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Reticulate Pigmentation In Mycosis Fungoides

• A 94-year-old white woman gave a 12-month history of a pruritic eruption on the limbs and trunk. She had been taking bumetanide 1 mg daily and propranolol 10 mg qid for 3 years for hypertension, and betahistine 4 mg qid and prochlorperazine 5 mg tid for Meniere disease. She had had rheumatic fever at the age of 47, but was otherwise well. Scaly, erythematous, papular lesions were present on the legs and arms, and on the trunk there were areas of telangiectasia, atrophy, and hyperpigmentation. Biopsy from a lesion on the abdominal wall showed histologic features consistent with mycosis fungoides, with a mixed dermal inflammatory infiltrate of mononuclear cells, including atypical cells, and showing epidermotropism. Complete blood count, renal, and liver function results were within normal limits, and chest roentgenogram showed no evidence of lymphomatous involvement. The eruption failed to improve with 0.025% betamethasone valerate ointment, and she was then treated with oral prednisolone 20 mg daily. After 4 weeks, there was considerable improvement, and the dose of prednisolone was reduced to 5 mg daily. At no stage did she receive therapeutic ultraviolet radiation. Six months later she developed tumorous lesions in the skin of the chest and back, and florid reticulate hyperpigmentation was also noted (Fig 1). A further biopsy was taken from a tumorous lesion and the adjacent hyperpigmented area. Her general condition deteriorated and she subsequently died while in hospital. Autopsy revealed that her death was due to severe aortic valve stenosis unconnected with the skin condition. There was no evidence of extracutaneous organ involvement. Histologic examination of the second skin biopsy also showed features of mycosis fungoides. Cell marker studies confirmed that the dermal infiltrate was of T lymphocyte origin. In the hyperpigmented area, there was pigmen-