Ultrasound features of Primary Cutaneous CD4+ Small/Medium-Sized T-Cell Lymphoproliferative Disorder Ecografía del síndrome linfoproliferativo

administration of multiple cycles of topical and systemic corticosteroid therapy, topical tazarotene, ciclosporin at a dose of 3 mg/kg/d (whose efficacy cannot be adequately evaluated due to treatment interruption after a month because of failure to attend follow-up), and methotrexate at a maximum dose of 20 mg/wk, which the patient continues to receive. Interestingly, despite hypertrophic LP being considered one of the most refractory variants, the lesions present on our patient’s legs responded very well to corticosteroid treatment. In conclusion, we have described a patient with a rare variant of LP. This case exemplifies the broad clinical spectrum that this disease can present on the palms and soles. The patient developed keratosis punctata-type lesions limited to the palmar creases, a clinical manifestation not previously described, hyperkeratotic interdigital plaques mimicking a superficial fungal infection, and diffuse palmoplantar keratoderma with a marked deterioration of her quality of life. Despite generally being considered a self-limiting disease, the lesions in our case showed a recalcitrant course, with plantar lesions even more refractory to treatment than the hypertrophic LP lesions. The broad morphological variety of palmoplantar lesions, with absence of the classic LP papules, makes diagnosis difficult, and this disease must be included in the differential diagnosis of hyperkeratotic palmoplantar dermatoses. Histology, which shows the typical features of LP, is essential for diagnosis.