Abstract
Erythrodermic variants of cutaneous T-cell lymphoma (CTLC) are one of the case of erythroderma. The aim of the study was to assess the value of scalp dermoscopy in differentiation between erythrodermic CTCL, psoriasis, and atopic dermatitis. A total of 76 patients were included into the study (16 patients with erythrodermic CTCL, 20 patients with psoriatic erythroderma, 20 with erythrodermic atopic dermatitis, and 20 healthy volunteers). The most common trichoscopic features of erythrodermic CTCL were: numerous pili torti, numerous broken hairs, white thick interfollicular bands, and patchy hyperpigmentation of the background. They were observed in 81% (13/16), 75% (12/16), 56% (9/16), and 37.5% (6/16) of patients with CTCL, respectively (p < 0.001). Other specific features of erythrodermic CTCL were 8-shaped hairs (19%; 3/16) and visible anagen bulbs (12.5%; 2/16) (p < 0.05 and p = 0.052, respectively). The most common vascular pattern of erythrodermic CTCL was perifollicular arrangement of glomerular (50%; 8/16; p < 0.001) or linear vessels (31%; 5/16; p < 0.05). Follicular spicules-like scaling was pathognomonic for erythrodermic CTCL (12%, 2/16) although its presence did not reach statistical significance (p = 0.052). In conclusion, the characteristic trichoscopic findings of erythrodermic CTCL are numerous pili torti, eight-shaped hairs, thick white interfollicular bands, color heterogeneity of the background and perifollicular arrangement of vessels.
Highlights
Erythrodermic variants of cutaneous T-cell lymphoma (CTLC) are one of the case of erythroderma
The observed trichoscopic features included: numerous pili torti, singular pili torti, numerous broken hairs, singular broken hair, eight-shaped hairs, black dots, yellow dots, linear perifollicular vessels, glomerular perifollicular vessels, glomerular vessels regularly distributed or clustered, dotted vessels, arborizing vessels, glomerular vessels arranged in lines or circles localized between follicular units, white thick interfollicular bands forming net, patchy hyperpigmentation, yellow interfollicular scaling, white interfollicular scaling, follicular spicules like scaling
In two of three patients diagnosed with erythrodermic cutaneous T-cell lymphoma (CTCL) and without numerous pili torti, singular pili torti were seen and they were not observed in other study groups
Summary
Erythrodermic variants of cutaneous T-cell lymphoma (CTLC) are one of the case of erythroderma. The most common trichoscopic features of erythrodermic CTCL were: numerous pili torti, numerous broken hairs, white thick interfollicular bands, and patchy hyperpigmentation of the background. They were observed in 81% (13/16), 75% (12/16), 56% (9/16), and 37.5% (6/16) of patients with CTCL, respectively (p < 0.001). Erythrodermic variants of cutaneous T-cell lymphoma (CTCL) such as Sezary Syndrome (SS) or erythrodermic mycosis fungoides are not the most common diagnoses in such cases, but establishing a proper diagnosis plays a pivotal role in disease prognosis, treatment option, and patients survival. Lallas et al.[9] evaluated 32 patients diagnosed with early patch stage of MF They described fine, short, linear vessels, spermatozoa-like vascular structures and orange-yellow patchy areas. Dermoscopic pattern consisted of numerous polygonal structures containing white lobules divided by septa of pigmented dots and studded with fine red dots or hairpin vessels
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