma faciale, cutaneous sarcoidosis, and leukemia cutis.

The disease can be idiopathic, or it can be caused by a foreign antigen, such as infection, medication or, perhaps most commonly, an arthropod bite. Kimura disease and angiolymphoid hyperplasia with eosinophilia also can produce this condition. Most cases of cutaneous lymphoid hyperplasia are polyclonal and benign; however, monoclonal cases that can lead to malignancy and true lymphoma do occur.

Treatment consists of surgical resection of localized lesions and excisional biopsy of smaller, symptomatic lesions. Cryotherapy and topical corticosteroids are other options. Some lesions regress spontaneously. Because of the risk that the disease may progress to true lymphoma, long-term follow-up of all patients is recommended.

This patient's lesions resolved after a 3-week course of twice-daily applications of a group III corticosteroid ointment, such as triamcinalone, 0.1%, or fluocinonide, 0.05%. The patient is seen yearly and has been told to return for evaluation if new lesions appear.