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Background: Tumor necrosis factor α (TNF-α) has been implicated in the pathogenesis of numerous inflammatory and autoimmune disorders. Accordingly, TNF-α inhibitors, such as thalidomide, infliximab (Remicade), adalimumab (Humira), and etanercept (Enbrel), have been used with success in the treatment of autoimmune disorders, including psoriasis, rheumatoid arthritis, inflammatory bowel diseases, and lymphoproliferative disorders. Although anti-TNF-α therapy is safe and well tolerated, various adverse cutaneous reactions have been reported. Observations: We encountered 5 patients who developed erythematous annular plaques on the trunk and extremities while receiving 4 different medications with inhibitory activity against TNF-α. One patient was treated with lenalidomide (Revlimid) for multiple myeloma, 2 received infliximab, and 1 received etanercept for severe rheumatoid arthritis; the last patient was in a clinical trial of adalimumab for psoriatic arthritis. Skin biopsy specimens revealed diffuse interstitial granulomatous infiltrates of lymphocytes, histiocytes, and eosinophils, palisading degenerated collagen. Withdrawal of the medications led to complete resolution of the skin lesions. Conclusion: Interstitial granulomatous dermatitis should be considered in the differential diagnosis of skin lesions occurring in the setting of anti-TNF-α therapy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Most cutaneous T-cell lymphomas demonstrate a malignant population with a CD4+ phenotype. In rare cases, CD8+ phenotypes have been described based on immunostaining of skin specimens. Although some CD8+ lymphomas have an indolent course, others, such as CD8+ epidermotropic cytotoxic T-cell lymphomas, are typically more aggressive. To our knowledge, involvement of peripheral blood or cerebrospinal fluid with a malignant population of CD8+ cells demonstrated by flow cytometry and T-cell receptor gene rearrangement has not been previously described. OBSERVATIONS: We describe a patient with a CD8+ cutaneous T-cell lymphoma with an initially indolent course and early stage diagnosed on the basis of a skin biopsy specimen. However, when flow cytometry was performed looking specifically at CD8+/CD4- cells in the peripheral blood and cerebrospinal fluid, a malignant population of CD8+/CD4-/CD26-/CD7- cells was discovered. CONCLUSIONS: It is important for prognosis and treatment to be able to identify CD8+ epidermotropic cytotoxic T-cell lymphoma and separate it from other relatively indolent CD8+ lymphomas. Furthermore, detection of an abnormal CD8+/CD26-/CD7- T-cell population within the peripheral blood has important prognostic and therapeutic implications. The use of flow cytometry looking for abnormal CD8+ populations in the peripheral blood or cerebrospinal fluid can assist with this critical information. [ABSTRACT FROM AUTHOR]

The article discusses the treatment of a 53-year-old white woman suffering from Sézary syndrome. Extracorporeal photopheresis, psoralen, UV-A, and interferon alfa-2b, 1.8 million units were injected subcutaneously three times weekly. Oral bexarotene in the quantity of 150 mg daily was also added to the medication. The patient's erythroderma and pruritus showed improvement but three months later the patient's erythroderma and pruritus recurred. Treatment with psoralen-UV-A was stopped.