Zusammenfassung
Eine 29-jährige Patientin stellte sich in unserer Klinik mit
seit 1 Jahr rezidivierenden papulonodösen Hautveränderungen an den
Unterarmen und Beinen vor. Histologisch zeigte sich ein buntes
keilförmiges dermales Infiltrat mit Lymphozyten unterschiedlicher
Größe und Morphe. Immunhistologisch fanden sich große
lymphoide Zellen mit hyperchromatischen Nuklei und deutlicher Expression von
CD45RO und CD30. Es wurde die Diagnose einer lymphomatoiden Papulose Typ A
gestellt. Eine systemische Beteiligung wurde ausgeschlossen. Wir begannen eine
Therapie lediglich mit topischen Kortikosteroiden mittlerer Stärke. Von
einer PUVA-Therapie oder der Gabe von Methotrexat wurde, auch auf Wunsch der
Patientin, abgesehen. Der Verlauf war spontan-remissiv und benigne unter dieser
„Wait-and-see”-Strategie. Wir diskutieren hier die relative
Benignität der Erkrankung und beleuchten kritisch das Risiko klonaler
Selektion potentiell aggressiverer T-Zellklone durch zu unkritischen,
verfrühten Einsatz von Methotrexat bzw. PUVA.
Abstract
A 29 year old female patient presented with papular-nodular skin
lesions on her lower arms and legs that had recurred for one year. A subsequent
skin biopsy showed a variegated wedge-shaped dermal infiltrate, composed of
lymphocytes of different size and morphology. The immunohistochemical staining
revealed large lymphoid cells with hyperchrome nuclei and an intense staining
for CD30. We diagnosed lymphomatoid papulosis type A. A systemic involvement of
organs was excluded. The treatment of the patient with topical class II-III
corticosteroids resulted in a significant clinical improvement. Respecting the
will of the patient, we did not start PUVA or methotrexate therapy. The course
was benign and spontaneously remissive under this wait-and-see-strategy. Here
we discuss the potential risks of selecting more aggressive clones by
uncritical early use of methotrexate or PUVA in lymphomatoid papulosis.
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Evgenia Markeeva
Klinik für Dermatologie, Venerologie und
Allergologie
Universitätsklinikum des Saarlandes
Kirrbergerstr. 1 – Gebäude 18
66421
Homburg
Email: evgenia.markeeva@uks.eu
