Introduction. A few cases of patients with both purpuric pigmented dermatit
is and cutaneous lymphoma have been reported. The aim of this study was to
evaluate the prognosis of purpuric pigmented dermatitis.
Material and methods. This is a monocentric retrospective study at the derm
atology department of the university hospital of Strasbourg. The records of
all patients hospitalized for purpuric pigmented dermatitis between 1967 a
nd 1997 have been reviewed.
Results. Eight women and 9 men aged between 17 and 84 years were hospitaliz
ed for purpuric pigmented dermatitis during the reference period. Except fo
r one patient, all had had a cutaneous biopsy showing the typical Features
of purpuric pigmented dermatitis. On the basis of clinical signs and course
, one patient was thought to have contact dermatitis and three patients wer
e thought to have a purpuric pigmented dermatitis -like drug eruption (mepr
obamate, pefloxacine and lorazepam or aspirin). The mean follow-up was one
year. During follow-up, two patients developed cutaneous T-cell lymphoma af
ter two and four years respectively and one patient developed Hodgkin's dis
ease with skin and lymph node involvement. Another patient who suffered fro
m purpuric pigmented dermatitis for four years had a monoclonal T cell popu
lation within the dermal infiltrate. Two patients died of their lymphoma.
Discussion. This study shows that purpuric pigmented dermatitis can be asso
ciated to or evolve into lymphoproliferative disease. This course should be
suspected when purpuric pigmented dermatitis is extensive, long-lasting (>
1 year), has a reticular arrangement and negative patch-testing, in this s
ituation, a long-term follow-up and treatments indicated in the early patch
stage of mycosis fungoides (PUVA therapy, chlormethine) seem adequate.