A 37-year-old male, with no history, came to the consultation with a lesion in the medial corner of the left upper eyelid, non-pruritic, of four months of evolution.
She had been treated with topical corticosteroids.
On examination, the patient had an erythematous plaque, nodular, with millium cysts, measuring 1.7 cm in diameter.
There were no other alterations.
The differential diagnosis was established between eczema, mycosis fungoides or millium in plaque (3).
A skin biopsy was performed, which reported the existence of inflammatory infiltrate in the papillary dermis consisting of small and medium sized lymphocytes intermingled with histiocytic cells and eosinophils.
The inflammatory infiltrate sometimes contacted the epidermal basal layer, which showed no signs of alteration, except isolated foci of vacuolization and occasional lymphocytic exocytosis.
Immunoperoxidase techniques showed that proliferating lymphocytic cells predominantly type T (L-1 and CD-3 positive) a fungal infection confirmed the diagnosis of cutaneous mycosis type T lymphoma.
Complementary tests, biochemistry, blood count, urinary sediment and extension study were normal.
Descending treatment was established with Descending Regimen 30 mg.
In the following review, the erythematous plaque had increased to 2 cm in diameter, and more millium cysts had appeared; there was a new lesion in the right upper eyelid.
Oral corticosteroids were removed and treatment with Imiqimod 5% cream was started, three weekly applications.
Diclofenac eye drops were administered to prevent conjunctivitis that could cause Imiquimod.
After two months of treatment there was an improvement of the inflamed nipple area and a decrease in the number of millium cysts. At three months, only three cysts were found, without inflammatory reaction.
Five months later residual skin lesions were removed.
The pathology report revealed a lymphocytic inflammatory infiltrate around some hair follicles cyst in millium form.
The epithelium showed exocytosis with small groups of lymphocytes, without evidence of microabscesses of Poitrier.
Immunoperoxidative techniques allowed identifying the infiltrate with positive markers T (ALL-1 and CD3).
All this led to the diagnosis of follicular mycosis fungoides.
