The patient arrived at the Hematology and Blood Transfusion Center of Bach Mai Hospital in Hanoi with numerous small, raised papules on his skin. Some had slightly necrotized, forming black scabs and leaving dark scars.
He had previously sought treatment at various clinics, even abroad, receiving diagnoses such as nonspecific dermatitis or dog roundworm infection. Despite trying various treatments, including corticosteroid creams, oral retinol, and UV therapy, his condition didn't improve.
Doctors at Bach Mai Hospital diagnosed him with lymphomatoid papulosis, a rare, chronic lymphoproliferative disorder. Associate Professor Nguyen Tuan Tung, the hospital's deputy director, said this case highlights how seemingly benign skin conditions can have a malignant histopathological basis. Accurate diagnosis requires close collaboration between dermatology, hematology, pathology, and immunology specialists.
Lymphomatoid papulosis is extremely rare, affecting only 1.2 to 1.9 people per million, typically those over 50. The disease manifests as recurring necrotizing papules that heal spontaneously but can progress to malignant lymphoma in 10% to 20% of cases.
A key feature of the disease is the contrast between its external appearance and histological nature. Patients may only have a few mildly itchy papules that heal and leave scars. However, skin biopsies and immunohistochemical staining reveal abnormal lymphocytes, positive for CD30, and sometimes even Reed-Sternberg cells, characteristic of Hodgkin lymphoma.
"In this patient's case, the lesions were classified as type A lymphomatoid papulosis, meaning a deep infiltration of abnormal lymphocytes without bone marrow or other organ involvement," explained Associate Professor Tung.
Regarding treatment, Dr. Tung said initial management might involve topical corticosteroids, retinol, or simply monitoring. However, if the disease spreads, becomes cosmetically concerning, or risks malignancy, low-dose immunosuppressants like methotrexate are prescribed.
The patient has responded well to 4 months of methotrexate, with existing lesions healing and no new papules appearing. Continued monitoring is essential as the disease can recur if medication is stopped.
Doctors advise against neglecting persistent skin lesions. If unexplained papules, red patches, scaling, or darkening persist for over 3 months, consult a specialist. Avoid prolonged use of topical medications, especially corticosteroids, as they can mask symptoms.
Le Nga
