Abstract

Mycosis fungoides (MF), the most common form of primary cutaneous T-cell lymphoma, can simulate a variety of common dermatologic disorders and patterns making diagnosis difficult in early stages. Diagnosis of MF in skin of color can be especially challenging as lesions may be subtle or have an atypical appearance. We present the case of a 41-year-old female, skin type V, with a three to four year history of treatment resistant, worsening perioral acneiform papules and nodules with the clinical differential diagnosis of periorificial dermatitis, granulomatous rosacea, cutaneous sarcoidosis or other granulomatous process. A punch biopsy from the chin revealed a dense pan-dermal lymphocytic infiltrate with folliculosebaceous involvement, composed of atypical T-cells with CD4 greatly predominating over CD8, suspicious for folliculotropic MF (FMF).  Additional clinical examination revealed facial alopecia in the area of the acneiform eruption and longstanding patchy xerosis on the trunk and extremities. A subsequent biopsy from a xerotic area was highly suspicious for early patch stage MF, while a biopsy from the lip again demonstrated changes of FMF. FMF, a rare clinically significant MF variant, can present as alopecia and/or as an acneiform eruption; however, only very rare cases of FMF with acneiform lesions have been noted in skin of color.  As this may be due to the variation in clinical findings, we present this case to raise awareness of FMF presenting as an acneiform eruption in hopes of improving earlier detection and diagnosis, and to stress the importance of a biopsy in similar-appearing, treatment resistant lesions.