Successful Treatment of a Patient with Lymphomatoid Papulosis by Methotrexate

Abstract

We report a case of lymphomatoid papulosis (LyP) that occurred in a 44-year-old Japanese male patient. Reddish papules with a small number of pustules and nodules were observed on the extremities, chest and upper back. Most lesions were also associated with central necrosis, ulceration and crusting, and regressed spontaneously within 4 to 6 weeks. Histopathological examination revealed wedge-shaped dense cellular infiltrate in the dermis, which was mixed with large atypical lymphoid cells, small lymphocytes, eosinophils and neutrophils. These large atypical cells expressed CD30 on their cell membrane and cytoplasm. Rearrangement of the T-cell receptor (TcR) beta-chain gene was detected in the skin lesion. Lymphadenopathy with histopathologic change similar to the skin lesions, but without TcR gene rearrangement, was found at the left inguinal area. Systemic administration of methotrexate (7.5-15.0 mg/week) was found to be dramatically effective in resolution of skin lesions and prevention of their recurrence.

British Association of Dermatologists’ guidelines for the safe and effective prescribing of methotrexate for skin disease 2016

“…MTX has been used for treating lymphomatoid papulosis, pityriasis lichenoides and palmoplantar pompholyx, but evidence for its efficacy is limited to case reports. Other possible indications supported by case reports include oral lichen planus, dermatomyositis, cutaneous vasculitis (including cutaneous polyarteritis nodosa, Behçet disease and erythema elevatum diutinum), pyoderma gangrenosum, necrobiosis lipoidica, granuloma annulare, alopecia areata, chronic idiopathic urticaria, Hailey‐Hailey disease and Langerhans cell histiocytosis …”

Clonal T-Cell Receptor γ-Chain Gene Rearrangements in Differential Diagnosis of Lymphomatoid Papulosis From Skin Metastasis of Nodal Anaplastic Large-Cell Lymphoma

“…There is no curative therapy for LyP, so the main goal of the management is to control symptoms and maintain the clinical response to improve quality of life. Several studies 22,23 demonstrated that low-dose methotrexate sodium (10–15 mg or less given weekly) is an effective and well-tolerated treatment for LyP. Systemic multiagent chemotherapy provides a response rate comparable to that of a low dose of methotrexate (86.7% and 87.5%, respectively).…”

Mycophenolic Acid for Lymphomatoid Papulosis

“…1 Phototherapy is also a viable and well-tolerated therapy for lymphomatoid papulosis 2 ; however, it is temporally and geographically restrictive and therefore not an option for many patients. The course of the disease is susceptible to systemic immunosuppressive agents, and good treatment success has been reported with MTX.…”