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Lichen Aureus Clinicopathologic Features, Natural History, and Relationship to Mycosis Fungoides FREE

Regina Fink-Puches, MD; Peter Wolf, MD; Helmut Kerl, MD; Lorenzo Cerroni, MD
[+] Author Affiliations

Author Affiliations: Department of Dermatology, Medical University of Graz, Graz, Austria.


Arch Dermatol. 2008;144(9):1169-1173. doi:10.1001/archderm.144.9.1169.
Text Size: A A A
Published online

ABSTRACT

Background  A possible association between lichen aureus (LA) and mycosis fungoides (MF) has been suggested in the past. We evaluated the clinicopathologic features of LA and its relationship to MF. Data from 23 patients with a clinicopathologic diagnosis of LA were reviewed.

Observations  Lesions were asymmetrically localized on 1 area of the body (mostly 1 extremity) and were characterized histologically by dense, bandlike lymphocytic infiltrates. A monoclonal T-cell population was detected in half of the cases. After a mean follow-up of 102.1 months, 14 patients had no sign of skin disease, 7 patients had unmodified skin lesions, and 2 other patients with unmodified skin lesions had died of unrelated conditions. Treatment modalities did not affect the outcome. There was no relationship between the presence or absence of monoclonality and patient status at follow-up assessments.

Conclusion  Patients with classic lesions of LA do not show progression to MF.

Figures in this Article

Lichen aureus (LA) is a chronic, persistent pigmented purpuric dermatitis (PPPD) characterized clinically by infiltrated localized golden brown lesions and histopathologically by a lichenoid lymphocytic infiltrate.1 The lesions are stable, are usually symptomless, and may persist for years.2 Although all body regions may be affected, LA occurs mainly on the legs. Histopathologically, LA differs from other PPPDs in the density of the lichenoid tissue reaction and the marked accumulation of hemosiderin-containing macrophages.3 In some cases, because of the dense bandlike infiltrates, the histopathologic differential diagnosis relative to mycosis fungoides (MF) may be difficult or impossible. In fact, purpuric lesions resembling LA histopathologically have been described in MF.46

An association between PPPD and MF has been reported in the context of cases of PPPD progressing to MF79 or the presence of purpura in lesions of MF.10 In a study of many cases of PPPD, Toro and coworkers11 suggest that this condition may be related to MF.

The aim of our study was to evaluate the clinicopathologic features and natural history of LA in a sample of patients. We also aimed to define its relationship, if any, to MF.

METHODS

PATIENTS

Data from 23 patients from the files of the Department of Dermatology, Medical University of Graz, were included in this study. In each case, the original histopathologic sections were reviewed by one of us (L.C.). Lichen aureus was diagnosed according to clinicopathologic correlation by reviewing clinical photographs when available or by reviewing medical records. Clinical data analyzed included age, sex, date of first diagnosis, duration of follow-up, and status of disease at the last follow-up assessment.

HISTOLOGIC, IMMUNOHISTOLOGIC, AND MOLECULAR BIOLOGIC EVALUATION

Sections with a maximum thickness of 4 μm and stained with hematoxylin-eosin, Giemsa, and periodic acid–Schiff were available for standard histologic evaluation. In all cases in which a paraffin block could be retrieved, analysis of the T-cell receptor was performed using polymerase chain reaction (PCR) techniques and primers as published previously1214 with minor modifications.15 Details about PCR procedures have been published previously.16

RESULTS

Twenty-three patients (11 male and 12 female) were included in the study. Age at diagnosis ranged from 1 to 77 years (mean age, 43.2 years; median age, 47 years). Clinical data are given in the Table.

In 18 patients, the lesions were asymmetrically distributed at a single body site on the lower (n = 15) or upper (n = 3) extremities (Figure 1). Five patients had solitary lesions located on the buttocks, back, shoulder, trunk, or breast.

Place holder to copy figure label and caption
Figure 1.

A-G, Different clinical presentations of patients with lichen aureus.

Graphic Jump Location

All cases histopathologically revealed variably dense, bandlike lymphoid infiltrates with slight fibrosis of the papillary dermis and the presence of hemorrhage and siderophages (Figure 2). Lymphocytes were the predominant cells in all cases. True epidermotropism of atypical lymphocytes was not observed, but most cases showed variable exocytosis of lymphocytes. A clear-cut grenz zone of uninvolved papillary dermis was not observed. In 1 case, 2 biopsy specimens from a persistent, unchanged skin lesion obtained 17 years apart revealed identical histopathologic pictures (Figure 3).

Place holder to copy figure label and caption
Figure 2.

Patient 14 in the Table. Dense bandlike infiltrate of lymphocytes with hemorrhage (hematoxylin-eosin, original magnification ×10).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

Patient 3 in the Table. A, Appearance of skin lesion in 1990. B, A biopsy specimen obtained in 1990 showed a bandlike infiltrate. C, Note sparse hemorrhage and coarse bundles of collagen in the papillary dermis. D, Appearance of the lesion in 2007. E, A biopsy specimen obtained in 2007 revealed persistence of the lymphocytic infiltrate. F, Note features similar to those of the biopsy specimen obtained in 1990. Hematoxylin-eosin, original magnification ×10 (B), ×20 (C and F), and ×4 (E).

Graphic Jump Location

Analysis of the T-cell receptor-γ gene rearrangement performed in 16 cases revealed a monoclonal band in 8 cases and a smear in the other 8 cases. There was no relationship between the presence or absence of monoclonality and the presence or absence of skin disease at follow-up assessments. In 1 patient, a monoclonal population of T lymphocytes was demonstrated in 2 biopsy specimens obtained 17 years apart. Although the lengths of the PCR products were similar, we could not sequence the products to check whether the same T-cell clone was persistent for such a long period.

Follow-up data were available for all 23 patients (mean follow-up period, 102.1 months; median, 76 months; range, 11-382 months). No patient developed skin lesions of MF. Fourteen patients were alive without any sign of skin disease. Five of them had received local corticosteroid treatment, 5 had obtained no therapy, 3 had undergone surgical excision, and 1 had received light therapy (UV-B at 311 nm). Seven patients were alive with skin disease. In all of these patients, skin lesions had remained largely unchanged during the follow-up period. Four of them had received local corticosteroid treatment, 2 had obtained no therapy, and 1 had received psoralen–UV-A therapy. Two patients had died of unrelated conditions after follow-up periods of 30 and 25 months. In both of these, skin lesions were unchanged at the time of death according to information given by relatives.

COMMENT

To our knowledge, this is the largest follow-up study on LA and its relationship to MF. Our data show that 9 patients (39%) had persistent skin disease after a mean follow-up of 102.1 months. However, there were no substantial changes in the clinical picture, and classic MF developed in none of these patients. In the literature, an association between PPPD (including LA, Shamberg disease, and other variants difficult to classify) and MF, as well as progression of PPPD to MF, is reported.4,10,1719 In this context, it is notable that the first patient with LA described in the American literature subsequently died of MF.20 In the study by Toro and coworkers,11 histopathologic examination and analysis of the T-cell receptor gene rearrangement in 56 patients with PPPD raised the suspicion that this condition is biologically related to MF. Barnhill and Braverman7 described 3 patients with PPPD evolving to MF during follow-up periods averaging 8.4 years. Lipsker et al21 evaluated 17 patients who were diagnosed clinically and histologically as having chronic pigmented purpura. Two of these patients developed cutaneous T-cell lymphoma within a few years. However, our results indicate that conventional cases of LA have an excellent prognosis and do not eventuate into MF. Viseux et al22 describe a patient with PPPD who developed MF after 24 years, but lesions in our patients were stable or regressed spontaneously, a finding that would be unusual for classic MF. In fact, 5 patients had skin lesions that resolved without any treatment and did not recur during the follow-up period (range, 37-168 months), indicating possible spontaneous resolution of the disease. Although lesions of MF can regress spontaneously as well, recurrences are the rule. However, the median follow-up period (76 months) among our patients may be too short to completely rule out the possibility of evolution to MF.

It is intriguing that histopathologic features of LA are sometimes indistinguishable from those of MF. In this context, in half of our cases a monoclonal population of T lymphocytes was observed, confirming previous observations by Toro and coworkers11 and by Crowson and coworkers.23 A similar finding was recently published by Magro and coworkers.24 However, their inclusion criteria differed, and approximately 40% of patients with PPPD having monoclonal populations of T lymphocytes were reported to have clinicopathologic features consistent with MF. A similar rate of clonal cases (about 50%) is found in follicular mucinosis–alopecia mucinosa, a disease that is linked to MF.25 The interpretation of rearrangement studies in these cases is controversial. Detection of a clonal T-cell receptor rearrangement has been observed in certain inflammatory benign skin disorders such as pityriasis lichenoides26,27 or lichen planus28 and is obviously not synonymous with malignant neoplasms. On the other hand, 1 of our patients had a monoclonal T-cell infiltrate in a lesion that had persisted unchanged and revealed identical histopathologic features in biopsy specimens obtained 17 years apart. It may be that LA is a clonal dermatosis in which the clone is kept under control by immune surveillance but in a few patients may escape immune surveillance and become a dominant clone. In this context, LA treatment should continue until complete resolution, or patients should be kept under regular follow-up observation. Recently, LA has been included in a group of “cutaneous T-cell lymphoid dyscrasias” with potential for progression to cutaneous T-cell lymphoma.29

The cause of PPPD and LA remains unknown. Familial cases30 and associations with hematologic diseases, hepatic diseases,31 and diabetes mellitus32 have been reported. In some cases, LA has been related to allergic contact allergens such as paraphenylenediamine, cobalt, benzoyl peroxide, balsam of Peru, and glass wool.21 Treatment in our patients varied, including local corticosteroid use, surgical excision, light therapy, and no treatment, but persistence or resolution of skin lesions was unrelated to the type of therapy. Given the reported possible association with MF,711 patients with PPPD or LA should be treated according to schemes efficacious for both diseases.

In conclusion, we showed that no progression to MF was observed in our group of patients with conventional LA. However, LA belongs to the expanding spectrum of so-called clonal dermatoses, and a possible evolution to MF cannot be ruled out. Therefore, close patient follow-up observation is recommended.

ARTICLE INFORMATION

Correspondence: Lorenzo Cerroni, MD, Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, A-8036 Graz, Austria.

Accepted for Publication: December 12, 2007.

Author Contributions: Drs Fink-Puches, Wolf, Kerl, and Cerroni had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Cerroni. Acquisition of data: Fink-Puches and Cerroni. Analysis and interpretation of data: Fink-Puches, Wolf, Kerl, and Cerroni. Drafting of the manuscript: Fink-Puches. Critical revision of the manuscript for important intellectual content: Wolf, Kerl, and Cerroni. Study supervision: Cerroni.

Financial Disclosure: None reported.

REFERENCES

Ratnam  KVSu  WPDPeters  MS Purpura simplex (inflammatory purpura without vasculitis): a clinicopathological study of 174 cases. J Am Acad Dermatol 1991;25 (4) 642- 647
PubMed Link to Article
Champion  RH Purpura. Champion  RHBurton  JLEbling  FJGTextbook of Dermatology. Vol 35th ed. Oxford, England Blackwell Scientific Publications1992;1881- 1892
Price  MLJones  EWCalnan  CDMacDonald  DM Lichen aureus: a localized persistent form of pigmented purpuric dermatitis. Br J Dermatol 1985;112 (3) 307- 314
PubMed Link to Article
Brehmer-Andersson  E Mycosis fungoides and its relation to Sézary's syndrome, lymphomatoid papulosis, and primary cutaneous Hodgkin's disease: a clinical histopathologic and cytologic study of fourteen cases and a critical review of the literature. Acta Derm Venereol Suppl (Stockh) 1976;56 (75) 3- 142
PubMed
Gordon  H Mycosis fungoides. Br J Dermatol 1950;62177- 178
Massone  CKodama  KKerl  HCerroni  L Histopathologic features of early (patch) lesions of mycosis fungoides: a morphologic study on 745 biopsy specimens from 427 patients. Am J Surg Pathol 2005;29 (4) 550- 560
PubMed Link to Article
Barnhill  RLBraverman  IM Progression of pigmented purpura-like eruptions to mycosis fungoides: report of three cases. J Am Acad Dermatol 1988;19 (1, pt 1) 25- 31
PubMed Link to Article
Georgala  SKatoulis  ACSymeonidou  S  et al.  Persistent pigmented purpuric eruption associated with mycosis fungoides: a case report and review of the literature. J Eur Acad Dermatol Venereol 2001;15 (1) 62- 64
PubMed Link to Article
Lipsker  D The pigmented and purpuric dermatitis and the many faces of mycosis fungoides. Dermatology 2003;207 (3) 246- 247
PubMed Link to Article
Ugajin  TSatoh  TYokozeki  HNishioka  K Mycosis fungoides presenting as pigmented purpuric eruption. Eur J Dermatol 2005;15 (6) 489- 491
PubMed
Toro  JRSander  CALeBoit  PE Persistent pigmented purpuric dermatitis and mycosis fungoides: simulant, precursor or both? Am J Dermatopathol 1997;19 (2) 108- 118
PubMed Link to Article
Cerroni  LSmolle  JSoyer  HP  et al.  Immunophenotyping of cutaneous lymphoid infiltrates in frozen and paraffin-embedded tissue sections: a comparative study. J Am Acad Dermatol 1990;22 (3) 405- 413
PubMed Link to Article
McCarthy  KPSloane  JPKabarowski  JHS  et al.  A simplified method of detection of clonal rearrangements of the T-cell receptor–γ chain gene. Diagn Mol Pathol 1992;1 (3) 173- 179
PubMed
Wan  JHTrainor  KJBrisco  MJMorley  AA Monoclonality in B cell lymphoma detected in paraffin wax embedded sections using the polymerase chain reaction. J Clin Pathol 1990;43 (11) 888- 890
PubMed Link to Article
Cerroni  LSignoretti  SHöfler  G  et al.  Primary cutaneous marginal zone B-cell lymphoma: a recently described entity of low-grade malignant cutaneous B-cell lymphoma. Am J Surg Pathol 1997;21 (11) 1307- 1315
PubMed Link to Article
Scarabello  ALeinweber  BArdigó  M  et al.  Cutaneous lymphomas with prominent granulomatous reaction. Am J Surg Pathol 2002;26 (10) 1259- 1268
PubMed Link to Article
Cather  JCFarmer  AManning  JT  et al.  Unusual presentation of mycosis fungoides as pigmented purpura with malignant thymoma. J Am Acad Dermatol 1998;39 (5, pt 2) 858- 863
PubMed Link to Article
Martínez  WPozo  JVazquez  J  et al.  Cutaneous T-cell lymphoma presenting as disseminated, pigmented, purpura-like eruption. Int J Dermatol 2001;40 (2) 140- 144
PubMed Link to Article
Puddu  PFerranti  GFrezzolini  A  et al.  Pigmented purpura-like eruption as cutaneous sign of mycosis fungoides with autoimmune purpura. J Am Acad Dermatol 1999;40 (2, pt 2) 298- 299
PubMed Link to Article
Waisman  M Lichen aureus. Arch Dermatol 1976;112 (5) 696- 697
PubMed Link to Article
Lipsker  DCribier  BHeid  EGrosshans  E Pigmented purpuric dermatitis revealing cutaneous lymphoma. Ann Dermatol Venereol 1999;126 (4) 321- 326
PubMed
Viseux  VSchoenlaub  PCnudde  F  et al.  Pigmented purpuric dermatitis preceding the diagnosis of mycosis fungoides by 24 years. Dermatology 2003;207 (3) 331- 332
PubMed Link to Article
Crowson  ANMagro  CMZahorchak  R Atypical pigmentary purpura: a clinical, histopathologic and genotypic study. Hum Pathol 1999;30 (9) 1004- 1012
PubMed Link to Article
Magro  CMSchaefer  JTCrowson  AN Pigmented purpuric dermatosis: classification by phenotypic and molecular profiles. Am J Clin Pathol 2007;128 (2) 218- 229
PubMed Link to Article
Cerroni  LFink-Puches  RBäck  BKerl  H Follicular mucinosis: a critical reappraisal of clinicopathologic features and association with mycosis fungoides and Sézary syndrome. Arch Dermatol 2002;138 (2) 182- 189
PubMed Link to Article
Shieh  SMikkola  DLWood  GS Differentiation and clonality of lesional lymphocytes in pityriasis lichenoides chronica. Arch Dermatol 2001;137 (3) 305- 308
PubMed
Weiss  LMWood  GSEllisen  LW  et al.  Clonal T-cell populations in pityriasis lichenoides et varioliformis acuta (Mucha-Habermann disease). Am J Pathol 1987;126 (3) 417- 421
PubMed
Schiller  PIFlaig  MJPuchta  U  et al.  Detection of clonal T cells in lichen planus. Arch Dermatol Res 2000;292 (11) 568- 569
PubMed Link to Article
Guitart  JMagro  C Cutaneous T-cell lymphoid dyscrasia: a unifying term for idiopathic chronic dermatoses with persistent T-cell clones. Arch Dermatol 2007;143 (7) 921- 932
PubMed Link to Article
Kanwar  AJThami  GP Familial Schamberg's disease. Dermatology 1999;198 (2) 175- 176
PubMed Link to Article
Wahba-Yahav  AV Schamberg's purpura: association with persistent hepatitis B surface antigenemia and treatment with pentoxifylline. Cutis 1994;54 (3) 205- 206
PubMed
Huntley  AC The cutaneous manifestations of diabetes mellitus. J Am Acad Dermatol 1982;7 (4) 427- 455
PubMed Link to Article

Figures

Place holder to copy figure label and caption
Figure 1.

A-G, Different clinical presentations of patients with lichen aureus.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Patient 14 in the Table. Dense bandlike infiltrate of lymphocytes with hemorrhage (hematoxylin-eosin, original magnification ×10).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

Patient 3 in the Table. A, Appearance of skin lesion in 1990. B, A biopsy specimen obtained in 1990 showed a bandlike infiltrate. C, Note sparse hemorrhage and coarse bundles of collagen in the papillary dermis. D, Appearance of the lesion in 2007. E, A biopsy specimen obtained in 2007 revealed persistence of the lymphocytic infiltrate. F, Note features similar to those of the biopsy specimen obtained in 1990. Hematoxylin-eosin, original magnification ×10 (B), ×20 (C and F), and ×4 (E).

Graphic Jump Location

Tables

References

Ratnam  KVSu  WPDPeters  MS Purpura simplex (inflammatory purpura without vasculitis): a clinicopathological study of 174 cases. J Am Acad Dermatol 1991;25 (4) 642- 647
PubMed Link to Article
Champion  RH Purpura. Champion  RHBurton  JLEbling  FJGTextbook of Dermatology. Vol 35th ed. Oxford, England Blackwell Scientific Publications1992;1881- 1892
Price  MLJones  EWCalnan  CDMacDonald  DM Lichen aureus: a localized persistent form of pigmented purpuric dermatitis. Br J Dermatol 1985;112 (3) 307- 314
PubMed Link to Article
Brehmer-Andersson  E Mycosis fungoides and its relation to Sézary's syndrome, lymphomatoid papulosis, and primary cutaneous Hodgkin's disease: a clinical histopathologic and cytologic study of fourteen cases and a critical review of the literature. Acta Derm Venereol Suppl (Stockh) 1976;56 (75) 3- 142
PubMed
Gordon  H Mycosis fungoides. Br J Dermatol 1950;62177- 178
Massone  CKodama  KKerl  HCerroni  L Histopathologic features of early (patch) lesions of mycosis fungoides: a morphologic study on 745 biopsy specimens from 427 patients. Am J Surg Pathol 2005;29 (4) 550- 560
PubMed Link to Article
Barnhill  RLBraverman  IM Progression of pigmented purpura-like eruptions to mycosis fungoides: report of three cases. J Am Acad Dermatol 1988;19 (1, pt 1) 25- 31
PubMed Link to Article
Georgala  SKatoulis  ACSymeonidou  S  et al.  Persistent pigmented purpuric eruption associated with mycosis fungoides: a case report and review of the literature. J Eur Acad Dermatol Venereol 2001;15 (1) 62- 64
PubMed Link to Article
Lipsker  D The pigmented and purpuric dermatitis and the many faces of mycosis fungoides. Dermatology 2003;207 (3) 246- 247
PubMed Link to Article
Ugajin  TSatoh  TYokozeki  HNishioka  K Mycosis fungoides presenting as pigmented purpuric eruption. Eur J Dermatol 2005;15 (6) 489- 491
PubMed
Toro  JRSander  CALeBoit  PE Persistent pigmented purpuric dermatitis and mycosis fungoides: simulant, precursor or both? Am J Dermatopathol 1997;19 (2) 108- 118
PubMed Link to Article
Cerroni  LSmolle  JSoyer  HP  et al.  Immunophenotyping of cutaneous lymphoid infiltrates in frozen and paraffin-embedded tissue sections: a comparative study. J Am Acad Dermatol 1990;22 (3) 405- 413
PubMed Link to Article
McCarthy  KPSloane  JPKabarowski  JHS  et al.  A simplified method of detection of clonal rearrangements of the T-cell receptor–γ chain gene. Diagn Mol Pathol 1992;1 (3) 173- 179
PubMed
Wan  JHTrainor  KJBrisco  MJMorley  AA Monoclonality in B cell lymphoma detected in paraffin wax embedded sections using the polymerase chain reaction. J Clin Pathol 1990;43 (11) 888- 890
PubMed Link to Article
Cerroni  LSignoretti  SHöfler  G  et al.  Primary cutaneous marginal zone B-cell lymphoma: a recently described entity of low-grade malignant cutaneous B-cell lymphoma. Am J Surg Pathol 1997;21 (11) 1307- 1315
PubMed Link to Article
Scarabello  ALeinweber  BArdigó  M  et al.  Cutaneous lymphomas with prominent granulomatous reaction. Am J Surg Pathol 2002;26 (10) 1259- 1268
PubMed Link to Article
Cather  JCFarmer  AManning  JT  et al.  Unusual presentation of mycosis fungoides as pigmented purpura with malignant thymoma. J Am Acad Dermatol 1998;39 (5, pt 2) 858- 863
PubMed Link to Article
Martínez  WPozo  JVazquez  J  et al.  Cutaneous T-cell lymphoma presenting as disseminated, pigmented, purpura-like eruption. Int J Dermatol 2001;40 (2) 140- 144
PubMed Link to Article
Puddu  PFerranti  GFrezzolini  A  et al.  Pigmented purpura-like eruption as cutaneous sign of mycosis fungoides with autoimmune purpura. J Am Acad Dermatol 1999;40 (2, pt 2) 298- 299
PubMed Link to Article
Waisman  M Lichen aureus. Arch Dermatol 1976;112 (5) 696- 697
PubMed Link to Article
Lipsker  DCribier  BHeid  EGrosshans  E Pigmented purpuric dermatitis revealing cutaneous lymphoma. Ann Dermatol Venereol 1999;126 (4) 321- 326
PubMed
Viseux  VSchoenlaub  PCnudde  F  et al.  Pigmented purpuric dermatitis preceding the diagnosis of mycosis fungoides by 24 years. Dermatology 2003;207 (3) 331- 332
PubMed Link to Article
Crowson  ANMagro  CMZahorchak  R Atypical pigmentary purpura: a clinical, histopathologic and genotypic study. Hum Pathol 1999;30 (9) 1004- 1012
PubMed Link to Article
Magro  CMSchaefer  JTCrowson  AN Pigmented purpuric dermatosis: classification by phenotypic and molecular profiles. Am J Clin Pathol 2007;128 (2) 218- 229
PubMed Link to Article
Cerroni  LFink-Puches  RBäck  BKerl  H Follicular mucinosis: a critical reappraisal of clinicopathologic features and association with mycosis fungoides and Sézary syndrome. Arch Dermatol 2002;138 (2) 182- 189
PubMed Link to Article
Shieh  SMikkola  DLWood  GS Differentiation and clonality of lesional lymphocytes in pityriasis lichenoides chronica. Arch Dermatol 2001;137 (3) 305- 308
PubMed
Weiss  LMWood  GSEllisen  LW  et al.  Clonal T-cell populations in pityriasis lichenoides et varioliformis acuta (Mucha-Habermann disease). Am J Pathol 1987;126 (3) 417- 421
PubMed
Schiller  PIFlaig  MJPuchta  U  et al.  Detection of clonal T cells in lichen planus. Arch Dermatol Res 2000;292 (11) 568- 569
PubMed Link to Article
Guitart  JMagro  C Cutaneous T-cell lymphoid dyscrasia: a unifying term for idiopathic chronic dermatoses with persistent T-cell clones. Arch Dermatol 2007;143 (7) 921- 932
PubMed Link to Article
Kanwar  AJThami  GP Familial Schamberg's disease. Dermatology 1999;198 (2) 175- 176
PubMed Link to Article
Wahba-Yahav  AV Schamberg's purpura: association with persistent hepatitis B surface antigenemia and treatment with pentoxifylline. Cutis 1994;54 (3) 205- 206
PubMed
Huntley  AC The cutaneous manifestations of diabetes mellitus. J Am Acad Dermatol 1982;7 (4) 427- 455
PubMed Link to Article

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