Case Number : Case 2199 - 13 November 2018 Posted By: Iskander H. Chaudhry

Folliculotropic MF

Folliculotropic MF, agree

Yes. It's my first possibility too. Folliculotropic MF. Agree. 

Agree with Colleagues. LED as dd, but no dermal mucin and last pic is more in keeping with FMF. 

Response from Dr Chaudhry:

This was a solitary lesion - any other suggestions ? 

Ask the patient if there was a previous tattoo

Yes Glauco. May be this is a tattoo ( fig 6 fit well ). Congrats for your skill.

?Lichenoid keratosis ?pseudo lymphomatous folliculitis

A myraid of tissue reactions in a tattoo can occur and sometimes a combination of more than one pattern is seen.Clinically they look very similar with apperance of a papule/nodule or thickening within the tattoo.

This looks like a dense reactive lymphoid infiltrate with focal lichenoid/interface changes. “Pseudolymphoma” is commonly used in various case reports or small series to describe this reaction.

Usually to red colour tattoos (but certainly can be seen with other colours) as one of the hypothesis is a reaction to the mercury compounds in a red dye.

Was this a red tattoo or another colour? 

I thought it could be a pseudolymphomatous reaction to tattoo pigment. 

Dear all - no history of tatoo pigment and the pigment is positive for Perl's stain. The immuno' marks and clinical did not support folliculotropic MF - after discussion with clinicians the final diagnosis of lichen aureus was rendered. 

Oh dear we forgot haemosiderin! Nice reminder of lichen aureus.